GW1--05191_Well Construction - GW1_20230814

SCArt.
:4.:r ,1 q r1-LIB RESIDENTIAL WELL CONSTRUCTION RECORD
•
7'I'v , a North Carolina Department of Environment and•Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2780 220096
1.WELL CONTRACTOR: f. DISINFECTION:Type. HTH Amount 127
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 450 To 480 From 710 To 740
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 60 Ft. 6 1/8 350 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. 1-8 BAGS
WELL CONSTRUCTION PERMIT#333504 From To Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply I,p( From To Ft. in. in.
DATE DRILLED 7/31/2023 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:
CITY: SUGAR GROVE COUNTY WATAUGA Depth Size Material
From To Ft.
OFF HWY 321 N OFF HWY 421 N OFF HWY 105 BYF ' 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 II Other 11. DRILLING LOG
(check appropriate box)
May be in degrees, From To Formation Description
LATITUDE — 36.25983N minutes,seconds or 0 15 DIRT
LONGITUDE - 81.87383W in a decimal format 15 49 •
SOFT SHALE
— — 49 170 GRANITE
Latitude/longitude source: X GPS o Topographic map 170 175 RED GRANITE
7 (location of well must be shown on a USGS topo map and 175 290 GRANITE
attached to this form if not using GPS) 290 310 RED GRANITE M,.- r e
310 450 GRANITE ""' .„i VC"�'
5.WELL OWNER 450 480 RED GRANITE AUG
� "'
OWNER'S NAME WESLEY& KATIE WIDDISON L. 480 710 GRANITE AUG 1 . 2023
710 740 QUARTZ
STREET ADDRESS 1805 CHERRY LAUREL DR 740 790 GRANITE Ir: Tir...74%,r ,,:.,., ,,
ORMOND BEACH FL 32174 - D+,; -.T ",0 l`s,;t
City or Town State Zip Code
( 386 )- 405-7322
Area code- Phone number -12. REMARKS: ,
2 GPM 450-480
6.WELL DETAILS: $GPM 710 740
a. TOTAL DEPTH: 790
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: 140 FT. RECORD HAS BEEN P OVID THE WELL OWNER.
(Use"+"if Above Top of Casing) / ^' ---.Qo O"C)^�3
d. TOP OF CASING IS 1 FT.Above Land Surface* C�f[
`Top of casing terminated at/or below land surface may require SI NA OF CERTIFIED L CO TOR DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
e. YIELD(gpm): 10 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-1a
1617 Mail Service Center 7 Raleigh, NC 27699-1617 Phone No.[phone] ext 568. Rev.3/07

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