GW1--07624_Well Construction - GW1_20231204

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/e*, r • RESIDENTIAL WELL CONSTRUCTION RECORD
`� t g,' North Carolina Department of Environment and Natural Resources-Division of Water Quality
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`""" . •, WELL CONTRACTOR CERTIFICATION# 2780 230085
1.WELL CONTRACTOR: f. DISINFECTION:Type 1HTH •Amount 139
KEITH PRESNELL . •
g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 440 To 443 From 725 To 730
DEWEY WRIGHT WELL& PUMP CO., INC From 775 To 780 ' 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 67 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) _ Flom __To_ _Et..1_8 BAGS ---- -
WELL CONSTRUCTION PERMIT# 125797 From To , 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 11/27/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM DX From To Ft. in. in.
4.WELL LOCATION: . 10.SAND/GRAVEL PACK:
CITY: BANNER ELK COUNTY AVERY Depth Size Material
From To Ft.
OFF CASTLE ROCK DR OFF HWY 184 OFF HWY 1 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 _ _ 36.126648 minutes,seconds or 0 47 DIRT
LONGITUDE 81.839389 in a decimal format 47 440 GRANITE
— — 440 443 GRANITE
Latitude/longitude source: X GPS 0 Topographic map 443 725 GRANITE
(location of well must be shown on a USGS topo map and 725 730 GRANITE
attached to this form if not using GPS) 730 775 GRANITE
775. 780 GRANITE
5.WELL OWNER 780 825 GRANITE
OWNER'S NAME KEITH AND NANCY MILLER C/O COT !
STREET ADDRESS PO BOX 596
LINVILLE NC 28646 — .
City or Town State '' Zip Code t T ;-_, , .,+7-)
( 828 ).. 964-3103 ,_, ..:�._ .i; `, .m..�.. ,
Area code- Phone number 12. REMARKS: D!-(' 0 1 2023 I
1 GPM 440-443 -
6.WELL DETAILS:
a. TOTAL DEPTH: 825 9 GPM 725-730 inf;;,-;_ _ :. ;;1 � -:r =7.41 �w;,;
10 GPM 775-780 I D': °_13
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 S NDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 100 FT. RECORD HAS BEEN RO IDED TO T ELL OWNER.
(Use"+"if Above Top of Casing) I it,_,2�{n e/1 3
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d. TOP OF CASING IS 1 FT.Above Land Surface* �� -
*Top of casing terminated at/or below land surface may require S GNATURE OF CERTIFIED;WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. i KEITH PRESNELL
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e. YIELD(gpm): 20 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-1a
1617 Mail Service Center—Raleigh, NC 27699-1617 Phone No.[phone] ext 568. '' ',Rev.3/07

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