GW1-2022-09131_Well Construction - GW1_20220930

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RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2780 4, 210235
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1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 70
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual Name) From 274 To From To
DE'WVEY WRIGHT WELL lip.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 286(f7 Depth Diameter Weight Material
From 0 To 88 Ft. 61/8 .330 PVC
City or Town State Zip Code From To Ft.
( V2 )264-2651 From To Ft.
Area code-Phone number 7.GROUT-. Depth Material Method
2.WELL INFORMATION: From 0 To 20 FtBENTO= Gravity-Flow
SITE WELL ID#(if applicable) From To Ft 20 BAGS
STATE WELL PERMIT#(if applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) 356752 &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supplyll From To Ft. in. in.
DATE DRILLED 9/1/2022 From To Ft. in. in.
TIME COMPLETED 03:00 AM❑ PM)I From To Ft. in. in.
9.SAND/GRAVEL PACK:
&WELL LOCATION:
Depth Size Material
CITY:TODD COUNTY ASHE From _To Ft.
552 SEATS RD OFF RAU-ROAD GRADE OFF BROWN From _To Ft.-
From--TO-Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley f7 Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box) 0 77 DIRT
May be in degrees,
LATITUDE 3 36.283358 minutes,seconds or 77 180 GRANITE
LONGITUDE $1.562234 in a decimal format 180 245 SHALE
Latitude/longitude source: W GPS ❑Topographic map 2d5 2711 CAR AAiITF
(location of well must be shown on a USGS topo map and 270 275 QUARTZ
attached to this form if not using GPS) 275 290 1 SHAI F
4.WELL OWNER 2Qn Ain GRANITE
OWNER'S NAMF,I=MMY SR'ATZ ,iin yen SHAI F
STREET ADDRESS32 SEATS.RD.;- -- - - _ __ 3d0- 405 _ GRAAIITF
TODD NC 28694
City or Town State Zip Code
(3( 36? )-877-0952
Area code-Phone number
5.WELL DETAILS: 11.REMARKS: S E P 3 A 2022
a. TOTAL DEPTH: 405 4-
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOAO � n c=fi'^"M.trJ Unil
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c. WATER LEVEL Below Top of Casing: 60 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
RECORD HAS BEENPROVIDED THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface* 1
'Top of casing terminated at/or below land surface may require J A
a variance in accordance with 15A NCAC 2C.0118 SIGN URE OF CERTIFIED WELL CONTRA TOR DATE
e. YIELD(gpm): 3 METHOD OF TEST Air KEITH PRESNELL
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-1 a
1617 Mail Service Center-Raleigh, NC 27699-1617 Phone No.[phone] ext 568. Rev.7/05
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