GW1--00489_Well Construction - GW1_20240116

' ' r .,,_ , RESIDENTIAL WELL CONSTRUCTION REICORD •
6 :ep'' North Carolina Department of Environment and Natural Resources-Division •
of Water Quality
1J rs •
,. <fi�s'.1u ,,; WELL CONTRACTOR CERTIFICATION# 3489 230117
1.WELL CONTRACTOR: f. DISINFECTION:Type'HTH • Amount 64
RICKY HUFFMAN t
g. WATER ZONES(depth):
Well Contractor(Individual)Name
. From 230 To 278 _ 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 O To 55 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 t Method
From 3 To'55 •Ft. CEMENT PUMP
---- SITE WELL ID#(if applicable) From U To 3 Ft. BENTONITI'
•
WELL CONSTRUCTION PERMIT#373830 r 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 1/8/2024 From -To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM DX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: DRY HOLE CouNTY WATAUGA Depth Size Material
From To Ft. •
LOT#21B-42B TOP OF BOONE OFF RUNNING DEE 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
(check appropriate box) 11. DRILLING LOG
May be in degrees, From To Formation Description
' LATITUDE _ _ 36.236322N minutes,seconds or 0 28 DIRT
81.696134W in a decimal format 28 42 • BROWN SHALE
LONGITUDE --- ,, --r- " �'
42 230 GRANITE �^^�. . tt
r--- t � P.,...Li
Latitude/longitude source: N GPS a Topographic map 230 278 SHALE ;^':, �,�r +:
(location of well must be shown on a USGS topo map and 278 330 GRANITE
attached to this form if not using GPS) 330 370 GRANITE QUARTZ JAN 1 A 2024
370 630 GRANITE
5.WELL OWNER 630 668 GRANITE QUARTZ 1,.,.,.-,,;.j;-3 fi'(�
OWNER'S NAME RYAN PARKS 668 700 SHALE In'c`%7r+:r '-- .,
700 905 GRANITE �V°" Jq...
STREET ADDRESS 122,WILLIAMS RIDGE DR
BOONE NC 28607
City or Town State Zip Code
( 828 )_ 773-1657
Area code- Phone number 12. REMARKS:
.5 GPM 230-278
6.WELL DETAILS:
a. TOTAL DEPTH: 905
b. DOES WELL REPLACE EXISTING WELL? YES O NOI#C 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: 600 FT. RECORD HAS BEEN PROVIDE TO THE WELL OWNER.
(Use"+"if Above Top of Casing) G 1 Q f J
d. TOP OF CASING IS 1 FT.Above Land Surface' [ .2o�-D
*Top of casing terminated at/or below land surface may require SIGNATUR F CER FIED 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
Submit the original to the Division of Water Quality within 30 days. Attn: Information n Mgt., Form GW-la
1617 Mail Service Center—Raleigh, NC 27699-1617 Phone'INo.[phone] ext 568. , ' Rev.3/07

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