GW1-2022-01233_Well Construction - GW1_20220103

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RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2780 210231
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 56
KEITH PRESNELL
g. WATER ZONES(depth):
Well COo9tra�cto`/r Indi IGHT Nam 246
&PUMP CO., INC. From 2` To 249 From To
From To From To
Well Contractor.Company Name From To From To
P.O.BOX 308
STREET ADDRESS 6.CASING: Thickness/
BOONE NC 28607 From OD oth 175 Ft Diameter W6 1/8eight Material
City or Town State Zip Code From To Ft. 0
( 828 )-264-2651 From To Ft.
Area code-Phone number
" 7.GROUT: Depth ! Material Method
2.WELLINFORMATION- From O To 20 Ft.BENTONIT Gravity Flow
SITE WELL"ID#(if applicable) ---From _ -To Ft-_ - — - - —-
STATE WELL PERMIT#(ifapplicable) From To Ft.
DWQ or OTHER PERMIT#(f applicable) WYlyy &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Ap gl/30/2021 licable Box): Residential Water Supply From To Ft. in. in.
DATE DRILLED From To Ft. in. in.
TIME COMPLETED AM❑ PM From To Ft. in. in.
9.SAND/GRAVEL PACK:
&WELL LOCATION:
Depth Size Material
CITY: LENOIR COUNTY CALDWELL From To Ft.
7063 RICHLAND RD OFF RICHLAND RD OFF 321 From _To From--TO- Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) Ft. o„
,ly/pn
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG .f
❑Slope ❑Valley El Flat ❑Ridge ❑Other From To Formation DbSti'Ii�orll 202?
(check appropriate box) 0, 150 DIRT
May be in degrees,LATITUDE 3 minutes,seconds or 150 162 SHALE WT
LONGITUDE in a decimal format 162 246 GR l7JrEQSfNG UNE
Latitude/longitude source: A GPS ❑Topographic map 246 249 QUARTZ
(location of well must be shown on a USGS topo map and 249 360 GRANITE
attached to this form if not using GPS) 350 374 SHALE
4.WELL OWNER 374 425 GRANITE
OWNER'S NAMES Sl"=
STREET ADDRESS1752 COTTON BARER COURT
COR9=S NC 28031
City or Town State Zip Code
(( SM )-312-9438
Area code-Phone number
5.WELL DETAILS: 11.REMARKS:
a. TOTAL DEPTH: 425 6 GPM 246-249
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOXI
c. WATER LEVEL Below Top of Casing: 150 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 PROVIDED TO TPk WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface* L _ /
*Top of casing terminated aVor below land surface may require
a variance in accordance with 15A NCAC 2C.0118 1" 00AIZ1,2 SIGNATURE OF CERTIFIED VVITtl CONTRMTOR DA E
e. YIELD(gpm): 6 METHOD OF TEST Air KEITH PRESNELL 1.
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,INC 27699-1617 Phone No. [phone] ext 568. Rev.7/05

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