GW1-2022-10116_Well Construction - GW1_20221110

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~• j �. RESIDENTIAL WELL CONSTRUCTION RECORD
g North Carolina Department of Environment and Natural Resources-Division of Water Quality
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WELL CONTRACTOR CERTIFICATION# 2780 f 210078
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 88
KEITH PRESNELL g, WATER ZONES(depth):
Well Contractor(Individual)Name From 348 To 358 From 470 To 480
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_To_ 1 Ft. 6 1/4 1RR (;AI V
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 Ft. BENTONIT GRAVITY
— rom
WELL CONSTRUCTION PERMIT#324852 From .To Ft;
-- -- l - - ---- --
• From To IFt.
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 10/31/2022 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: CRESTON COUNTY ASHE Depth Size Material
From To Ft.
OFF MUDDY BRANCH RD OFF HWY 88 OFF HWY From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From TO IFt.
TOPOGRAPHIC/LAND SETTING:
0 Slope 0 Valley X Flat 0 Ridge 0 Other 11. DRILLING LOG
(check appropriate box)
LATITUDE 36.428165 May t e in degrees, From To Formation D" ��
— — minutes,seconds or 0 10 DIRT MUD `t—l �D
LONGITUDE 81.651388 in a decimal format 10 120 GRANITE
120 142 SHALE AI(lt/ 11
Latitude/longitude source: X GPS 0 Topographic map 142 305 GRANITE Q 2022
(location of well must be shown on a USGS topo map and 305 348 SHALE
attached to this form if not using GPS) 348 358 QUARTZ roc
358 470 GRANITE
5.WELL OWNER 470 480 WHITEi PINK QUARTZ
OWNER'S NAME CHRIS FRANK 480 505 GRANITE
STREET ADDRESS C/O SUPERIOR CONST. MNGMT.
SUGAR GROVE NC 28679
City or Town State Zip Code
(828 )_ 297-4884
Area code- Phone number 12. REMARKS:
2 GPM 348-358
6.WELL DETAILS: 3 GPM 470-480
a. TOTAL DEPTH: 505
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 CONSTRUCTIO NDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 80 FT. RECORD HAS BEEN PROVIDED TO E ELL OWNER.
(Use"+"if Above Top of Casing) W
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d. TOP OF CASING IS 1 FT.Above Land Surface*
'Top of casing terminated at/or below land surface may require SIZ3NA7bVE OF C IED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
e. YIELD(gpm): 5 METHOD OF TEST AIR PRINTED NAME OF PERSON((CONSTRUCTING THE WELL
t
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Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt., Form GWAa
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.3/07
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