GW1--02315_Well Construction - GW1_20240410

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r'° r F ;� RESIDENTIAL WELL CONSTRUCTION REC6RD .
c"a f.5 North Carolina Department of Environment and Natural Resources-Division of i,itet(��11(t\'�
WELL CONTRACTOR CERI]HCAT➢ON# 3489 230183
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 63
RICKY HUFFMAN
g. WATER ZONES(depth): '.
Well Contractor(Individual)Name From 372 To 373
• 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/
BOONE NC 28607 Depth Diameter Weight Material
From 0 To 60 Ft. 6 1/6 :1.50 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 F. BENTONIT GRAVITY
From To Ft. 18 BAGS
- _- --WELL-CONSTRUCTION PERMIT#394162- .-- ----- - - - From-- - - To- - Ft! i • - - . -- ____ ___ _—,_
• 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 3/15/2024 From To Ft. in. in.
TIME COMPLETED 03:00 AM PM X From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: BOONE COUNTY WA T AUGA Depth Size Material
From To Ft. 1,- :_';`' w-__ r'i.r-.:
LOT#32 POPLAR FOREST OFF HOWARDS CREEK From To Ft.' : C.'�`= 1.,,.i. V 1^ ,t
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft. A D r)
TOPOGRAPHIC/LAND SETTING: H� f1 2024
Slope Valley X Flat Ridge Other :N� - T.�'
(check appropriate box) 11. DRILLING LOG In ? �,; .„R,,; :U
May be in degrees. From To Formation Descri ition`-:,;-P.
LATITUDE _ _ 36.15200 minutes,seconds or 0 50 DIRT
LONGITUDE 81.40538 in a decimal format 50 170 r,RANITF
— — 170 235 SHALF'
Latitude/longitude source: X GPS Topographic map 235 290 GRANITE
(location of well must be shown on a USGS topo map and 290 320 SHALE i '
attached to this form if not using GPS) 320 365 GRANITEQUARTZ MIX
365 372 GRANITEI
5.WELL OWNER 372 373 VOID I
OWNER'S NAME MICHAEL ELLIOT%TOM EGGERS C 373 400 GRANITE
STREET ADDRESS 9872 NC HWY 105S
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BOONE NC 28607
City or Town State Zip Code
( 828 )_ 963-7000 ,
Area code- Phone number l!2. REMARKS:
30 GPM 372-373
• 6.WELL DETAILS:
a. TOTAL DEPTH: 400
b. DOES WELL REPLACE EXISTING WELL? YES NOX
I DO HEREBY CERTIFY THAT THIS WELL,WAS CONSTRUCTED IN ACCORDANCE WITH
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15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 100 FT. ORD S BE N PROVIDE T THE WELL OWNER.
(Use"+"if Above Top of Casing) 1 d. TOP OF CASING IS 1 FT.Above Land Surface* / 9,'`\L1 ' - Q11%
*Top of casing terminated at/or below land surface may require SIGNATUR OF CERT I WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
e. YIELD(gpm): 30 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. II Rev.3/07
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