GW1--00153_Well Construction - GW1_20231229

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'C 3 %'. RESIDENTIAL WELL CONSTRUCTION RECORD
5 North Carolina Department of Environment and Natural Resources-Division of Water Quality
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""',G,." '. , WELL CONTRACTOR CERTIFICATION# 3489 230160
1.WELL CONTRACTOR: f. DISINFECTION:Types HTH Amount 89
RICKY HUFFMAN g. WATER ZONES(depth): ,
Well Contractor(Individual)Name
From 285 To 310' : 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 80 ' Ft. 6 1/6 350 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
SITE WELL ID#(if applicable) From 0 To 20 Ft. BENTONIT GRAVITY
From_ To Ft. 19 BA_GS __
WELL CONSTRUCTION PERMIT# 183563 - From To F 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 12/19/2023 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 Size Material
From To • Ft.
LOT#39 OFF MOSSY CREEK COURT OFF BOULDE From To Ft. - ~,. '_ l ,i
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING: DEC 2 9 Z023
X Slope 0 Valley 0 Flat 0 Ridge 0 Other • ,
11. DRILLING LOGcheck appropriate box) (211,1
May be in degrees, From To Formation nDescripiion c
LATITUDE 36.2152 minutes,seconds or 0 70 DIRT
LONGITUDE_ _ 81.359 in a decimal format 70 138
138 152 G ANITF
Latitude/longitude source: X GPS 0 Topographic map 152 285 GRANITE
(location of well must be shown on a USGS topo map and 285 310 PINK QUARTZ
attached to this form if not using GPS) 310 340 SHALE
340 505 GRANITE
5.WELL OWNER 1
OWNER'S NAME ANTHONY PALAZZO I ;
STREET ADDRESS PO BOX 3244
BOONE - NC 28607 -
City or Town State Zip Code
( 828 )- 260-6742 ,
Area code- Phone number 12. REMARKS:
2 GPM 385-310
6.WELL DETAILS: ,
a. TOTAL DEPTH: 505 1
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: 70 FT. RECORD HAS B EN PRO IDE THE WELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface* ) ^( -9-0a�
*Top of casing terminated at/or below land surface may require SIGNATURE F CER ED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. 1
RICKY HUFFMAN ,. 1 '
e. YIELD(gpm): _ 2 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 Mgt., Form GW-la
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. 1 Rev.3/07

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