GW1-2022-10711_Well Construction - GW1_20221205

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RESIDENTL4L WELL CONSTRUCTION RECORD
3 North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2780 1220204
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 70
KEITH PRESNELL g. WATER ZONES(depth)I:
Well Contractor(Individual)Name From 122 To 128 From 368 To 380
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/
BOONS NC 28607 Depth- Diameter Weight Material
From To_B$_Ft._6 1/A 'irn PVC,
City or Town State Zip Code From To Ft.
8( 28 l_264-2651 From To Ft.
Area code- Phone number
2.WELL INFORMATION: 8. GROUT: Depth Material Method
---SITE,WEL-L-ID'#(ifapplicable) - -- - - — __ _ _ From 0 To 20 :Ft. B_ENTONIT GRAVITY
From To� ''Ft.- 19 BAGS
WELL CONSTRUCTION PERMIT#309530 From To !Ft.
OTHER ASSOCIATED PERMIT#(if applicable) 9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply K From To Ft. in. in.
DATEDRILLED 11/23/2022 From To Ft. in. in.
TIME COMPLETED 03:00 AM U PM OX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: FLEETWOOD COUNTY ASHE Depth Size Material
From To ` Ft.
OFF MILLER FARM RIDGE RD OFF JOHN MILLER 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)
LATITUDE 36.31209N May be in degrees, From To Formation Description
— — minutes,seconds or 0 79 DIRT
81.49003W in a decimal format 79 122 GRANITE
LONGITUDE_ _ 122 128 QUARTZ
Latitude/longitude source: X GPS 0 Topographic map 128 2ao GRANITE
(location of well must be shown on a USGS topo map and 280 330 SHALE
attached to this form if not using GPS) 330 368 GRANITE
368 380 SHALE QUARTZ MIX
5.WELL OWNER 380 405 GRANITE
OWNER'S NAME JUSTIN &JULIE HAYNES I ;� I m; 3 0- -
a�d
STREET ADDRESS 1594 MEAT CAMP RD d DEC
BOONE NC . 28607 - 22
City or Town State Zip Code
,_,c_-_,.a',ir!1 ern.^�:,z•'::�01:r'.
(828 )- 964-8664 D�r10; Cv
Area code- Phone number 12. REMARKS:
2 GPM 122-128
6.WELL DETAILS: 2 GPM 368-380
a. TOTAL DEPTH: 405
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 ONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 60 FT. RECORD HAS B EN ROVID THE WELL OWNER.
(Use"+"if Above Top of Casing) �] j
d. TOP OF CASING IS 1 FT.Above Land Surface' v/ I ]/'j� of
'Top of casing terminated at/or below land surface may require SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL I ,
e. YIELD(gpm): 4 METHOD OF TEST AIR PRINTED NAME OF PERSOIN CONSTRUCTING THE WELL
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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 668. Rev.3/07

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