GW1--03418_Well Construction - GW1_20230518

ESIDENTiAL WELL CONSTRUCTION RECORD
k , I ,Q- • North Carolina Department of Environment and Natural Resources-Division of Water Quality
= `� ' WELL CONTRACTOR CERTIFICATION# 2780 210236
1.WELL CONTRACTOR: • f. DISINFECTION:Type HTH Amount 43
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name From 30 To 140
From 182 To 183
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 40 Ft. Fi 1/8 350 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 FL 22 BAGS
WELL CONSTRUCTION PERMIT# 184470 From To Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply IX From To Ft. in. in.
DATE DRILLED 5/11/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM DX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: SUGAR GROVE COUNTY WATAUGA Depth Size Material
From To Ft.
OFF 321N OFF 421N From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft. _
TOPOGRAPHIC/LAND SETTING:
0 Slope 0 Valley X Flat 0 Ridge 0 Other 11. DRILLING LOG
(check appropriate box)
May be in degrees, From To Formation Description
LATITUDE _ _ 36.249553 minutes,seconds or 0 12 DIRT
LONGITUDE— — 81.831559 in a decimal format 12 12 18 GRANITE
Latitude/longitude source: )4 GPS 0 Topographic map 30 140 GRANITE
(location of well must be shown on a USGS topo map and 140 160 QUARTZ
attached to this form if not using GPS) 160 182 GRANITE
182 183 VOID
5.WELL OWNER 183 225 GRANITE ^ •?. y ' y"q
OWNER'S NAME PAUL MORRIS-MORRIS INVESTMEN .n``- ?—°...:
STREET ADDRESS 207 NEW MARKET CTR#215 MAY �`0pJ
BOONE NC 28607 1
City or Town State Zip Code f^ Pn ,.,r,,. .- ,.,r,3 t r A
(919. )- 368-5126 ln' "'_
Area code- Phone number 12. REMARKS:
5 GPM 30-140 •
6.WELL DETAILS: 20 GPM 182-183
a. TOTAL DEPTH: 225
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 CONSTRU ON STANDARDS,AND THAT A COPY OF THIS
C. WATER LEVEL Below Top of Casing: 20 FT. RECORD HAS BEEN PROVIDE THE WELL OWNER. t—
(Use"+"if Above Top of Casing) /� •
�` 6.a�
d. TOP OF CASING IS 1 FT.Above Land Surface*
*Top of casing terminated at/or below land surface may require SIGNATURE OF RTIFIED WELL CONT CTOR 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
•
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

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