GW1-2023-02823_Well Construction - GW1_20230420

.SrAF4' -.
7 ^c RESIDENTIAL WELL CONSTRUCTION RECORD
,a; North Carolina Department of Environment and Natural Resources-Division of Water Quality
•
w rrt�U,Jam..
WELL CONTRACTOR CERTIFICATION# 2780 220019
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 63
KEITH PRESNELL g. WATER ZONES(depth): .
Well Contractor(Individual)Name From 130 To 135 From 368 To 370
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 Rn Ft. R 1/ti 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. 20 BAGS
WELL CONSTRUCTION PERMIT#183900 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 4/3/2023 From_ To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM OX • From To Ft. in. in.
•
4.WELL LOCATION: 10.SAND/GRAVEL PACK: •
CITY: BANNER ELK couNTY WATAUGA Depth Size Material
From To Ft. •
LOT#6 OFF ANDREWS RD OFF BROADSTONE RI 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)
May be in degrees, From To Formation Description
LATITUDE — — 36.17596N minutes,seconds or 0 65 DIRT
LONGITUDE 81.83520W in a decimal format 65 130 GRANITE
— — - 130 135 SHALE
Latitude/longitude source: X GPS 0 Topographic map 135 230 GRANITE
(location of well must be shown on a USGS topo map and 230 235 GRANITE
attached to this form if not using GPS) 235 368 GRANITE
5.WELL OWNER 368 370 GRANITE •
370 400 GRANITE
OWNER'S NAME ROBERT CUTTING
STREET ADDRESS 5307 HANAHAN DR :•;._ :, ;:: "._•
WILMINGTON NC 28403 1) 9, it )Il'1
City or Town State Zip Code
(910 )_ 386-9894
Area code- Phone number ; l .;;,,:, .", 'T:' 3 i t;a
12. REMARKS: •, ;,,:ti�,.��;�,z •
2 GPM 130-135
6.WELL DETAILS: 4 GPM 368-370
• a. TOTAL DEPTH: 400
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 CONST-.- ON STANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 100 FT. RECORD HAS BEEN PROVID THE WELL OWNER.
(Use"+"if Above Top of Casing) q,. ...ej_..4 � � ��L
d. TOP OF CASING IS 1 FT.Above Land Surface` �`// ,rr���`Top of casing terminated at/or below land surface may require SIGNATER IFIED HELL CONTRAC OR DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL ,
e. YIELD(gpm): 6 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
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. Rev.3/07
1

. . .
/I. . . •
. . . .
. .
. .,
. ..
•",„..,..... '
.. .
. • ,-. ...
...,, .
,• tl) -
. .... , .
:'.' - • . . .... .,
._ .
. ,.-
....' -'•.'.,..•-'',,F
. _..-i.'`...•..,:•..p,-c_•
r4. . .
•
. .
i ''.c•l7, .. : :...".•
...
. ? 0
.:......._.. • ; ..._,:.._1.•
..
. :-.
•,k1/4/ • ... .
-, ..:• - . . _ ,
. _
. .
. •-;," • . . .
• . .
. . ........ . i
. .-•:. . . .
. •
. . -•r...--, . . ,• .. .
. .
. • 7 . •
. .
. . i
. . .
. ..: e'.7......,-t .
. . .. . .
.. •
. ' .
. .
. : . .
. . .
. . . . -..;', -.• .. . .
. . .
. .
. .
. _
. • , .
. , . . .
. . .
.. .
. .
. .
• . .
. • 'a- in . • .
. •Cr- .• • .
. .
. . . .
. ..•
. ,•••'"-...7.1,
.. . 1.(), . .. .
, •.__ .:.,,' _
. .
. • .
. . • . .
. .
. .
. .
. . . • .
. .
. -_:••
. . .
• .
. . . .
. . • ••-, . ...
. . ,
. . . . .., .:.--
. .
. . .
. ...-
, . .
, .
. . . .
- • .
• 1
. .
, .
._........
, : •-'1
. ._ .-.•
. .
, -,..../•,.. ... . ,
• .,
.
• ebroadsivoe. . • _:
I ....
—., . ...,-
. ..
. . •,,.
. •..,,
. . .
. . . ...,,-
. 1 •,; . .•
, ,.......;:.,..5 • . • . .
. :•7 .
-.,,..) .