GW1--07906_Well Construction - GW1_20231205

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k i y ,71. . RESIDENTML WELL CONSTRUCTION RECORD
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u''_, North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2780 230091
1.WELL CONTRACTOR: f. DISINFECTION:Type 'HTH Amount 64
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name From 250 To 255 From 370 To 375
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 120 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#(ifapplicable) From 0 To 20 Ft. BENTONIT GRAVITY
- From - -- - To , Ft.-19 BAGS - - -- -
WELL CONSTRUCTION PERMIT#362371 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 11/14/2023 From To Ft., in. in.
TIME COMPLETED 03:00 AM 0 PM OX From To . Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: BOONE COUNTY WATAUGA Depth Size Material
From To Ft.
OFF KESTREL RD OFF FLAME AZALEA DR OFF N From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
X Slope 0 Valley 0 Flat 0 Ridge 0 Other 11. DRILLING LOG
(check appropriate box)
May be in degrees, From To Formation Description
LATITUDE 36.17624N
— — minutes,seconds or 0 100 DIRT
LONGITUDE 81.64471W in a decimal format 100 250 GRANITF
— — 250 255 GRANITE
Latitude/longitude source: X GPS 0 Topographic map 255 370 GRANITE
(location of well must be shown on a USGS topo map and 370 375 QUARTZ
attached to this form if not using GPS) 375 405 GRANITE .,_,
5.WELL OWNER 1 .. i ...,r L.u..n v t"
OWNER'S NAME BILLY PACHECO
DEC 0 :>a Z023
STREET ADDRESS 9528 FALLEN PEAR LN NE
LELAND NC .. - 28451 - Intrr;r.-=:-i^n ?.-7.__,0..::g Uie
City or Town State Zip Code - Ca':10/7.YG;,; ,
( 910 )_ 431-7985
Area code- Phone number 12. REMARKS:
1 GPM 250-255
6.WELL DETAILS: 4 GPM 370 375
a. TOTAL DEPTH: 405
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: 100 FT. RECORD HAS BEEN PRO D TO THE WELL OWNS .
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface* k �''i -�h
*Top of casing terminated at/or below land surface may require SIGNATURE OF CERTIFIED WELL CO TRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL '
e. YIELD(gpm): , 5 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-1 a
1617,Mail Service Center—Raleigh, NC 27699-1617 Phone No.[phone] ext 568. Rev.3/07

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