GW1--03777_Well Construction - GW1_20230602

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5-r- RESIDENTIAL WELL CONSTRUCTION RECORD
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w ✓4!it E, North Carolina Department of Environment and Natural Resources-Division cif Water Quality
'.4- _,R ' '- WELL CONTRACTOR CERTIFICATION# 2780 230072
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1.WELL CONTRACTOR: f. DISINFECTION:Type NTH Amount 69
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name From 365 To 366 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 40 Ft. 6 1/11 250 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.18-BAGS- — — - -
WELL CONSTRUCTION PERMIT#268400 From To ;Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply ID( From To Ft. in. in.
DATE DRILLED 5/23/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM OX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
Depth Size IVI6. .iar`'r;^ f"��
CITY: BOONE COUNTY WATAUGA ;. ;. ;,,,,. ;; '
From To Ft. .�'.T,ti-.., •.>'0.....i V ,.._ 4.,.r
LOT#330R TWIN RIVERS DR OFF HWY 105 From To . Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
JUN G j 2023
TOPOGRAPHIC/LAND SETTING:
0 Slope 0 Valley X Flat 0 Ridge 0 Other lri�i?'"=-'�n '�' �'j"''" 3 l'r.t
(check appropriate box) 11. DRILLING LOG L'';='Q:7-.gY-.3
May be in degrees, From To Formation Description
LATITUDE _ 36.156384 minutes,seconds or 0 28 DIRT
LONGITUDE 81.744617 in a decimal format 28 195 GRANITE
— — 195 215 SHALE
Latitude/longitude source: X GPS 0 Topographic map 215 330 GRANITE
(location of well must be shown on a USGS topo map and 330 365 GREEN GRANITE
attached to this form if not using GPS) 365 366 VOID'
5.WELL OWNER 366 420 GRANITE
OWNER'S NAME KIP DELLINGER C/O WILLIAM DRUM
STREET ADDRESS 7803 HWY 105S
BOONE NC 28607
City or Town State Zip Code
( 828 )_ 773-3789
Area code- Phone number 12. REMARKS:
12 GPM 365-366
6.WELL DETAILS:
a. TOTAL DEPTH: 420
b. DOES WELL REPLACE EXISTING WELL? YESO NO I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,WELL CONSTRUCT STANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 80 FT. RE RD HAS BEE - VIDED O T IE WELL OWNER. _
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface* 5-3) ����
*Top of casing terminated at/or below land surface may require SIGNATURE OF CERTIFIED WELL CONTRACT R DATE
a variance in accordance with 15A NCAC 2C.0118. 'KEITH PRESNELL '
e. YIELD(gpm): 12 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:InformationjMgt.,
Form GW-la
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. I Rev.3/07

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