GW1-2022-09643_Well Construction - GW1_20221021

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ESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2780 220023
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 88
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name From 190 To 230 From 386 To 438
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 68 Ft. F 1/R 350 PVC:
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:-48-SAGS--
WELL CONSTRUCTION PERMIT#363916 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 09/29/2022 From To Ft. in. in.
TIME COMPLETED_03000 AM 0 PM uX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: WEST JEFFERSON COUNTY ASHE Depth Size Material
From To Ft.
WATERTANK RD OFF 221-OFF 421 From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
0 Slope 0 Valley X Flat 0 Ridge 0 Other 11. DRILLING LOG
(check appropriate box)
May be in degrees, From To Formation Description
LATITUDE — — 36.33680N minutes,seconds or 0 59 DIRT
LONGITUDE 81.47411W in a decimal format 59 190 GRANITE
— — 190 230 SHALE
Latitude/longitude source: X GPS o Topographic map 230 386 GRANITE
(location of well must be shown on a USGS topo map and 386 438, SHALE . D
+
attached to this form if not using GPS) 438 480 GRANITE � 1
5.WELL OWNER _ 2 1 2022
OWNER'S NAME ODIE GILBERT
STREET ADDRESS 2769 WATERTANK RD _.__., ,•;.-, PfN9L1
Itil►It'117NfR'Z
WEST JEFFERS_C NC 28694
City or Town State Zip Code
(336 )- 957-6030
Area code- Phone number 12. REMARKS:
1 GPM 190-230 .2 GPM 386-438
6.WELL DETAILS:
a. TOTAL DEPTH: 480
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 CONSTRUCTI STANDARDS,AND THAT A COPY OF IS
c. WATER LEVEL Below Top of Casing: 50 FT. Eco D HA)BEE PROVIDED T T EMELL OWNER.
(Use"+"if Above Top of Casing) 1
d. TOP OF CASING IS 1 FT.Above Land Surface` 7A
'Top of casing terminated at/or below land surface may require IGNA RE OF CERTIFIED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
e. YIELD(gpm): 3 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-1a
1617 Mail Service Center-Raleigh,INC 27699-1617 Phone No.[phone] ext 668. Rev.3/07

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