GW1--05024_Well Construction - GW1_20230807

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...,4 RESIDENTIAL WELL CONSTRUCTION RECORD
t L.(,`` ,,, i North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2780 220139
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 74
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 260 To 280 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 () To 165 Ft. 6 1/4 188 GAL V
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
SITE WELL-ID#(if applicable)- From 0 To 20 Ft. BENTONIT GRAVITY
From To , Ft. 34 BAGS
WELL CONSTRUCTION PERMIT#372946 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 7/20/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM) 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.
OFF JESTES CEMETERY OFF 105 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 _ _ 36.08137 minutes,seconds'or 0 80 DIRT
LONGITUDE 81:48390 in a decimal format 80 120 GRAVFI MUD
— — 120 150 DIRT
Latitude/longitude source: X GPS o Topographic map 150 260 GRANITE
(location of well must be shown on a USGS topo map and 260 280 GRANITE QUARTZ
attached to this form if not using GPS) 280 340 GRANITE
5.WELL OWNER 340 370 GREEN GRANITE
370 425 GRANITE OWNER'S NAME ROBERT CLARK - p— ,0-..,a--! ,_
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STREET ADDRESS 147 SUNSHINE DR k � : ✓�"° t"""`
BANNER ELK NC 28604 AUr nun
City or Town State Zip Code . •
( 843 )- 810-7349 ,.,:/:a?+.�: r,:'31;r��
Area code- Phone number 12. REMARKS:-
1n� C:°/ '`�" '
2 GPM 260-280
6.WELL DETAILS:
a. TOTAL DEPTH: 425
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOD( I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,WELL CONSTR TION STANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 50 FT. RECORD HAS BEEN PROVI O THE WELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface* p,z ,
3
*Top of casing terminated at/or below land surface may require SIGNATU E OF CERTIFI WELL CONTRACTOR DATE
. a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
e. YIELD(gpm): 2 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
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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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