GW1--04266_Well Construction - GW1_20230626

,'5f••-f" } RESIDENTIAL WELL CONSTRUCTION RECOR®
a' » �i- North Carolina Department of Environment and Natural Resources-Division of Water Quality
''`'" , WELL CONTRACTOR CERTIFICATION# 2780 220152
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 46
KEITH PRESNELL
g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 140 To 160 From 260 To 261
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 O To 50 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
From 0 To 20 Ft. BENTONIT GRAVITY
SITE WELL ID#(if applicable) From To R. 22 BAGS
WELL CONSTRUCTION PERMIT#369462 From To Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply ID( From To Ft. in. in.
DATE DRILLED 6/14/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM O PM OX From To Ft. in. in.
4.WELL LOCATION: , 10.SAND/GRAVEL PACK: Size a 1yl$,1.:"" tr't1 J�. F,
CITY: BANNER ELK WATAUGA Depthr- -_.%
COUNTY From To Ft.
LOT#S2 MONTEAGLE OFF SHAWNEE OFF GWAL" From To Ft. JUN 9, (( 7Q73
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING: to;;,a:,Yiun r'r, =, a UrUr.
X Slope 0 Valley 0 Flat 0 Ridge 0 Other DiriQ/Os3
(check appropriate box) 11. DRILLING LOG
May be in degrees, From To Formation Description
LATITUDE —— 36.18610N minutes,seconds or 0 38 DIRT
(
LONGITUDE 81.84084W in a decimal format 38 140 GRANITE
— — - 140 160 QUARTZ
Latitude/longitude source: X GPS 0 Topographic map 160 210 GRANITE
(location of well must be shown on a USGS topo map and 210 220 SHALE
attached to this form if not using GPS) 220 260 GRANITE
260 261 VOID
5.WELL OWNER 261 305 GRANITE !
OWNER'S NAME RICARDO ROJAS
STREET ADDRESS 114 LANTERN RIDGE LN
CARY NC 27519
City or Town State Zip Code
( 727 )- 409-4639
Area code- Phone number 12. REMARKS:
6 GPM 140-160
6.WELL DETAILS: 24 GPM 260-261
a. TOTAL DEPTH: 305
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 ION STANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 80 FT. RECORD HAS B EN OVID T THE WELL OWNER.
(Use"+"if Above Top of Casing) / i
d. TOP OF CASING IS 1 FT.Above Land Surface* / i ' 4. ��`
��
i "
'Top of casing terminated at/or below land surface may require SIGNATURE OF CERTIFIED LL " A •
TOR 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
I
•
•
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

p
„I.)/ /9st
\411
4.71242,4?
_1,* 0 y
r