GW1-2022-10258_Well Construction - GW1_20221031

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RESIDENTL4L WELL CONSTRUCTION RECORD
es North Carolina Department of Environment and Natural Resources-Division olI Water Quality
WELL CONTRACTOR CERTIFICATION# 2780 210244
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 57
KEITH PRESNELL g. WATER ZONES(depth)`.
Well Contractor(Individual)Name
From 230 To 234 '' From 310 To 315
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/
Depth Diameter Weight Material
BOONE NC 28607 From n To Rn !Ft. R 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
From 0 To 20 Ft. BENTONIT GRAVITY
SITE WELL ID From To jFt`_-17 BAGS
WELL CONSTRUCTION PERMIT#AG WELL From To IFt.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply O From To Ft. in. in.
DATE DRILLED 10/19/2022 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: LAUREL SPRINGS COUNTY ASHE Depth Size Material
669 CRANBERRY CREEK RD From To Ft._From To !Ft. ,'— r�. D
A Wit-
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft. OCT �(1�
TOPOGRAPHIC/LAND SETTING:
0 Slope 0 Valley X Flat 0 Ridge 0 Other 17. DRILLING LOG Ini3�v�� �n PrM 'UMd
(check appropriate box) f
LATITUDE 36.467468 May be in degrees, From To Formation Descrip'�'a"Q'�OG
minutes,seconds or 0 71 DIRT
LONGITUDE 81.317991 in a decimal format 71 130 GRANITE
— — 130 162 SHALE
Latitude/longitude source: X GPS 0 Topographic map 162 230 GRANITE
(location of well must be shown on a USGS topo map and 230 234 SHALE QUARTZ
attached to this form if not using GPS) 234 310 GRANITE
5.WELL OWNER 310 315 QUARTZ;
315 345 GRANITE
OWNER'S NAME KAYLEA GOSS
STREET ADDRESS 669 CRANBERRY SPRINGS RD
LAUREL SPRING! NC 28644
City or Town State Zip Code
(828 )- 406-9615
Area code- Phone number 12. REMARKS:
2 GPM 230-234
6.WELL DETAILS: 2 GPM 310-315
a. TOTAL DEPTH: 345
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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 CONSTRUCTIONISTANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 60 FT. RECORD HAS BEEN PROVIDEDA-O)T HE WELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface* ✓S1( ® ya
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'Top of casing terminated at/or below land surface may require SIGNATURE OF CERTIFIED WELL CONTRA OR DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
e. YIELD(gpm): 4 METHOD OF TEST AIR PRINTED NAME OF PERSON�CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information jMgt., Form GW-1a
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.3/07
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