GW1-2021-02149_Well Construction - GW1_20210620

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2780 2100sq
1.WELL CONTRACTOR:
KEITH PRESNELL f. DISINFECTION:Type �_HTH _Amount
g. WATER ZONES(depth):
Well Contractor(Individual Name
DEWEY WRIGHT WE 260 WELL &PUMP CO., INC. From To From 400r o
From 415 To From To
Well Contractor Company Name From To From To
STREET ADDRESS P.O.BOX 308 6.CASING: Thickness/
BOONE NC 28 7 Depth Diameter Weight Material
From 0 To $0 Ft. 61/8 .350 PVC
City or Town State Zip Code From To Ft._
( 828 )- 264-2651 From To Ft._
Area code-Phone number 7.GROUT Depth Material Method
2.WELL INFORMATION:
From o To 20 Ft. BENTONTT Graaity Flow
SITE WELL ID#(if applicable) From To Ft. 14BAGS
STATE WELL PERMIT#(if applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) 146230 &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply CY From To Ft._ in. in.
DATE DRILLED 6/9/2021 From To Ft. in. in.
TIME COMPLETED 03:00 AM❑ PM LY From To Ft._ in. in.
9.SAND/GRAVEL PACK:
3.WELL LOCATION:
WEST JEF�SRSON ASHE Depth Size Material
CITY: COUNTY From To Ft.
WOODPECKER RIDGE OFF SMOKE RISE PATH OFF From _To Ft._ _
From To Ft. _
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box) 0 65 SAND/CLAY
N36-19.132 May in degrees, 65 260 GRANITE
LATITUDE 3 minutes,seconds or
LONGITUDE W081*X255 in a decimal format 250 260 CREVICE
Latitude/longitude source: LXWS ❑Topographic map 250 400 GRANITE
(location of well must be shown on a USGS topo map and 400 400 CREVICE
attached to this form if not using GPS) 400 415 _ GRANITE
4.WELL OWNER 415 415 CREVICE
OWNER'S NAME JOHN$LINDA BROWN 415 440 GRANITE STREET ADDRESS%BRI"WMVER, PO BOX 826
RICFII.AMS NC 28574
City or Town State Zip Code
( (336))- 213-5714 nit
Area code-Phone number forM3ti0n C0
5.WELL DETAILS: 11.REMARKS: "VIM Rglull n
a. TOTAL DEPTH: 440 0.25 GPM 260- 0.25 GPM 400-
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO® 24.5 GPM 415-
c. WATER LEVEL Below Top of Casing: 30 Fr I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use"+"if Above Top of Casing) 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO L OWNER. /
WELL A )
d. TOP OF CASING IS 1 FT.Above Land Surface" —AzZet—1 [
Top of casing terminated at/or below land surface may require
kAZk
a variance in accordance with 15A NCAC 2C.0118 SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
e. YIELD(gpm): 25 METHOD OF TEST Air KEITH PRESNELL
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, NC 27699-1617 Phone No.[phone] ext 568. Rev.7/05

Smoke Qis=►4h
C �
� l
�Co'e- knob Rd
� M
' Of
Jo-
i
0