GW1--03714_Well Construction - GW1_20230602

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t RESIDENTIAL WELL CONSTRUCTION RECORD
o ',..,e, - �,q; North Carolina Department of Environment and Natural Resources-Division of Water Quality
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� ,, ' WELL CONTRACTOR CERTIFICATION# 2780 220197
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1.WELL CONTRACTOR: - f. DISINFECTION:Type HTH Amount 58
KEITH PRESNELL g. WATER ZONES(depth): '
Well Contractor(Individual)•Name From 180 To 181 From 285 To 287
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 f) To 1:10 Ft. 6 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 Ft. 19 BAGS
WELL CONSTRUCTION PERMIT#365949 From To I 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 05/18/2023 From - To Ft. in. in. •
TIME COMPLETED 03:00 AM 0 PM IIX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: BOONE COUNTY WATAUGA Depth Size Material •
From To Ft.
OFF ONTARIO RIDGE OFF TWIN RIVERS DR OFF 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 — _ 36.11107 • minutes,seconds or 0 70 DIRT
LONGITUDE 81.40497 in a decimal format ' 70 165 GRANITE
— — 165 180 GREEN GRANITE
• Latitude/longitude source: X GPS II Topographic map 180 181 VOID
(location of well must be shown on a USGS topo map and 181 285 GRANITE
attached to this form if not using GPS) 285 287 VOID .
287 320 GRANITE i'° f:'—'
5.WELL OWNER I- �"�
JONATHAN &STEPHANIE ALLEN C/C ^
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OWNER'S NAME
STREET ADDRESS PO BOX 1967 • JUN G v 2023
BLOWING ROCK NC 28605
tr,;.- ;: , ,,, .:;J t:re:t
City or Town • State Zip Code • .
C;:fieQ;v'...Y
(828 )- 260-2649
Area code- Phone number 12. REMARKS:
10 GPM 180-181
6.WELL DETAILS: 20 GPM 285-287
a. TOTAL DEPTH: 320
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,WELL CONSTRUCT STANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 30 FT. RECORD HAS BEEN PROVIDED. O T E WELL OWNER.
(Use"+"if Above Top of Casing) l/ '7 -3
d. TOP OF CASING IS 1 FT.Above Land Surface' p� �J
*Top of casing terminated at/or below land surface may require SIGNATURE OF C FIED L CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL '
e. YIELD(gpm): 30 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-1 a
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. 1 I Rev.3/07

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