GW1--06668_Well Construction - GW1_20231006

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rls .. y RESIbENTML WELL CONSTRUCTION RECORD
} k =• �pk North Carolina Department of Environment and Natural Resources-Division of Water Quality
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'''',:n,' WELL CONTRACTOR CERTIFICATION# 2780 230139
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1.WELL CONTRACTOR: f. DISINFECTION:Type, HTH Amount 129
KEITH PRESNELL g. WATER ZONES(depth): • _
Well Contractor(Individual)Name From 178 To 185'
From To
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#(if applicable) From 0 To 20 Ft. BENTONIT GRAVITY_
From To~ 1 Ft. 17 BAGS
WELL CONSTRUCTION PERMIT#373374 From r To ' Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply IK • From To Ft. in. in.
DATE DRILLED 9/5/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM OX From ' To Ft. in. in.
4.WELL LOCATION: 1 10.SAND/GRAVEL PACK:
CITY: WEST JEFFERSON COUNTY ASHE Depth Size Material
From To • Ft. 'i,F.:1--•7 . c, ;z,':<'
OFF KANAWHA OFF BOGGS RD OFF HWY 163 OF From To . 'Ft. ' '4.'`a`"''L--_i I.—-'•_ •
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft. OCT2021 _
TOPOGRAPHIC/LAND SETTING: l•
0 Slope 0 Valley X Flat 0 Ridge 0 Other • , Infor • 'gin 4�r� =,ri:."�,° I-%I :
11. DRILLING LOG
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(check appropriate box) ' i r,,;5•,...t,
LATITUDE 36.21318N May be in degrees, From To Form atiri T3e`st;11ion
— — minutes,seconds or, 0 70 DIRT;
LONGITUDE 81.26020-W in a decimal format 70 178 GRANITE
— — 178 185 QUARTZ
Latitude/longitude source: X GPS u Topographic map 185 380 GRANITE
(location of well must be shown on a USGS topo map and 380 430 SHALE '
• attached to this form if not using GPS) 430 475 GRANITE QUARTZ MIX
• 475 530 GRANITE
5.WELL OWNER 530 570 SHALE I
OWNER'S NAME RICHARD EHRHART 570 700 GRANITE
STREET ADDRESS 595 KANAWHA DR
WEST JEFFERS-0 NC 28694- '
City or Town- State Zip Code
( 704 )- 905-8898
Area code- Phone number 12. REMARKS:
.75 GPM 178-185 I
6.WELL DETAILS: I.
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a. TOTAL DEPTH: 700 •
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: 40 FT. RECORD HAS BEEN PROVIDE •THE WELL OWNER.
(Use"+"if Above Top of Casing) ;6 V L I
d. TOP OF CASING'IS 1 FT.Above Land Surface*
*Top of casing terminated at/or below land surface may require SIGNATURE OF CERTIFIED WELL RACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL j'
e. YIELD(gpm): .75 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
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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 !
f Rev.3/07
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