GW1--05494_Well Construction - GW1_20230825

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q' RESIDENTIAL WELL CONSTRUCTION RECORD'
�� t*,1 z,47 North Carolina Department of Environment and Natural Resources-Division�of1 Water Quality
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._ . WELL CONTRACTOR CERTIFICATION# 2780 2;30065
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1.WELL CONTRACTOR: f. DISINFECTION:Typel HTH Amount 49
KEITH PRESNELL
g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 126 To 220. From 270 To 271
DEWEY WRIGHT WELL& PUMP CO., INC From_ To ', From To
Well Contractor Company Name From To I' From - To
STREET ADDRESS PO BOX 308 7. CASING: Thickness/
• Depth I; Diameter Weight Material
BOONE NC 28607 From 0 To 60 ; Ft. 6 1/6 350 PVC
City or Town State , Zip Code , From__ To 1 Ft.
(828 )_264-2651 From To Ft.
Area code- Phone number
2.WELL INFORMATION: 8. GROUT: Depth Material Method
From 0 To 20 I Ft. BENTONIT GRAVITY
SITE WELL ID#(if applicable) _Ero_m= ____T0 -- l Ft_20.BAGS._,_. _,- _ _ - ________
WELL CONSTRUCTION PERMIT#396138 From To I Ft._
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: I Depth ' Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply IX From To Ft. in. in.
DATE DRILLED 8/14/2023 From To- 1 Ft. in. in.
TIME COMPLETED'03:00 AM II PM OX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
:
CITY: DEEP GAP`' COUNTY WATAUGA . Depth Sizei Material
From To Ft.
OFF JAKES MTNIRD OFF.ELK CREEK RD OFF OL[ 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 II Ridge 0 Other
(check appropriate box) , • 11. DRILLING LOG I;
May be in degrees, From To Formation Description
LATITUDE — — 36.201279 minutes,seconds or 0 50 DIRT I'
LONGITUDE 81.557057 in a decimal format 50 120 GRANITE
— — 120 126 SHALE
Latitude/longitude source: X GPS u Topographic map 126 220 GRANITE
(location of well must be shown on a USGS topo map and- • 220 230 GREEN GRANITE
attached to this form if not using GPS) 230 .270 QUARTZI
270 271 VOID I I
5.WELL OWNER 271 325 • GRANITE•OWNER'S KL ! RECENED
TREEADDRSS 664BUCSKINN
DEEP GAP NC • 28618 AUG 2 5 2023
City or Town State Zip Code
(828 )- 964-1473 Ir.;corA— ::-, ?f:%. y.•.-1 .:ri$
, Area code- Phone number 12. REMARKS:
2 GPM 126-220 I
6.WELL DETAILS: $ GPM 270-271
a. TOTAL DEPTH: 325
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 CONSTR ION STANDARDS,AND THAT A COPY OF THIS
C. WATER LEVEL Below Top of Casing: 80 FT. RErO D HAS B ROVID D T THE WELL OWNE
(Use"+"if Above Top of Casing) � . I 65'-'2°P2 3
d. TOP OF CASING IS 1 •FT.Above Land Surface*
*Top of casing terminated at/or below land surface may require SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
a variance in accordance•with 15A NCAC 2C.0118. KEITH PRESNELL I
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e. YIELD(gpm): 10 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 IVlgt., Form GW-la
1617 Mail Service Center—Raleigh, NC 27699-1617 Phone No.[phone] ext 568. 1 ' Rev.3/07
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