GW1--06742_Well Construction - GW1_20231023

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RESIDENTIAL WELL CONSTRUCTION RECORD
` North Carolina Department ol'Environment and Natural Resources-Division of 1Vater uaht
y
WELL CONTRACTOR CERTIFICATION# 3489 230021
1.WELL CONTRACTOR: f. DISINFECTION:Type 'HTH Amount 67
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 210 To 220 From 382 To 384
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 0 To 126 Ft. 6 1/8 350 PVC
City or Town State Zip Code From To Ft.
(828 )_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. 25 BAGS
WELL CONSTRUCTION PERMIT#389261 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 10/3/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM Il PM 0X From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: BOONE COUNTY WATAUGA Depth Size Material
From To Ft.
OFF JAKES MTN RD OFF LITTLE LAUREL OFF BAI 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 — _ 36.194600 minutes,seconds or 0 117 • DIRT
LONGITUDE 81.601111 in a decimal format 117 170 GRANITE
— — 170 195 SHALE
Latitude/longitude source: X GPS 0 Topographic map 195 210 GRANITE
(location of well must be shown on a USGS topo map and 210 220 GRANITE QUARTZ
attached to this form if not using GPS) • 220 300 GRANITE ' _
300 320 SHALE; .i,.�, ,.:r ,.:_ i,,;: y y
5.WELL OWNER 320 382 GRANITE
OWNER'S NAME KIMBERLY&CHARLES MILLER 382 384 VOID OCr 9 " 2()23 384 405 GRANITE
STREET ADDRESS 3777 JAKES MTN RD
BOONE NC 28607 !e'er-:..;°-;r, ;>. ;,1
City or Town State Zip Code
( 828 )_ 964-1813 -
Area code- Phone number 12. REMARKS:
2 GPM 210-220
'6.WELL DETAILS: 6 GPM 382 384
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 BEEN PROVIDED TOT E WELL OWNER.
(Use"+"if Above Top of Casing) i /
d. TOP OF CASING IS 1 FT.Above Land Surface* — �I�4 Or LQ�y
*Top of casing terminated at/or below land surface may require SIGNATURE CER IFI:1 WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
e. YIELD(gpm): 8 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
1
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-la
1617 Mail Service Center—Raleigh, NC 27699-16.17 Phone No.[phone] ext 568. Rev.3/07

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