GW1--05117_Well Construction - GW1_20230818

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cRESIDENTIAL WELL CONSTRUCTION RECORD
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—-' '' North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2780 230067
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 43
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name From 170 To 195 From 246 To 248
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 80 ' Ft. 6 1/8 350 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
SITE WELL ID#(ifapplicable) From 0 To 20 Ft. BENTONIT GRAVITY
_ _-- — ------- - -- - From To -Ft.-30 BAGS --- -
WELL CONSTRUCTION PERMIT#392950 From To ' Ft.
OTHER ASSOCIATED PERMIT#(if applicable) '
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply IX From To Ft. in. in.
DATE DRILLED 8/1/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM I PM DX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: ZIONVILLE COUNTY ASHE Depth Size Material
- -- From To Ft.
462 OSCAR RD OFF HWY 88/67 OFF HWY 421N From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
0 Slope 0 Valley 0 Flat 0 Ridge 0 Other 11. DRILLING LOG
(check appropriate box)
May be in degrees, From To Formation Description
LATITUDE _ — 36.393003 minutes,seconds or 0 68 DIRT
LONGITUDE 81:710491 in a decimal format 68 .170 GRANITF
— — 170 195 GREEN GRANITE
Latitude/longitude source: X GPS 0 Topographic map 195 246 GRANITE
(location of well must be shown on a USGS topo map and 246 248 VOID
attached to this form if not using GPS) 248 265 GRANITE
5.WELL OWNER
OWNER'S NAME EDDIE STEPHENS . RECEIVED
STREET ADDRESS 462 OSCAR RD
ZIONVILLE - NC 28698 AUG 1 8 2023
City or Town State Zip Code
( 828 )_ 964-5457 -1fitainigkarPrOtalfairlititfra—
DWQ130G
Area code- Phone number 12. REMARKS:
2 GPM 170-195
6.WELL DETAILS: 18 GPM 246 248
a. TOTAL DEPTH: 265 ,
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 CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 60 FT. RE R HAS BEEN PRO IDED ' rl IE WELL OWNER.
(Use"+"if Above Top of Casing) G 2,,5�
d. TOP OF CASING IS 1 FT.Above Land Surface*
*Top of casing terminated at/or below land surface may require SIGNATURE OF CERTI IED E NTR CTOR 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
I
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. i Rev.3/07

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