GW1--04262_Well Construction - GW1_20230626

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4S y RESIDENTIAL WELL CONSTRUCTION RECORD
" a-,. ;t`' �i; North Carolina Department of Environment and Natural Resources-Division of Water Quality
`''.„,n,,' WELL CONTRACTOR CERTIFICATION# 2780 230033
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 74
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 370 To 380 From To
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 n To RO Ft. 6 1/f3 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 Fr 18 BAGS —
WELL CONSTRUCTION PERMIT#365849 From To Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply 9( From To Ft. in. in.
DATE DRILLED 6/16/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM IX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: BANNER ELK COUNTY WATAUGA Depth Size Material
From To R. . y °;
LOT#52 MONTEAGLE OFF SHAWNEE RD OFF GL From To Ft. "b.'k...•a:__a it h_ .>:
(Street Name,Numbers,Community,Subdivision,Lot No„Parcel,Zip Code) From To Ft. +�+i
TOPOGRAPHIC/LAND SETTING: J V lV ✓ `' 2023
0 Slope 0 Valley X Flat 0 Ridge 0 Other
(check appropriate box) 11. DRILLING LOG tnfJrr aMon Pr^':✓y``14F:g Unf
May be in degrees, From To Formation Descrtp'imai;3OG
LATITUDE _ _ 36.19421 N minutes,seconds or 0 50 DIRT '
LONGITUDE _ 81.84782W _in a decimal format 5000 170 70 GRANITE
Latitude/longitude source: X GPS ii Topographic map 200 310 GRANITE
(location of well must be shown on a USGS topo map and 310 340 GREEN GRANITE
attached'to this form if not using GPS) 340 370 GRANITE
5 370 380 QUARTZ I
.WELL OWNER
380 425 GRANITE
OWNER'S NAME BRETT BUTLER C/O MASTERCRAFT
STREET ADDRESS PO BOX 134
•
WEST JEFFERSO NC 28694
City or Town State Zip Code
(336 )- 877-7735
Area code- Phone number 12. REMARKS:
5 GPM 370-380
6.WELL DETAILS:
a. TOTAL DEPTH: 425
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: 50 FT. RECORD HAS BEEN PROVIDED TOT ELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface* ✓ lQ 21 _2.`-' t i
*Top of casing terminated at/or below land surface may require SI NATURE O C .R I D WE DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
e. YIELD(gpm): 5 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
1
i
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 Rev.3/07

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