GW1--05486_Well Construction - GW1_20230825

•
M n ESIDENTL4L WELL CONSTRUCTION RE(CORD
5 , ; a North Carolina Department of Environment and Natural Resources-Divisio[olf Water Quality
•'''"`;'~`�'' WELL CONTRACTOR CERTIFICATION# 3489 210201
.1 i
1.WELL CONTRACTOR: f. DISINFECTION:Type 1 ITH Amount 40
RICKY,HUFFMAN g. WATER ZONES(depth):: .
Well Contractor(Individual)Name
•
From 135 To_165 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 60 1 Ft. 6 1/8 350 PVC
City or Town State Zip Code • From To I' 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#353111 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 IX From To Ft. in. in.
DATE DRILLED 8/10/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM 0X From To Ft. in. in. _
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: DEEP GAP COUNTY WATAUGA Depth Size Material
From• To Ft.
OFF ELK CREEK RD OFF OLD 421 OFF 421S From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To I. Ft.
TOPOGRAPHIC/LAND SETTING: is
0 Slope 0 Valley X Flat 0 Ridge o Other
(check appropriate box) 11. DRILLING LOG '
May be in degrees, I From To Formation Description •
LATITUDE — — 36.145828 minutes,seconds or 0 51 DIRT I' ' /
LONGITUDE 81.501034 in a decimal format 51 120 GRANITE
— — 120 - 135 SHALE
Latitude/longitude source: X GPS o Topographic map 135. 165 GRANITE QUARTZ
(location of well pust be shown on a USGS topo map and 165 225 GRANITE •
attached to this form if not using GPS) . I .
',
5.WELL OWNER
OWNER'S NAME BRIAN ELLINGTON
STREET ADDRESS 2201 BLUEBERRY ST Q"Sv"`�'
BELMONT NC 28012 -
City or Town State Zip Code A V(i 2 .-! 2a23
( 980 )_ 425-4403 t��
Area code- Phone number 12. REMARKS: ats� ". :'
5 GPM 135-165 I ; L"'';•' .` •
6.WELL DETAILS:
a. TOTAL DEPTH: 225 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: 30 FT. RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
(Use"+"if Above Top of Casing) A 1, Q
d. TOP OF CASING IS 1 FT.Above Land Surface* p^I I-23
*Top of casing terminated at/or below land surface may require SIGNATUR O RTI I WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN I
e. YIELD(gpm): 5 METHOD OF.TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
E '
Submit the original to the Division of Water Quality within 30 days. Attn:Information I Mgt.,
Form GW-1a
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.3/07
I.

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