GW1-2021-02515_Well Construction - GW1_20210901

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RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
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WELL CONTRACTOR CERTIFICATION# 2780 200218
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount
70
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual Name) From 371 To 372 From TO
DEW+EY WRIGHT WELL &PUMP CO., INC. From To From To
Well Contractor Company Name From To From To
STREET ADDRESS P•O.BOX 308 6.CASING: Thickness/
BOONE NC 2WW Depth Diameter Weight Material
From 0 Tom- Ff. .d 118 350
City or Town State I C
—,�p1 From To Ft.
( 828 )-264-2651 a� _'°
From To Ft.
Area code-Phone number ! t q 7.GROUT: Depth Material Method
2.WELL INFORMATION: ;�p /� i L02� From 0 To 20 Ft.MUOONIT Gravi Flaw
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SITE WELL ID#(if applicable) �1_ �n�¢it;7 nil From To—
o ts'Ft.16RAG . _- - —
STATE WELL PERMIT#(f applicablW o n, 'inn i1nn From To Ft.
DWQ or OTHER PERMIT#(if applicable) 7 37 v &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply From To Fi. in. in.
DATE DRILLED 8=2021 From To Ft. in. in.
TIME COMPLETED 03:00 AM❑ PM 10 From To Ft. in. in.
9.SAND/GRAVEL PACK:
&WELL LOCATION:
Depth Size Material
CITY: I,110 d.FALLS COUNTY AVERY From--To Ft.
OFF SMICICLAND LN OFF HWY 221 OFF HWY 105 From _ o 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 28 DIRT
May be in degrees,
LATITUDE 3 35*24.707 minutes,seconds or 28 371 GRAY GRANITE
LONGITUDE _ _ 081#15.910 in a decimal format 371 372 QUARTZ/CREVICE
Latitude/longitude source: Of GPS ❑Topographic map 372 405. GRAY/BLUE GRANITE
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAMECLAUDB FRANI=-
STREET ADDRESSfo JOSH-FRANKLIN: 165 STRICKI"D LN - -
I:IlNZ1=FALLS NC 28647
City or Town State Zip Code
( (8= _260-0212
Area code-Phone number
5.WELL DETAILS: 11.REMARKS:
a. TOTAL DEPTH: 405 12 GPM 371 -372
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO)I
C. WATER LEVEL Below Top of Casing: 60 FT 1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use"+"if Above Top s Casing) 15A NCAC 2C,WELL CONSTRUCTION TANDARDS,AND THAT A COPY O THIS
R ORD HAS BEEN I EDT E ELL OWNER. ��?�
d. TOP OF CASING IS 1 FT.Above Land Surface* Il /J
*Top of casing terminated at/or below land surface may require
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a variance in accordance with 15A NCAC 2C.0118 SIGNOW OF CE D.I WEEL CONTRA DATE
e. YIELD(gpm): 12 METHOD OF TEST Air KEITH PRESNELL i
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
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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.7/05
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