GW1--00152_Well Construction - GW1_20231229

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�IE�IDENTL4L WELL CONSTRUCTION RECORD
i ,, ,'' North Carolina Department of Environment and Natural Resources-Division of Water Quality
'.*�"`'"° "0"''' WELL CONTRACTOR CERTIFICATION# 3489 230098
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1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 0
RICKY HUFFMAN I
g. WATER ZONES(depth):
Well Contractor(Individual)Name From To ' From To
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 128 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
SITE WELL ID#(if applicable) From 0 To 20 ,'Ft. BENTONIT GRAVITY
From To ' Ft. 19 BAGS
WELL CONSTRUCTION PERMIT#183543 " - - From' To !Ft. —
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OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply 1K From To Ft. in. in.
DATE DRILLED 12/14/2023 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 Ft.
LOT#40 BOULDER CREEK SUBDIVISION OFF MO; 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 •
(check appropriate box) 11. DRILLING LOG
May be in degrees, From To Formation Description --
LATITUDE — — 36.190733 minutes,seconds or 0 115 DIRT
LONGITUDE 81.709013 in a decimal format 115 198 GRANITE
— — 198 220 SHALE
Latitude/longitude source: X GPS a Topographic map 220 430 GRANITE
(location of well must be shown on a USGS topo map and 430 485 GREEN GRANITE.-.,. _
fr'
485 520 SHALE' f r..-,.%,
attached to this form if not using GPS) _ ' a
5.WELL OWNER 520 700 GRANITE! ,f ,,,,, „,
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OWNER'S NAME SATCHMO&CO I ' DEC 2 c: 2023
STREET ADDRESS 151 EAST WEXFORD In;cm ;- i-,., a._
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BOONE NC 28607 ra,`,; -;* :'.." ..
City or Town State Zip Code
( 828 )- 964-1809
Area code- Phone number 12. REMARKS:
DRY HOLE
6.WELL DETAILS:
a. TOTAL DEPTH: 700 '
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: 700 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` 4FIED
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*Top of casing terminated at/or below land surface may require SIGNAT E OF CE WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
e. YIELD(gpm): 0 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 GW-la
1617 Mail Service Center—Raleigh, NC 27699-1617 Phone No.[phone] ext 568. I Rev.3/07
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