GW1--06555_Well Construction - GW1_20231006

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t it 4... RESIDENTIAL WELL CONSTRUCTION RECORD
I R North Carolina Department of Environment and Natural Resources-Division of Water Quality
• "'"_'„` "• - WELL CONTRACTOR CERTIFICATION# 3489 230061
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1.WELL CONTRACTOR: f. DISINFECTION:Type i-ITH ` Amount 157
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 240 To 270 ' From 740 To 790
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 I. Diameter Weight Material
BOONE NC 28607 From 0 To 65 .Ft. 6 1/8 350 PVC
City or Town State Zip Code From To Ft.
(828 )-264-2651 )" ;;;T yy ->,Il ,t ' From To Ft.
Area code- Phone number '; -F: ,.,..q i ( ' .
2.WELL INFORMATION: 8. GROUT: Depth , Material Method
OCT 0 G 2023 • ' From 0 To 20 ,Ft. BENTONIT GRAVITY
SITE WELL ID#(if applicable) - - - From To (Ff. 18 BAGS-
WELL CONSTRUCTION PERMIT 9TUA r'^':'';';`; -0 Uf' From To Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth 'Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply IX From To Ft. in. in.
DATE DRILLED 9/25/2023 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: BOONE COUNTY WATAUGA Depth Size Material
From To I:Ft. -
WELL#2 OFF GREENWOOD VALLEY DR OFF BIG I From To 1 Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To I'Ft.
TOPOGRAPHIC/LAND SETTING: is
_' -.11,:-.Slope 0 Valley X Flat 0 Ridge 0 Other I.
• (check appropriate box) 11.DRILLING LOG
LATITUDE 36.27896N May be-in degrees, From To I Formation Description
— — minutes,seconds or 0 52 DIRT
LONGITUDE 81.64382W in a decimal format 52 185 GRANITF
— — 185 240 SHALE
Latitude/longitude source: X GPS o Topographic map 240 270 GREEN GRANITE
(location of well must be shown on a USGS topo map and 270 410 GRANITE .
attached to this form if not using GPS) 410 475 SHALE I '
5.WELL OWNER 475't 740. GRANITE
740 790 SHALE
OWNER'S NAME WATAUGA CO. HABITAT FOR HUMAI 790 900 GRANITE
STREET ADDRESS PO BOX 33 DTS
BOONE NC 28607 .
City or Town State Zip Code .
( 828 )- 773-7179
•
Area code- Phone number 12. REMARKS:
1 GPM 240-270 !;
6.WELL DETAILS: 900 1 GPM 740-790 1,
a. TOTAL DEPTH:• I
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: 50 FT. RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
(Use"+"if Above Top of Casing) I,
• d. TOP OF CASING IS 1 FT.Above Land Surface* 4 -96?4l3
*Top of casing terminated at/or below land surface may require SIGNATUR OF CER I ED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. 4�
RICKY HUFFMAN
. e. YIELD(gpm): 2 METHOD OF TEST AIR PRINTED NAME OF PERSON;CONSTRUCTING THE WELL
G ' •
Submit the original to the Division of Water Quality within 30 days. Attn: Informati onIMgt.,
Form GW-la
1617_M `ail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. I 1 Rev.3/07

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