GW1--02928_Well Construction - GW1_20240513

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RESIDENTIAL WELL CONSTRUCTION RECORID
e.' North Carolina Department of Environment and Natural Resources-Division of Water Quality
•,4%-,,,,:,""''' WELL CONTRACTOR CERTIFICATION# 3489 230161
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, • 1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 25
RICKY HUFFMAN g. WATER ZONES(depth)i:
Well Contractor(Individual)Name
From 138 To 140 I. 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 100 iFt. A 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; 22 BAGS - - - -
WELL CONSTRUCTION PERMIT# 183554 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 4/3/2024 From To Ft. in. in.
TIME COMPLETED 03:00 AM PM X From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK: 17,'T ^- ?��--.
Depth Size INterial�.f A__ b ;:;
•
•CITY: BOONE COUNTY WATAUGA From To IFt.
LOT#41 OFF MOSSY'CREEK CT OFF BOULDER C •From To '!Ft. MAY 1 - 1024
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To 'Ft.
TOPOGRAPHIC/LAND SETTING: It...:"'..`, ,' •.�4. J !Jr
Slope Valley X Flat Ridge Other 11. DRILLING LOG
(check appropriate box)
May be in degrees, From To , Formation Description
LATITUDE _ 36.31423 minutes,seconds or 0 40 DIRT '
LONGITUDE 81.42549 in a decimal format 40 88 SC)FTISHFI I
— — 88 138 GRANITE
'Latitude/longitude source: X GPS Topographic map 138 140 VOID I I '
(location of well must be shown on a USGS topo map and 140 155 GREEN GRANITE
attached to this form if not using GPS) 155 •200 GRANITE
5.WELL OWNER I I
I
OWNER'S NAME ANTHONY PALAZZO I,
STREET ADDRESS PO BOX 3244
BOONE - NC 28607 - -
City or Town State Zip Code -
8( 28 )_ 260-6742
Area code- Phone number 12. REMARKS:
25 GPM 1338-140
6.WELL DETAILS: I
a. TOTAL DEPTH: 200 I'
b. DOES WELL REPLACE EXISTING WELL? YES 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 TO THE WELL OWNER.
(Use"+"if Above Top of Casing) 2,t,;,4 d. TOP OF CASING IS 1 FT.Above Land Surface*
*Top of casing terminated at/or below land surface may require SIGNATUR OF CER I IED y- �
WELL CONTRACTOR DATE
. a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
e. YIELD(gpm): 25 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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