GW1-2021-03395_Well Construction - GW1_20210607

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RESIDENTIAL WELL CONSTRUCTION RECORD'
" North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2780 k I ?A 1
1.WELL CONTRACTOR: HTH Amount 72
KEITH PRESNELL f. DISINFECTION:Type
g. WATER ZONES(depth): '
Well Contractor(Individual Name) From 105 To From 225TO
DEWEY WRIGHT WELL &PUMP CO., INC.
From 315 To From 365To
Well Contractor Company Name From To From To
STREET ADDRESS P O.BOX 30$ 6.CASING: Thickness/
BOONE NIC 2 M Depth Diameter Weight Material
From 0 To 46 Ft.' 61/8 .350 PVG
City or Town State Zi C From To Ft.'
( 828 )-264-2651 R C f ft D From To Ft.
Area code-Phone number
7.GROUT: Depth Material Method
2.WELL INFORMATION:
J U N X 7 2021 From_0 To 20 Ft.BE=M= Gy-witA,Flow
SITE WELL ID#(d applicable] From To Ft.' 23 BAGS
STATE WELL PERMIT#(if applicabWf'Ofr''''3ti0n f Unit From To Ft:
DWO or OTHER PERMIT#(If applicable) v &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply From To Ft. in. in.
DATE DRILLED 5/2&2021 From To Ft. in. in.
TIME COMPLETED 03:00 AM❑ PM 16 From To Ft. in. in.
9.SAND/GRAVEL PACK:
3.WELL LOCATION:
Depth Size Material
CITY: LENOIR: COUNTY CALDWELL From _To Ft.
LOT 50/SEC 2 OFF TOMAHAWK RIDGE DR OFF AB From _To Ft.-
From--To-" Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box) 0 39 CLAYISAND
May be in degrees,
LATITUDE 3 minutes,seconds or 39 185 GRANITE
LONGITUDE in a decimal format 185 185 CREVICE
Latitude/longitude source: LIGPS ❑Topographic map 185 225 GRANITE
(location of well must be shown on a USGS topo map and 225 225• CREVICE
attached to this form if not using GPS) 225 315 GRANITE
4.WELL OWNER 315 315 CREVICE
OWNER'S NAME MICHAI3L GARVEY 315 365 GRANITEIGUARTZ
STREET ADDRESS6512 DEAL RD. 365 365 CREVICE.
MATTHEWS NC . 28104 365 40D GRANITE .
City or Town State Zip Code
U 400-3566 ,
Area code-Phone number
5.WELL DETAILS: 11.REMARKS:
a. TOTAL DEPTH: 400 0.5 GPM 185- 0.5 GPM 225-
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO SI 2 GPM 315- 1 GPM 365-
c. WATER LEVEL Below Top of Casing: 40 FT. I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use"+"if Above Top of Casing) 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
RECORD HAS BEEN OVID9NO,THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface* 1
Top of casing terminated at/or below land surface may require d
a variance in accordance with 15A NCAC 2C.0118 SIG RTIFIED WELL C OR DATE
i
e. YIELD(gpm): 4 ' METHOD OF TEST Au KEITH PRESNELL
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days.Attn: Information i Mgt., Form GW-1 a
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.7/05
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