GW1--05491_Well Construction - GW1_20230825

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,,,,Ty RESIDENTLAL WELL CONSTRUCTION RECORD
`„ , x+ , ` North Carolina Department of Environment and Natural Resources-Division of Water Quality
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' '" °r i` WELL CONTRACTOR CERTIFICATION# 2780-
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1.WELL CONTRACTOR: f. DISINFECTION:Type I;1TH•
Amount 118
KEITH PRESNELL g. WATER ZONES(depth):;
Well Contractor(Individual)Name From 285 To 3201
From 548 To 560
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 I, Diameter Weight Material
BOONE NC 28607 From 0 To 80 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
SITE WELL ID#(if applicable) From 0 To 20 I Ft. BENTONIT GRAVITY
From To. i EL, 17 BAGS _
WELL CONSTRUCTION PERMIT#382547 From .To I Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth ' Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply IX From To Ft. in. in.
DATE DRILLED 8/4/2023 From To Ft. in. in.
TIME COMPLETED 03:00 I AM 0 PM DX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: SUGAR GROVE COUNTY WATAUGA Depth Size Material
From To 1 Ft.
324 MAST GAP OFF HWY 321 N OFF HWY 421 NOF From To Ft. •
(Street Name,Numbers,Community,Subdivision,Lot No,,Parcel,Zip Code) From , To I.Ft.
TOPOGRAPHIC/LAND SETTING: '
0 Slope 0 Valley X Flat II Ridge 0 Other •
(check appropriate box) 11.DRILLING LOG •
May be in degrees, From To Formation Description
LATITUDE , — 36.22818N minutes,seconds or 0 70 DIRT
LONGITUDE 81.78846W , in a decimal format 70 195 GRANITE
— — 195 210 SHALE
210 285 GRANITE '^"'""•
Latitude/longitude source: GPS o Topographic map ^•�
(location of well must be shown on a USGS topo map and 285 320 GREEN GRANITEti A
attached to this form if not using GPS) 320 390 GRANITE390 420 ' SHALE 1
AUGJ
5.WELL OWNER 420 548 GRANITE U 9-5 2023
OWNER'S NAME BRUCE WALLACE 548 560 QUARTZ;GRANITE
STREET ADDRESS 324 MAST GAP RD 560 575 GRANITE tittZ% P,�icit?i,.= '' �t' 1
575 605 SHALE DV,O; =
SUGAR GROVE NC 28679 - 605 705 GRANITE -
City or Town State Zip Code -
( 828 )_ 616-0911
Area code- Phone number 12. REMARKS:
I 1 GPM 285-320
6.WELL DETAILS: t.
a. TOTAL DEPTH: 705 1 GPM 548 560 !;
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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: 120 FT. RECORD HAS BEEN PROVID 0 THE WELL OWNER.
(Use"+"if Above Top of Casing) 9,LeiiL j. f7 �� 2
d. TOP OF CASING IS 1 FT.Above Land Surface* SIGNATURE OF CERTIFIED W�.4_,AJ i � / _� J.
*Top of casing terminated at/or below land surface may require ,ELL CONTR 7{CTOR 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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