GW1--05025_Well Construction - GW1_20230807

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;,'F_ RESIDENTIAL WELL CONSTRUCTION RECORD
3 > North Carolina Department of Environment and Natural Resources-Division of Water Quality
"' ' WELL CONTRACTOR CERTIFICATION# 2780 230080
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1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 18
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name From 90 To 91 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 63 Ft. 6 1/4 188 GAI V
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. 50 BAGS
WELL CONSTRUCTION PERMIT#391585 From To Ft.
OTHER ASSOCIATED PERMIT#Of 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 7/24/2023 . From To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM 0X From To Ft. in. in.
4.WELL LOCATION:. 10.SAND/GRAVEL PACK:
CITY: VILAS COUNTY WATAUGA Depth Size Material
From To Ft.
OFF STONE MTN RD OFF MTN DALE OFF BETHEL 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 ,
(check appropriate box) 11. DRILLING LOG
May be in degrees, From To Formation Description
LATITUDE — — 36.317132 minutes,seconds or 0 40 DIRT
LONGITUDE 81.859506 in a decimal format 40 50 r)IRT MUr)GRAVFI
— — 50 90 GRANITE
Latitude/longitude source: N GPS 0 Topographic map 90 91 VOID
(location of well must be shown on a USGS topo map and 91 100 GRANITE
attached to this form if not using GPS)
5.WELL OWNER
OWNER'S NAME DEXTER CORNETT _
STREET ADDRESS 901 STONE MOUNTAIN RD _ � 'L./ .4��
VILAS NC 28692 02
• City or Town State Zip Code AUG ,� 2
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( 828 )_ 964-9989 • -3rr.-.;��;-,:Unli
Area code- Phone number to °`";,^�
12. REMARKS: D;'ji�l'.'.:�3
. 40 GPM 90-91
6.WELL DETAILS:
a. TOTAL DEPTH: 100
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO 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: 15 FT. RECORD HAS BEEN PROVITO THE WELL OWNER.(Use"+"if Above Top of Casing) /�f� 7�� 0�
d. TOP OF CASING IS 1 FT.Above Land Surface* V/o((
*Top of casing terminated at/or below land surface may require SIGNATURE OF CERTIFIED WELL CO RACTOR DATE
a variance in accordance with 15A NCAC 2C.0118.
KEITH PRESNELL
e. YIELD(gpm): 40 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. Rev.3/07

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