GW1-2023-02821_Well Construction - GW1_20230420

1' :rRESIDENTIAL WELL CONSTRUCTION RECORD '
,,.ii- North Carolina Department of Environment and Natural Resources-Division of Water Quality
"`�^' t". WELL CONTRACTOR CERTIFICATION# 2780 220230
I.WELL CONTRACTOR: • f. DISINFECTION:Type HTH Amount 66
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name From 355 To 360
From 115 To 120
DEWEY WRIGHT WELL&PUMP CO., INC From 390 To 393
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 70 Ft. 8 VS 350. 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. 24 BAGS
WELL CONSTRUCTION PERMIT#184672 From To Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply X From To Ft. in. in.
DATE DRILLED 4/6/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM II PM I)( From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: BANNER ELK COUNTY WATAUGA Depth Size Material
From To Ft.
4444 LAUREL CREEK RD OFF ROMINGER OFF HV From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING: •
0 Slope 0 Valley 0 Flat 0 Ridge 0 Other__ 11. DRILLING LOG
(check appropriate box)
LATITUDE 36.21791 N May be in degrees, From To Formation Description
— — minutes,seconds or 0 55 DIRT
LONGITUDE 81.83549W in a decimal format 55 115 GRANITE
— — 115 120 GRANITE
Latitude/longitude source: X GPS 0 Topographic map 120 355 GRANITE
(location of well must be shown on a USGS topo map and 355 360 GRANITE
attached to this form if not using GPS) 360 390 GRANITE
390 393 GRANITE rT
5.WELL OWNER 393 420 GRANITE I` 1' „t,-- r o ;)
OWNER'S NAME CAROLYN REED REV.TRUST
STREET ADDRESS 2901 WEST TRILBY AVE APR 2 0 2023
TAMPA FL 33611 :, _i lJr,:i
City or Town State Zip Code - ^_„
(813 )- 786-8789
Area code- Phone number 12. REMARKS:
1 GPM 115-120, 3 GPM 355-360, 16 GPM 390-393 '
6.WELL DETAILS:
a. TOTAL DEPTH: 420
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOX I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,WELL CONSTRUCTIONS NDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 100 FT. RE HAS BEEN PROV DED TO T E V ELL OWNER.
(Use + if Above Top" " of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface' ‘b LO c('V/ ~z
oa
*Top of casing terminated at/or below land surface may require SIGNAT OF CERTIFIE WELL CONTRACT DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
e. YIELD(gpm): 20 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
i
I I
I
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1a
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.3/07

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