GW1-2023-01000_Well Construction - GW1_20230125

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RESIDENTIAL WELL CONSTRUCTION RECORD
- g,- North Carolina Department of Environment and Natural Resources-Division of Water Quality
^ WELL CONTRACTOR CERTIFICATION# 2780 220140
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 59
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 160 To 192 From 243 To 244
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. Ri 1/4 188 GAI V
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
From 0 To 20 Ft. BENTONIT GRAVITY
_--.-- - SITE WELL ID#(if applicable) -- - From To Ft. 18 BAGS - -
WELL CONSTRUCTION PERMIT#215964 From To Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply K From To Ft. in. in.
DATE DRILLED 1/18/2023 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: BANNER ELK COUNTY AVERY Depth Size Material
From To Ft.
LOT GS27 OFF EAGLE SPRINGS OFF CAMP EAGL 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 — — 36.19950N minutes,seconds or 0 2 DIRT
LONGITUDE 81.91041W in a decimal format 2 160 GRANITE
— — 160 192 PINK GRANITE
Latitude/longitude source: X GPS ii Topographic map 192 24o GRANITE
(location of well must be shown on a USGS topo map and 240 243 BROWN SHALE
attached to this form if not using GPS) 243 244 VOID
5.WELL OWNER 244 280 PINK GRANITE
OWNER'S NAME AARON&LAURA TOWNS C/O PRIME 280 305 GRANITE f,*',;.:i , �...,_F"'t
STREET ADDRESS 300 E. MAIN ST - 4
WILKESBORO NC 28697 IAN
City or Town State Zip Code .r =.c'r Ur'
(336 )- 262-7720 1tt�v nDVSQi3,
Area code- Phone number 12. REMARKS:
2 GPM 160-192
6.WELL DETAILS: 28 GPM 243-244
a. TOTAL DEPTH: 305
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 CONSTRU N STANDARDS,AND THAT A CO Y OF THIS
c. WATER LEVEL Below Top of Casing: 21 FT. HA BE P VIDE TO HE WELL OWNER.
(Use"+"if Above Top of Casing) VVV
d. TOP OF CASING IS 1 FT.Above Land Surface- /
•Top of casing terminated atfor below land surface may require SIGNATURE OF CERTIFIED WELL CONTRACTOR 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
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt., Form GWA a
1617 Mail Service Center—Raleigh,INC 27699-1617 Phone No.[phone] ext 568. Rev.3/07

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