GW1-2022-10702_Well Construction - GW1_20221205

/ RESIDENTL4L WELL CONSTRUCTION RECORD-.
3 t ^* North Carolina Department of Environment and Natural Resources-Division of Water Quality
r ^�" WELL CONTRACTOR CERTIFICATION# 2780 2201.99
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1.WELL CONTRACTOR:' f. DISINFECTION:Type HTH Amount 113
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name From 0 To 400 From 668 To 670
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_To Ft.
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
SITE WELL ID#(if applicable) From 0 To Ft.
_ _` ----From --- - To--- s Ft. —WELL CONSTRUCTION PERMIT#WP1003 From To Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth . Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply K From To Ft. in. in.
DATEDRILLED 11/30/2022 From To Ft. in. in.
TIME COMPLETED_03:00 AM O PM OX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: DRILL DEEPER COUNTY CALDWELL Depth size afer'al�Ez
From To Ft.
9309 HEADWATERS OFF BOLICK OFF BLACKBER From To Ft. �2
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft. E
TOPOGRAPHIC/LAND SETTING:
0 Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box) 11.DRILLING LOG
LATITUDE 36.09994 May be in degrees, From TO Formation Description
—— minutes,seconds or 0 400 EXISTING
LONGITUDE 81.61985 in a decimal format 400 490 GRANITE
— — 490 510 SHALE
Latitude/longitude source: X GPS 0 Topographic map 510 575 GRANITE
(location of well must be shown on a USGS topo map and 575 600 GRANITE QUARTZ
attached to this form if not using GPS) 600 668 GRANITE
5 668 670 QUARTZ
.WELL OWNER
670 700 GRANITE
OWNER'S NAME STEVEN &RONELLE SMITH
'STREET ADDRESS 20500 RIO ORO DR
CORNIELIUS NC 28031 -
City or Town State Zip Code
(301 )- 325-5546
Area code- Phone number 12. REMARKS:
0-400 EXISTING 1 GPM
6.WELL DETAILS: 668-670 2 GPM
a. TOTAL DEPTH: 700
b. DOES WELL REPLACE EXISTING WELL? YES 0 NODC I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
'ti:ry c. WATER LEVEL Below Top of Casing: 150 FT. RE ORD HAS BEEN PROVIDED T WELL OWNER.
(Use"+"if Above Top of Casing) L /
d. TOP OF CASING IS 1 FT.Above Land Surface' I 1 �wf l ff
'Top of casing terminated attor below land surface may require SIGNATURE OF CERTIFIEN W LL ONTRACTO DATE
-a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL 1
e. YIELD(gpm): 3 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 GWAa
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 668. Rev.3/07

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