GW1--03997_Well Construction - GW1_20230612

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" RESIDENTIAL WELL CONSTRUCTION RECORD
13 { .� ,g North Carolina Department of Environment and Natural Resources-Division of Water Quality
,•"."�_;",,,, WELL CONTRACTOR CERTIFICATION# 2780 220067 •
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 123
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name From 320 To 340
From 645 To 670
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 f) To 50 Ft. 6 1/6 350 PVC
City or Town State Zip Code From To Ft.
(828 )_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-1-9-BAGS ------ ----
WELL CONSTRUCTION PERMIT#852733 From To Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply EX From To Ft. in. in.
DATE DRILLED 6/5/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM OX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: ELK PARK COUNTY AVERY Depth Size Material
From To Ft.
OFF FLAT SPRINGS RD, OFF 321, OFF 421 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 _ 36.17610 minutes,seconds or 0 40 DIRT
LONGITUDE _ 81.45e60 in a decimal format 40 170 190 G AITF
SLatitude/longitude source: X GPS o Topographic map 190 320 GRANITE
(location of well must be shown on a USGS topo map and 320 340 GRANITE QUARTZ MIX
attached to this form if not using GPS) 340 645 GRANITE
645 _ 670 RED GRANITE
5.WELL OWNER 670 700 GRANITE
OWNER'S NAME THOMAS REECE q _
STREET ADDRESS 530 LAKE RIDGE RD Rs L; p! ._
D
BUTLER TN 37640 - JUN t 9 7023
City or Town State Zip Code
(828 )_ 964-1682 U •
Area code- Phone number 12. REMARKS: 1v>i a MOG aM�... y�
2 GPM 320-340 `�b��
6.WELL DETAILS: 2 GPM 645 670
a. TOTAL DEPTH: 700
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 DARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below.Top of Casing: 80 FT. RE H BEEN PRDVIDTOT LL OWNER.
(Use"+"if Above Top of Casing) U l C
d. TOP OF CASING IS 1 FT.Above Land Surface'
*Top of casing terminated at/or below land surface may require SIGNATURE OF CE IED WELL CONT A DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
e. YIELD(gpm): 4 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-la
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.3/07
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