GW1--01089_Well Construction - GW1_20240216

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' " a RESIDENTIAL WELL CONSTRUCTION RECORD
,� , North Carolina Department of Environment and Natural Resources-Division o I Water Quality
WELL CONTRACTOR CERTIFICATION# 3489 220222 •
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1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 23
RICKY HUFFMAN
Well Contractor(Individual)Name g. WATER ZONES(depth)'.
From 168 To 170 l 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 O To fin 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-Cif-applicable)- -- - ---' - From To jFt. 1i- BAGS _y
WELL CONSTRUCTION PERMIT# 131636 From ' To 1 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 2/6/2024 From To Ft. in.' in.
TIME COMPLETED 03:00 AM II PM DX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: ZIONVILLE COUNTY WATAUGA Depth Size Material
From To Ft.
4253 OLD US 421 OFF SILVERSTONE OFF TATER 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 — — 36.29607N minutes,seconds or 0 69 DIRT
;LONGITUDE 81.77048W in a decimal format 69 168 GRANITE
— — 168 170 VOID
Latitude/longitude source: X GPS 0 Topographic map 170 175 GRANITE
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
5.WELL OWNER I
OWNER'S NAME JARRETT FRANKLIN/JOANNA WEIN1 i
STREET ADDRESS 414 STUART WILLIAMS RD .-•§g-)
BOONE NC 28607 ? 't,LI, A E-i
City or Town State Zip Code ,
,( 828 )- 964-1420 �b 1 [rl�
- Area code- Phone number 12. REMARKS: lilii:r ii is^P1?r a : �+r'd ISt
40 GPM 168-170 _ ,�•x
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• .WELL DETAILS:
a. TOTAL DEPTH: 175 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: 60 FT. RECORD HAS BEEN PROVIDED T THE LL OWNER.
(Use"+"if Above Top of Casing) ,,,
d. TOP OF CASING IS 1 FT.Above Land Surface*- 0:_✓'— Og
*Top of casing terminated at/or below land surface may require SIGNATURE CERTIFIED LL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118:::, RICKY HUFFMAN
e. YIELD(gpm): 40 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
.
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. Rev.3/07

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