GW1--06556_Well Construction - GW1_20231006

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i` f" } N . , RESIDENTIAL WELL CONSTRUCTION RECORD
•v `� - i North Carolina Department of Environment and Natural Resources-Division of Water Quality
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`'�'" "".', :` " WELL CONTRACTOR CERTIFICATION# 3489 220218
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1:WELL CONTRACTOR: / f. DISINFECTION:Type'.HTH Amount 97
RICKY HUFFMAN
g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 630 To 685 From 685 To 686
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 80 Ft. 6 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 I Ft. 19 BAGS
WELL CONSTRUCTION PERMIT# 138232 From To 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 9/13/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM IIX From To Ft. in. in.
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4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: VILAS COUNTY WATAUGA Depth Size Material
From To I Ft.
LOT 15&16 STONE CREEK SUBDIVISION OFF JOE From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING: •
0 Slope 0 Valley X Flat 0 Ridge 0 Other 11.DRILLING LOG
(check appropriate box)
LATITUDE 36.275181 N May be in degrees,
0•From To Formation Description
— — minutes,seconds or 70 DIRT' e-.,, _
81.77130W in a decimal format 70 230 GRANITF • (" = •.i
LONGITUDE_ — F'"
230 270 SHALE '�E.,=•,�.,T�; :F`f �,..�
Latitude/longitude source: )`; GPS a Topographic map 270 410 GRANITE s,.a is
(location of well must be shown on a USGS topo map and 410 445 SHALE , Or r 0 C n
445 630 GRANITE
attached to this form if not using GPS) CI ZJ
630 685 GRANITE QUARTZ in,',,;?;;,,
5.WELL OWNER - 685 686 VOID I I C.;^y;• _. -; J 11,-
OWNER'S NAME JOSE ISASI C/O PATRICK TARRANT 686 705 GRANITE ••_,v'13 ='•
STREET ADDRESS 387 GRAND CREEK RD
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VILAS NC 28692
City or Town State Zip Code
(813 )- 714-2226
Area code- Phone number 12. REMARKS: i
5 GPM 630-685 I
6.WELL DETAILS: 10 GPM 685-686 I' '
a. TOTAL DEPTH: 705
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b. DOES WELL REPLACE EXISTING WELL? YES o 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: 220 FT. RECORD HAS EN PROVIDED TO THE WELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface* 9-p3
*Top of casing terminated at/or below land surface may require SIGNATUR O CERTI I WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN i { ,
e. YIELD(gpm): •15 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:Informati`n`,Mgt., Form GW-la
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. f ' Rev.3/07
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