GW1--04464_Well Construction - GW1_20230710

;.,, ,-1. RESIDENTIAL WELL CONSTRUCTION RECORD
-i•`• raj North Carolina Department of Environment and Natural Resoi •ces-Division of Water Quality
"7:,:`,.-.' ' WELL CONTRACTOR CERTIFICATION# 2780 230092
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 73
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 380 To 381 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 1) To 40 Ft. Fi 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 Ft. 16 BAGS
WELL CONSTRUCTION PERMIT#353154 From To 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 6/19/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM OX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY:_BANNER ELK COUNTY WATAUGA Depth Size Material
From To , Ft.
LOT#51 FOXFIRE DR MONTEAGLE SUBDIVISION From To Ft. •
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
0 Slope 0 Valley 0 Flat 0 Ridge 0 Other 11.DRILLING LOG
(check appropriate box)
May be in degrees, From To Formation Description
LATITUDE _ — 36.19336 minutes,seconds or 0 v 29 DIRT
LONGITUDE 81.84721 in a decimal format 29 190 GRANITE
— — 190 230 SHALE
Latitude/longitude source: X GPS 0 Topographic map 230 365 GRANITE
(location of well must be shown on a USGS topo map and 365 380 GREEN GRANITE
•attached to this form if not using GPS) 380 381 VOID __
5.WELL OWNER 381 425 GRANITE
OWNER'S NAME ROBERT GOURDEAU C/O MASTERC _ _ , f --;
STREET ADDRESS PO BOX 134 ».° z '`-' °-•^ .
WEST JEFFERSO NC 28694 Al f► N23
• City or Town State Zip Code
( 336 )_ 877-7735 '3 .a,;r 1Jri;i
Area code- Phone number 12. REMARKS: Info.t‘•-"-D.v: •i' '•-�`= '
7 GPM 380-381 •
6.WELL DETAILS: •
a. TOTAL DEPTH: 425 . •
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 CONSTRUSTANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Topiof Casing: 60 FT. RE R HAS BEE VIDE T HE WELL OWNER.
(Use'4-if Above Top of Casing) r ^gf
ool .5
d. TOP OF CASING IS 1 FT.Above Land Surface*
*Top of casing terminated at/or below land surface may require SIGNATURE OF CERT IED W L CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL 1
e. YIELD(gpm): 7 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. Rev.3/07 -
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