GW1--03127_Well Construction - GW1_20230505

ti r . s RESIDENTIAL WELL CONSTRUCTION RECORD
t " ro,g North Carolina Department of Environment and Natural Resources-Division of Water Quality
•
p R WELL CONTRACTOR CERTIFICATION# 2780 220127
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 123
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name From 235 To 270 From 640 To 660
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 4R Ft. 6 1/R 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
SITE WELL ID#(ifapplicable) - - - From 0 -To 20 Ft—BENTONIT ----GRAVITY-- ------
From To Ft. 19 BAGS
WELL CONSTRUCTION PERMIT#166377 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 4/26/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM 0X From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: BANNER ELK COUNTY WATAUGA Depth Size Material
From To Ft.
ROMINGER RD OFF ROMINGER RD OFF HWY 194 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 II Other 11.DRILLING LOG
(check appropriate box)
May be in degrees, From To Formation Description
LATITUDE — — 36.20922N minutes,seconds or 0 8 DIRT
- LONGITUDE 81.81936W in a decimal format 8 28 GRANITE
— — - 28 30 DIRT
Latitude/longitude source: X GPS 0 Topographic map 30 190 GRANITE
(location of well must be shown on a USGS topo map and 190 235 SHALE
attached to this form if not using GPS) _235 270 GREEN GRANITE
270 350 GRANITE
5.WELL OWNER 350 380 SHALE
OWNER'S NAME NORVIN CLONTZ 380 410 GREEN GRANITE
410 640 GRANITE
STREET ADDRESS 11201 QUIETWOODS CT 640 660 GRANITE QUARTZ
CHARLOTTE NC 28277 660 700 • GRANITE f�_ --i ?.-- ? -=M,
City or Town State Zip Code C �� ..._
( 704 )_ 315-7001 MAY 0 5. 2023
Area code- Phone number 12. REMARKS:
1.5 GPM 235-270 ,_u ?r.:�a ::'- Ur�.1
1 f1111T.:s•..�
6.WELL DETAILS: 8.5 GPM 640-660 D''` "�`'
a. TOTAL DEPTH: 700
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 CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 80 FT. RECORD HAS BEEN PROVIDED THE WELL OWNER.
(Use"+"if Above Top of Casing) //}}�
3
d. TOP OF CASING IS 1 FT.Above Land Surface*
r L/s/�� �~ ��
*Topof casingterminated at/or below land surface mayrequire SIGNATURE F ERTIFIED WELL CONTRACTOR DATE
Q
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
e. YIELD(gpm): 10 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

VII
Ctif
1 .
u02: .6,• .
06" 6.07.0
cc)
(-11
. ,
•02
y /94
•
•
er-
rir (f)
to 5.
_ _