GW1--06554_Well Construction - GW1_20231006

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`� ES/DENT/AL WELL CONSTRUCTION RECORD
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� North Carolina Department.of Environment and Natural Resources-Division fof Water Quality .
'""" ,�,,. WELL CONTRACTOR CERTIFICATION# 3489 230060
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1.WELL CONTRACTOR: - f. DISINFECTION:Type I HTH Amount 124
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name • From 670 To 671 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: i' Thickness/
Depth Diameter Weight Material
BOONE NC 28607 From 0 To 120 ; Ft. 6 1/81 350 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 f Ft. 20 BAGS
WELL CONSTRUCTION PERMIT#391024 From To I Ft.
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 9/27/2023 From To .Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM OX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: BOONE • COUNTY,WATAUGA Depth I Size Material
From To . +Ft.
OFF GREENWOOD DR OFF BIG HILL OFF HWY 19 From ' To_ - iFt.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To .Ft.
TOPOGRAPHIC/LAND SETTING: -
• 0 Slope II Valley X Flat 0 Ridge 0 Other 11. DRILLING LOG
(check appropriate box)
May be in degrees, From .'-To • Formation Description
LATITUDE _ — 36.28088N minutes,seconds or 0 ' 105 DIRT
LONGITUDE 81.64409W in a decimal format 105 190 GRANITE
— — 190 220 SHALE.
Latitude/longitude source: X GPS 0 Topographic map ' 220 460 GRANITE
(location of well must be shown on a USGS topo map and . 460 500 SHALE;
attached to this form if not using GPS) 500 670 GRANITE;
5.WELL OWNER 670 671 VOID R !
671 705 GRANITE; I,^-
OWNER'S NAME WATAUGA HABITAT FOR HUMANITY 1v '.e--,;f r;�-.,-,
STREET ADDRESS PO BOX 333 DTS r ''"2^ '
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BOONE 'NC 28607 \��T 0 6 2023
City or Town State Zip Code - In',..,r.:,
828 773-7179 ` - Ur•
Area code- Phone number 12. REMARKS:
20 GPM 670-671 '
6.WELL DETAILS: '
a. TOTAL DEPTH: 705
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO)#C I DO HEREBY CERTIFY THAT THIS WELI!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 PROVID TO THE WELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface* , 9' -- p. 3
*Top of casing terminated at/or below land surface may require SIGNATUR F CE IED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. • RICKY HUFFMAN !; j •,
e. YIELD(gpm): 20 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 Mlgt., Form GW-la
1617 Mail Service Center—Raleigh, NC 27699-1617 Phone No.[phone] ext 568. Rev.3/07
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