GW1-2022-10114_Well Construction - GW1_20221110

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RESIDENTIAL WELL CONSTRUCTION RECORD
ag; North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2780 220003
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 106
KEITH PRESNELL
g. WATER ZONES(depth):
Well Contractor(Individual)Name From 605 To 640 From 688 To 689
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 n To 48 Ft. F 1/8 350 PVC:
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
SITE WELL ID#(if applicable) From 0 To 20 iFt. BENTONIT GRAVITY
From To
WELL CONSTRUCTION PERMIT#337442 _ rFt. 18 BAGS
_
From To—,Ft.
OTHER ASSOCIATED PERMIT#('If applicable) 9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply X From To Ft. in. in.
DATE DRILLED 11/2/2022 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: WARRENSVILLE COUNTY ASHE Depth Size Material
From To Ft.
OFF HICKORY TRAIL OFF HWY 88 OFF 221 OFF 4: 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 _ _ 36.457454 minutes,seconds or 0 39 DIRT
LONGITUDE 81.537845 in a decimal format 39 220 GRANITIF VIA
220 265 SHALE _,
Frl
Latitude/longitude source: X GPS o Topographic map 265 380 GRANITE
(location of well must be shown on a USGS topo map and 380 422 SHALE
attached to this form if not using GPS) 422 590 GRANITE 2022
5.WELL OWNER 590 605 SHALE
605 640 GRANITE QUARTZIroorlInaU 3;1 PrOC61111,1111111111111
OWNER'S NAME KEITH MOORE 640 688 GRANITE
688 689 VOID I
STREET ADDRESS C/O MASTERCRAFT CRC LLC PO E 689 705 GRANITE
WEST JEFFERSO NC 28694
City or Town State Zip Code
( 336 )- 877-7735
Area code- Phone number 12. REMARKS:
.5 GPM 605-640
6.WELL DETAILS: 14.5 GPM 688-689
a. TOTAL DEPTH: 705
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOAC I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,WELL CONSTRUC ON STANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 200 FT. RECORD HAS BEEN PROYIDEYJOTHE WELL OWNER.
(Use"+"if Above Top of Casing) 7L
I
d. TOP OF CASING IS 1 FT.Above Land Surface*
*Top of casing terminated at/or below land surface may require SIGNATURE OF CE 1 D ELL CO T R DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
e. YIELD(gpm): 15 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
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Submit the original to the Division of Water Quality within 30 days. Attn:Informatin:Mgt., Form GW-1a
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 668. Rev.3/07

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