GW1-2021-02778_Well Construction - GW1_20211130

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RESIDENTIAL WELL CONSTRUCTION RECORD
o North Carolina Department of Environment and Natural Resources-Division of Water Quality
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WELL CONTRACTOR CERTIFICATION# 2780 210094
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 86
KEITH PRESNELL g. WATER ZONES(depth):'
Well Contractor(Individual Name) From 240 To 2 2-- From 370 To 378
DEWEY WRIGHT WELL &PUMP CO., INC. From To From To
Well Contractor Company Name From To From TO
STREET ADDRESS P.O.BOX 308 6.CASING: Thickness/
BOONE NC 28607 Depth Diameter Weight Material
From 0 To 63 Ft. (51/4 .188 GALV
City or Town State Zip Code From To Ft.
( K8 )-264-2651 From To Ft.
Area code-Phone number
2.WELL INFORMATION: 7.GROUT: Depth Material Method
From 0 To 20- Ft.BE,NTONIT Gravity Flow
--SITE-WEL-LID-#(If-applicable). -- --- _ _ -- ----From-- - To Ft.-1$BA-GS ------
STATE WELL PERMIT#(dapplicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) 322249 &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply W From To Ft. in. in.
DATE DRILLED 11/17/2021 From To Ft. in. in.
TIME COMPLETED 03:00 AM❑ PM® From To Ft. in. in.
9.SAND/GRAVEL PACK:
3.WELL LOCATION:
Depth Size Material
CITY. FZ.KST WOOD COUNTY ASIM From To Ft.
CREE=E LMLkDOWS SUBDIVISION OFF LAKE F From _To Ft.
From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box) 0 48 DIRTIMUD
May be in degrees,
LATITUDE 3 36.280226 minutes,seconds or 48 190 GRANITE
LONGITUDE -81.511030 in a decimal format 190 198 SHALE
Latitude/longitude source: IR GPS ❑Topographic map 198 240 GRANITE
(location of well must be shown on a USGS topo map and 2A—o40 242 QUARTZ
attached to this form if not using GPS) 42 310 `( eflIITF
4.WELL OWNER 31.0 140 RH eI F
OWNER'S NAMEBRVRRT.V GRF'F:NI'c a4�n 370 GRenuT-F
STREET ADDRESS/oMASTERCRAFT.HOMES; FOBOX-134 370- _-- 37a- - --QUaRT7re4AIF
WEST JEFFMON NC 29694 378 425 GRANITE
City or Town State Zip Code
(3( 30 )- 877-V35
Area code-Phone number
5.WELL DETAILS: 11.REMARKS: ��r�;<<
a. TOTAL DEPTH: 425 2 GPM 240-242 6 GPM 370-379n
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO)Q
C. WATER LEVEL Below Top of Casing: ARTESIAN FT. I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use"+"if Above Top of Casing) 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
RE ZDASIBEEN�PtRVIDEDW-NEWE LL OWNER.d. TOP OF CASING IS FT.Above Land Surface' , PTop of casing terminated at/or below land surface may require d a variance in accordance with 15A NCAC 2C.0118 S GNAT E OF xWIED VJE1 L CONTRACTOI DATE
e. YIELD(gpm): 8 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-1 a
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.7/05
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