GW1--04195_Well Construction - GW1_20240717

SfArt,,.
r Y RESIDENTIAL WELL CONSTRUCTION RECORD
Air.; ' North Carolina Department of Environment and Natural Resources-I)is isiun of Water()twin)l' 1 i' >
WELL CONTRACTOR CERTIFICATION# 3489 230145
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 56
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 180 To 182 From 275 To 276
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 92 Ft. Fi 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. 18 BAGS _
WELL CONSTRUCTION PERMIT#374700- a 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 6/18/2024 From To Ft. in. in.
TIME COMPLETED 03:00 AM PM X From To Ft. in. n.
4.WELL LOCATION: -10.SAND/GRAVEL PACK:
CITY: BOONE couNTY WATAUGA Depth Size Material
From To Ft.
OFF COOK FAMILY LN OFF POPLAR GROVE S OF From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
Slope Valley Flat Ridge Other 11. DRILLING LOG
(check appropriate box)
May he in degrees, From To Formation Description
LATITUDE — _ 36.193223 minutes.seconds or 0 4 DIRT
LONGITUDE 81.711124 in a decimal format 4 10 C,RANITF
— — 10 80 CLAY
Latitude/longitude source: X GPS Topographic map 80 140 GRANITE
(location of well must be shown on a USGS topo map and 140 148 QUARTZ
attached to this form if not using GPS) 148 180 GRANITE
180 182 VOID
5.WELL OWNER 182 275 GRANITE
OWNER'S NAME MEGHAN NATIONS 275 276 VOID
STREET ADDRESS
119 HUBERT NORRIS RD 276 325 GREEN GRANITE
BOONE NC 28607
City or Town State Zip Code �'`...•:' L-! 1 D
( 828 )_ 964-0678
Area code- Phone number 12. REMARKS: JUL 1 I 2024
10 GPM 180-182
6.WELL DETAILS: 20 GPM 275-276 1110: 1;4.Y�� ' "i
-".'',S `',1:U -
a. TOTAL DEPTH: 325 INV.:,5v3
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: 50 FT. RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
(Use"+"if Above Top of Casing) _
d. TOP OF CASING IS 1 FT.Above Land Surface* ��"� ��� v
*Top of casing terminated at/or below land surface may require SIGNATU E OF CERT ED 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. Rev.3/07

\
b
.,-', - , Z3-
�a I
e� � I
\ -------- - U/
v\ �� \ r
- � � � 1 \ `2 � i,-s1'