GW1-2023-02395_Well Construction - GW1_20230404

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`?tw f %, RESIDENTIAL WELL CONSTRUCTION RECORD
? p North Carolina Department of Environment and Natural Resources-Division of Water Quality
R WELL CONTRACTOR CERTIFICATION# 2780
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 21
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 730 To 731 From To
DEWEY WRIGHT WELL&PUMP CO., INC From To From To •
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 308 7. CASING: Thickness/
Depth Diameter Weight Material
BOONE NC 28607 From 0 To 37 Ft. 6 1/8 3S0 PVC
City or Town State Zip Code From To Ft.
• (828 )_264-2651 From To Ft.
Area code- Phone number
2.WELL INFORMATION: 8. GROUT: Depth • Material Method
• From 0 To 20 Ft. BENTONIT GRAVITY
SITE WELL ID#(if applicable) _ — - From_ To - Ft. 20 BAGS
WELL CONSTRUCTION PERMIT#371518 From To Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check A plicable Box): Residential Water Supply X From To Ft. in. in.
DATE DRILLED 3 1(01Qoo3 From To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM IlX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: DRY HOLE couNTY WATAUGA Depth Size Material
From To Ft.
OFF PINNACLE DR OFF EAST KING ST From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC I LAND SETTING:
0 Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box) 11.DRILLING LOG
May be in degrees, From To •Formation Description
LATITUDE — — 36.22953N minutes,seconds or 0 25 DIRT
LONGITUDE 81.69483W in a decimal format 25 730 BLACK GRANITE
— — 730 731 BLACK GRANITE
Latitude/longitude source: X GPS o Topographic map 731 800 BLACK GRANITE .---. -.-.. ,
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS) —
5.WELL OWNER APR J 4 2023
OWNER'S NAME NAFE FAMILY HOLDINGS C/O APPAL
STREET ADDRESS PO BOX 2826
BOONE NC 28607
City or Town State Zip Code — —
(828 )_ 406-1490
Area code- Phone number 12. REMARKS:
.25 GPM 730-731
6.WELL DETAILS:
a. TOTAL DEPTH: 800
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOX I DO HEREBY CERTIFY THAT THIS WE WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,WELL CONSTRUCT! S ANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 700 FT. R CORD HAS BEEN PROVIDED T ELL OWNER.
(Use"+"if Above Top of Casing) q r�
r V
d. TOP OF CASING IS 1 FT.Above Land Surface*
*Top of casing terminated at/or below land surface may require SIGNATURE OF CERTIFIED WELL CONTRA R DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
e. YIELD(gpm): .25 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
.r..,
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt., Form GW-la
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 568. I Rev.3/07
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