GW1--07201_Well Construction - GW1_20231108

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'` ,r a , ,%• RESIDENTIAL WELL CONSTRUCTION RECORD
3',,„ "' North Carolina Department of Environment and Natural Resources-Division iof Water Quality
WELL CONTRACTOR CERTIFICATION#-2780 220196
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 48
KEITH PRESNELL _g. WATER ZONES(depth):
Well Contractor(Individual)Name From 130 To 133 From 200 To 205
DEWEY WRIGHT WELL&PUMP CO., INC From 290 To 295. 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 100 ! Ft. F 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: 1 8. GROUT: Depth Material Method
From 0 To 20 : Ft. BENTONIT GRAVITY
SITE WELL ID#(if applicable) . From To Y Ft. 19 BAGS
WELL CONSTRUCTION PERMIT#334795 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 10/25/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM II PM[IX From To Ft. in. in.
4.WELL LOCATION: . • 10.SAND/GRAVEL PACK:
CITY: VILAS COUNTY WATAUGA Depth Size Material
` From To Ft.
W OFF BAIRDS CREEK RD OFF HY 105 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 — 36.21637N minutes,seconds or 0 85 DIRT
LONGITUDE 81.75205W in a decimal format 85 130 GRANITE •
— — 130 • 133 RED GRANITE
Latitude/longitude source: )6 GPS o Topographic map 133 200 GRANITE
(location of well must be shown on a USGS topo map and 200 205 RED GRANITE
attached to this form if not using GPS) 205 290 GRANITE
290 295 RED GRANITE
5.WELL OWNER 295 320 GRANITE
' OWNER'S NAME CHARLES EARP I '
STREET ADDRESS 2122 BAIRDS CREEK RD
VILAS NC 28692 _
City or Town State Zip Code •. ,
(828 )_ 773-4954 ,
Area code- Phone number 12. REMARKS: 1 NOV 0 S 2023
1 GPM 130-133 li
6.WELL DETAILS: 1'GPM 200-205 1 ' - `''"
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a. TOTAL DEPTH: 32° it ., '4,,... J
2 GPM 290-295 ,
b. DOES WELL REPLACE EXISTING WELL? YES o NOX I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,WELL CONSTRU ION STANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 60 FT. REC RD HAS BEEN PROVID TP,THE WELL OWNER. / ,r�
(Use"+"if Above Top of Casing) • � t �/f Q ) {0 ��© .2V�
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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 C T CTOR DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL 1
e. YIELD(gpm): 4 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. 1 Rev.3/07
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