GW1-2022-09641_Well Construction - GW1_20221021

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RESIDENTL4L WELL CONSTRUCTION RECORD
y A, North Carolina Department of Environment and Natural Resources-Division of Water Quality
.,a�«F WELL CONTRACTOR CERTIFICATION# 2780 1220032
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 87
KEITH PRESNELL g. WATER ZONES(depth):,
Well Contractor(Individual)Name From 490 To 491 From To
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/
BOONE NC 28607 Depth Diameter Weight Material
From To_q8_Ft.-6 1/R iri0_ P\/r
City or Town State Zip Code From To Ft.
8( 28 )-264-2651 From To Ft.
Area code- Phone number
2.WELL INFORMATION: 8. GROUT: Depth Material Method
SITE WELL ID#(if applicable) From 0 To 20 Ft. BENTONIT GRAVITY
--- — -- - - —-—-From To----Ft:2&-BAGS
WELL CONSTRUCTION PERMIT# 147066 From To Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply X From To Ft. in. in.
DATE DRILLED 09/30/2022 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: WEST JEFFERSON . COUNTY ASHE Depth Size Material
From To Ft.
TRAILWOOD DR OFF SMOKE RISE OFF BRIGHT 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
(check appropriate box) 11.DRILLING LOG
May be in degrees, From To Formation Description
LATITUDE — — 36.32305N minutes,seconds or 0 87 DIRT '
LONGITUDE 84.43808W in a decimal format 87 196 GRANITF
— — 196 245 SHALE
Latitude/longitude source: X GPS 0 Topographic map 245 410 GRANITE �+}�
(location of well must be shown on a USGS topo map and 410 440 SHALES t°°`+ Is F••
attached to this form if not using GPS) 440 490 GRANITE t.ii— Ate•
5 490 491 VOID i
.WELL OWNER
491 500 GRANITE f1('7 022
OWNER'S NAME EDDIE STEPP
STREET ADDRESS 1717 26TH AVE Nsage
IrttsN
N.MYRTLE BEACI SC 29582
City or Town State Zip Code
(336 )- 263-1450
Area code- Phone number 12. REMARKS:
30 GPM 490-491
6.WELL DETAILS:
a. TOTAL DEPTH: 500
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: 80 FT. R HAS BEEN R DED TO WELL OW�. r.TMI
R
(Use•"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface* U`Top of casing terminated attor below land surface may require SIGNATURE OFCERTIFIED WE DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
e. YIELD(gpm): 30 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
i
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt., Form GW-1a
1617 Mail Service Center—Raleigh,INC 27699-1617 Phone No.[phone] ext 568. Rev.3107

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