GW1-2022-10560_Well Construction - GW1_20221121

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RESIDENTIAL WELL CONSTRUCTION REORD
North Carolina Department of Environment and Natural Resources-Division o 4 Water Quality
WELL CONTRACTOR CERTIFICATION# 2780 1220086
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1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 67
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name From 210 To 230 From 340 To 365
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 190 Ft. Fi 1/R 35n Pyr
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 WELLJD#(ifapplicable) From To IFt.'18 BAGS
WELL CONSTRUCTION PERMIT#870 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 11/8/2022 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: LENIOR COUNTY CALDWELL Depth Size Material
From To Ft.
4462 YADKIN VIEW OFF 268 OFF YADKIN RIVER F 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 D Other 11.DRILLING LOG
(check appropriate box)
LATITUDE 36.00967N May be in degrees, From TO Formation Description
— — minutes,seconds or 0 107 DIRT
LONGITUDE 08.50174W in a decimal format 107 210 GRANITE
— — 210 230 PINK QUARTZ
Latitude/longitude source: X GPS D Topographic map 230 270 GRANITE
(location of well must be shown on a USGS topo map and 270 290 SHALE r�
attached to this form if not using GPS) 290 340 GRANITE �" t"0 it rr'fi a 0 M lf:
5.WELL OWNER 340 365 QUARTZ t Z ,. •.o
365 405 GRANITE
OWNER'S NAME ISAAC WEBB Alfl\I ZOZ
STREET ADDRESS 2032 GLASS RD
LENIOR NC 28645
City or Town State Zip Code
82( 8 )- 499-1491
Area code- Phone number 12. REMARKS:
1 GPM 210-230
6.WELL DETAILS: 4 GPM 340-365
a. TOTAL DEPTH: 405
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: 80 FT. RECORD HAS B E ROVIDE THE WELL OWNER.
(Use"+"if Above Top of Casing) (^C Q
d. TOP OF CASING IS 1 FT.Above Land Surface* v/ V yL
'Top of casing terminated aUor below land surface may require SIGNATURE OF CERTIFIED W L CONTRAC R DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
e. YIELD(gpm): 5 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-1a
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. I Rev.3/07

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