GW1-2022-10558_Well Construction - GW1_20221121

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.�V RESIDENTIAL WELL CONSTRUCTION RECORD
y? � North Carolina Department of Environment and Natural Resources-Division of Water Quality
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WELL CONTRACTOR CERTIFICATION# 2780 220198
1.WELL CONTRACTOR: f. DISINFECTION:Type 'HTH Amount 91
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name From 225 To 270 From 440 To 458
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/
BOONE NC 28607 Depth Diameter Weight Material
From To 40 Ft._6 1/8 350 PVC
City or Town State Zip Code From To Ft.
8( 28 )-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. 19 BAGS WELL CONSTRUCTION PERMIT#921 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 11/9/2022 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:
CITY: LENOIR COUNTY CALDWELL Depth Size Material
From To Ft.
OFF MULBERRY CREEK OFF ROBY MARTIN OFF 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 11.DRILLING LOG
(check appropriate box)
May be in degrees, From TO Formation Description
LATITUDE — _ 35.997163 minutes,seconds or 0 30 DIRT
LONGITUDE 81.641035 in a decimal format 30 189 GRANITE
— — 189 225 SHALE
Latitude/longitude source: X GPS o Topographic map 225 270 GRANITE QUARTZ
(location of well must be shown on a USGS topo map and 270 330 GRANITE
attached to this form if not using GPS) 330 380 GRANITE QUARTZ
5.WELL OWNER 380 440 GRANITE
440 458 QUARTZ
OWNER'S NAME BANE CHANDLER 458 505 GRANITE (r ' •� t s '
STREET ADDRESS 2060 VALWAY RDA
LENOIR NC 28645 NEW 2 1 20ZZ
City or Town State Zip Code
(828 )- 754-5274 ^-'A•; Urw�
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Area code- Phone number 12. REMARKS:
2 GPM 225-270
6.WELL DETAILS: 4 GPM 440-458
a. TOTAL DEPTH: 505
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: 60 FT. RE99RD HAS BEEN PROVIDED TO E WELL OWNER.
(Use"+"if Above Top of Casing) 1 t
d. TOP OF CASING IS 1 FT.Above Land Surface- f r`
*Top of casing terminated at/or below land surface may require SIGNATTJRE OF Cr-RTIPIE15 VVEL MNTfWTf0R DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
e. YIELD(gpm): 6 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-1a
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.3/07

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