GW1-2021-07470_Well Construction - GW1_20211116

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RESIDENTIAL WELL CONSTRUCTION RECORD
_ North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2780 20OM
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1.WELL CONTRACTOR:
f. DISINFECTION:Type HTH Amount 57
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual Name) From 11g To 120 From 282 To 294
DEVVEY YVhdlGH T 'V1ELL &PUf+ P CO., INC:. From To From To
Well Contractor Company Name From To From To
STREET ADDRESS P.O.BOX 308 6.CASING: Thickness/
BOONS NC W607 Depth Diameter Weight Material
From0 Tom Ft. 61/8 .350 PVC
City or Town State Zip Code From To Ft.
( 828 )-264-2651 From To Ft
Area code-Phone number 7.GROUT: Depth Material Method
2.WELL INFORMATION: From 0 To 20 Ft!BENTONPT GrevityFlow
—SITE-WEL-L-ID#(it-applicable)— - _—._.�__ _--From--To-----Ft-2GBP_GS----
STATE WELL PERMIT#of applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) 32690 &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply ra From To Ft. in. in.
DATE DRILLED 11/2/2021 From To Ft. in. in.
TIME COMPLETED 03:00 AM❑ PM KI From To Ft. in. in.
9.SAND/GRAVEL PACK:
&WELL LOCATION: Depth I Size Material
CITY: WARP"SVILLE COUNTY ASHE From _To Ft.
LOT 46 OFF FALL LN OFF QUAIL RUN OFF HWY 88 From _To Ft.
2Q21
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From _To Ft.- WOV14
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG DWRSECTION
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other From To Fo rA o Q riRNTSSING UNI'
(check appropriate box) 0 30 DIRT
May be in degrees,
LATITUDE 3 _ N36*09.938 minutes,seconds or 30 118 GRANITE
LONGITUDE _ _ W081*53.205 in a decimal format 118 120 QUARTZ
Latitude/longitude source: X GPS ❑Topographic map 120 188 GRANITE
(location of well must be shown on a USGS topo map and 188 198 SHALE
attached to this form if not using GPS) 198 235 GRANITE
4.WELL OWNER 235 258 SHALE
OWNER'S NAMEBROOKS SCI3AFFER 258 282 GRANITE
STREET ADDRESS`($=NNES CT, 282 284 QUARTZ
STONY POINT NC 28678 284 3055 GRANTIE
City or Town State Zip Code
(I 843) )-540-4540
Area code-Phone number
5.WELL DETAILS: 11.REMARKS:
a. TOTAL DEPTH: 305 5 GPM 118- 120 25 GPM 282-284
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO);]
c. WATER LEVEL Below Top of Casing: 20 FT, I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use"+"if Above Top of Casing) 15A NCAC 2C,WELL CONSTRUC N STANDARDS,AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDE O E WELL OWNER.
d. TOP OF CASING IS 1 FT Above Land Surface" q6iz� ® /
"Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C.0118 SIGNATURE OF CER IFIED WELL CONTRACTOR DATE
e. YIELD(gpm): 30 METHOD OF TEST Air KEITH PRESNELL
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-Raleigh,NC 27699-1617 Phone No.[phone] ext 566. Rev.7/05
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