GW1--03794_Well Construction - GW1_20230602

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!n ' • RESIDENTIAL WELL CONSTRUCTION RECORD
"5 ''Y' -tr o North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION#
2780 220154
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 73
•
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name. From 165 To 185 From 390 To 392
, 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 87 Ft. R 1/R 35(1 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 Et,9_BAGS
WELL CONSTRUCTION PERMIT#215954 From To ' Ft.
•
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply EX From To Ft. in. in.
DATE DRILLED 5/16/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM El PM DX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: ELK PARK COUNTY AVERY Depth Size Material
From To Ft.
SAMANTHA SPRINGS OFF'CURTIS CREEK OFF 1I 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)
LATITUDE 36.15115N May be in degrees, From To Formation Description
— — minutes,seconds or 0 50 DIRT
LONGITUDE 81.92333W in a decimal format 50 165 GRANITE
— — 165 185 QUARTZ
Latitude/longitude source: )i GPS u Topographic map 185 205 GRANITE
(location of well must be shown on a USGS topo map and 205 230 GRANITE RED GRANITE
attached to this form if not using GPS) 230 390 GRANITE
5.WELL OWNER 390 392 VOID
392 405 GRANITE
OWNER'S NAME FREDA GREENE
STREET ADDRESS 273 HICKORY LN �,. 9 z.>; 0
BOONE NC _ 2.8607
City or Town State Zip Code i ,,3',1i U NZ3
(828 )_ 264-9410 ° A
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Area code- Phone number • ' 12. REMARKS: 11.,, �'£ '-r.•.:rv.;y�,
5 GPM 165-185 "�
6.WELL DETAILS: 15 GPM 390 392
a. TOTAL DEPTH: 405
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 CONSTRUCT STANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 40 FT. RE ORD HAS BEEN P OVIDED 0 T E WELL OWNER.
. (Use"+"if Above Top of Casing) L i 5er ^Q-2 3
d. TOP OF CASING IS 1 FT.Above Land Surface' �/J� -/r
*Top of casing terminated at/or below land surface may require SIGNATURE 0 RTIFIED LL CONT , CTOR 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
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 568.1. Rev.3/07
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