GW1-2022-10117_Well Construction - GW1_20221110

RESIDENTIAL WELL CONSTRUCTION RECORD
g' North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2780 220077
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 63
KEITH PRESNELL
g. WATER ZONES(depth),:
Well Contractor(Individual)Name From 128 To 142 From 340 To 365
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 Tom_Ft._6 1/R 150 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
WELL CONSTRUCTION PERMIT#`246238 From To `Ft. 19 BAGS
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 11/3/2022 From To Ft. in. in.
TIME COMPLETED 03:00 AMU PM OX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: LANSING COUNTY ASHE Depth I Size Material
From To Ft.
OFF SPENCER BRANCH RD OFF 194 OFF 221 OFI 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 11. DRILLING LOG
(check appropriate box)
LATITUDE 36.56288N May be in degrees, From To Formation Description
— — minutes,seconds or 0 70 DIRT
LONGITUDE 81.49273W in a decimal format 70 128 GRANITE I '�
128 142 SHALE : •
Latitude/longitude source: )k GPS 0 Topographic map 142 270 GRANITE
(location of well must be shown on a USGS topo map and 270 290 SHALE
attached to this form if not using GPS) 290 340 GRANITE NOV 1 0 L2022
5.WELL OWNER 340 365 QUARTZ
365 400 GRANITE OD f-- LW
OWNER'S NAME BOBBI HARRIS I py
STREET ADDRESS C/O MASTERCRAFT CRC LLC POE
WEST JEFFERSO NC 28694
City or Town State Zip Code
(336 )- 877-7735
Area code- Phone number 12. REMARKS:
1 GPM 128-142
5.WELL DETAILS: 3 GPM 340-365
a. TOTAL DEPTH: 400
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOX I DO HEREBY CERTIFY THAT THIS WELUlWAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,-WELL CONSTRUCTIPN STANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 100 FT. RQCORD HAS WELL OWNER.
(Use"+"if Above Top of Casing) � 9�'Ljm "QA
d. TOP OF CASING IS 1 FT.Above Land Surface- ( �✓"� ��
"Top of casing terminated at/or below land surface may require SIGNATU OF CERTIFIED WELL CONTRA DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL I
e. YIELD(gpm): 4 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
0
i
f
i
Submit the original to the Division of Water(duality within 30 days. Attn: Information�Mgt., W-1a
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Form G Rev.
07

107
Cb
74,
J-pir
........... .................................