GW1--04918_Well Construction - GW1_20240816

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• RESIDENTIAL WELL CONSTRUCTION RECORD
. ti�1�x-f 1 North Carolina Department of Ens ironment and Natural Resources- Division of Water Quality
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a" WELL CONTRACTOR CERTIFICATION # 3489 240033
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 88
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 380 To 398 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 148 Ft. 8 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#WP#1089 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 7/19/24 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: LENIOR COUNTY CALDWELL Depth Sig_ , Material
From To Ft. "-4; f:-,-,,
OFF PHOEBE LN OFF RICHLANDS OFF HWY 321 From To Ft. `'‘.-e 1.. 1,/1!'^'i)
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel Zip Code) From To Ft. AUG 1 '' 102'
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TOPOGRAPHIC/LAND SETTING:
Slope Valley X Flat Ridge Other Irr.';;;;;;;,,;,; ,;,_,-„r
(check appropriate box) •
11. DRILLING LOG _ � 4"44.:-.a t .
May be in degrees, From To Format2b'4Ee6Grii3tion
LATITUDE 36.09269N minutes,seconds or 0 139 DIRT
LONGITUDE 81.60592W in a decimal format 139 190 GRANITF
— — 190 230 SHELL
Latitude/longitude source:.X GPS Topographic map 230 380 GRANITE
(location of well must be shown on a USGS topo map and 380 398 QUARTZ
attached to this form if not using GPS) 398 460 GRANITE QUARTZ MIX
5.WELL OWNER 460 505 GRANITE
OWNER'S NAME KATIE PURGASON C/O NATALIE HO
STREET ADDRESS 3499 TEAGUE TOWN RD
TAYLORSVILLE NC 28681
City or Town State Zip Code
( 704 )- 240-0048
Area code- Phone number 12. REMARKS:
6.WELL DETAILS:
a. TOTAL DEPTH: 505
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) e Q
d. TOP OF CASING IS 1 FT.Above Land Surface' L'1 -1'4U,�-�
*Top of casing terminated at/or below land surface may require SIGNATU E O CER D WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
e. YIELD(gpm): 5 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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