GW1--00213_Well Construction - GW1_20231229

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,Y��STA7F,yry
r )� RESIDENTIAL WELL CONSTRUCTION RECORD
`e '' North Carolina Department of Environment and Natural Resources-Division of Water Quality
�� �" WELL CONTRACTOR CERTIFICATION# 2780 230141
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 71
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name ,
From 200 To 203 From 300 To 305
DEWEY WRIGHT WELL& PUMP CO., INC From 375 To 380 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 59 Ft. 6 1/8 350 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
SITE WELL ID#(if applicable) J From 0 To 20 :Ft. BENTONIT . GRAVITY
-- From To- '`iFt' 18-BAGS- =- — - -
WELL CONSTRUCTION PERMIT#939727 From To •Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply ID( From To Ft. in. in.
DATE DRILLED 11/30/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM D PM DX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK: '
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CITY: BANNER ELK COUNTY AVERY Depth Size Material
From To 'Ft.
OFF OLD TURNPIKE OFF 194 OFF 184 OFF HWY 1 From To 'Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING: -
0 Slope 0 Valley 0 Flat II Ridge 0 Other 11. DRILLING LOG
(check appropriate box)
May be in degrees, From To Formation Description
LATITUDE — — 36.168970 minutes,seconds or 0 39 DIRT •
LONGITUDE •81.863574 in a decimal format 39 200 GRANITE
— — 200 203 GRANITE
Latitude/longitude source: X GPS o Topographic map 203 300 GRANITE
(location of well must be shown on a USGS topo map and 300 305 QUARTZ
attached to this form if not using GPS) 305 375 GRANITE;
375 380 GRANITE
5.WELL OWNER 380 400 GRANITE`
OWNER'S NAME ADAM SOSME C/O VONCO CONSTR I -
C 2
STREET ADDRESS 198 BUCK CREEK RD - `-'.t, .__ • ;., „
ROAN MTN TN 37687
City or Town State Zip Code �� �,ZQ2J
( 828 )- 260-1583 Inrcr,r:<.':frn ,��n. .
Area code- Phone number 12. REMARKS: .,.,.....%a`�S
2 GPM 200-203 D'y` " �
6.WELL DETAILS: 2 GPM 300-305 '
a. TOTAL DEPTH: 405 6 GPM 375 380 ,
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: 10 FT. RECORD HAS BEEN PROVIDE 0 THE WELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface* 9-Lat. Liz.,004e0 /.2-J 326 !'-i
*Top of casing terminated at/or below land surface may require SIGNATURE OF CERTIFIED WELL CON ACTOR DATE .
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL '
e. YIELD(gpm): 10 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL '
I
, I
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1 a
1617;Mail Service Center—Raleigh,NC 27699-1617 Phone No. [phone] ext 568. Rev.3/07

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