_Well Construction - GW1_20230310 (71)

H ..G ^r
Y RESIDENTIAL WELL CONSTRUCTION RECORD
\b "F ,g i North Carolina Department of Environment and Natural Resources-Division of Water Quality
`�` "' '" WELL CONTRACTOR CERTIFICATION# 2780 220034 •
1
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 106
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name From 285 To 310 From 560 To 561
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 0 To 108 Ft. f 1/fi 350 PVC
.' City or Town State Zip Code From To Ft.
(828 )_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#(if applicable) From To Ft. 22 BAGS
WELL CONSTRUCTION PERMIT#150278 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 2/22/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM IX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: WEST JEFFERSON COUNTY ASHE Depth Size Material
t.
From To Ft. }-li r i ". t
LOT#12 OFF WESTVIEW DR, OFF CLARENCE LY/ From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft. !\ill,ArRj 2123
• TOPOGRAPHIC/LAND SETTING:
0 Slope 0 Valley N Flat 0 Ridge 0 Other i
checkappropriate box) 11. DRILLING LOG nfci-F 1-.1C1-1 ;a
r`'C.-7/,.;.J tJn.
May be in degrees, From To Formation°Decription
LATITUDE — — 36.36126N minutes,seconds or 0 98 DIRT
LONGITUDE 81.50769W in a decimal format 98 190 GRANITF
— — 190 230 SHALE
Latitude/longitude source: X GPS o Topographic map 230 285 GRANITE
(location of well must be shown on a USGS topo map and 285 310 QUARTZ
attached to this form if not using GPS) 310 440 GRANITE
440 490 GRANITE QUARTZ MIX
5.WELL OWNER 490 560 GRANITE
OWNER'S NAME GUSTAVO DELAFE 560 561 VOID
STREET ADDRESS 16041 SW 61 CT 561 605 GRANITE
SW RANCHES NC 33331
City or Town State Zip Code
(305 )_ 992-8874
Area code- Phone number ' 12. REMARKS:
5 GPM 285-310
6.WELL DETAILS: 15 GPM 560-561
a. TOTAL DEPTH: 605
b. DOES WELL REPLACE EXISTING WELL? YES 0 NON 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: 100 FT. REC D S BEEN PR VIDED TO ELL OWNER.
(Use"+"if Above Top of Casing) ��-
d. TOP OF CASING IS 1 FT.Above Land Surface*
3 -C
*Top of casing terminated at/or bOlow land surface may require SIGNATURE OF CERTIFIED WELL CONTRACTO DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
e. YIELD(gpm): 20 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 Mgt., Form GW-la
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.3/07

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