GW1--00490_Well Construction - GW1_20240116

'� •, . RESIDENTIAL WELL CONSTRUCTION RECORD
" North Carolina Department of Environment and Natural Resources-Division Of Water Quality
} ;
`"«�_� WELL CONTRACTOR CERTIFICATION# 3489 220,214
l
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 115
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 648 To 650 . 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/
BOONE NC 28607 Depth Diameter Weight Material
From 0 To t Ft.
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 To I Ft.__
. - .SITE WELL ID#(if applicable) , --- --- — --
From To +Ft. _
WELL CONSTRUCTION PERMIT#272937 From To ! Ft.
t.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply lX From To Ft. in. in.
DATE DRILLED.12/27/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM O PM OX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK: '
' CITY: DRILL DEEPER , couNTY WATAUGA Depth Size Material
From • _To .., Ft.
764 FIRETOWER RD OFF EAGLE ROOST OFFBRC 'From " . - To : Ft.
(Street Name,Numbers,Community,Subdivision,Lot.No.,Parcel,Zip Code) From To Ft. •- •-
TOPOGRAPHIC/LAND SETTING:
0 Slope o Valley 0 Flat o Ridge Il Other '
(check appropriate box) 11. DRILLING LOG
May be in degrees, From To Formation,Description
LATITUDE _ 36.07317 minutes,seconds or 0 500 EXISTING WELL
LONGITUDE 81.43753 in a decimal format 500 590 GRANITE
— — 590 610 SHALE
Latitude/longitude source: X GPS o Topographic map 610 648 QUARTZ GRANITE fl ---„
(location of well must be shown on a USGS topo map and 648 650 VOID I ? ',h__- ,6." °'�t: ^��'
650 665 GRANITE W �'� -f
attached to this form if not using GPS) I ' ��I�: tv
5.WELL OWNER 2024
OWNER'S NAME KEVIN RAY C/O CAROLINA DREAM
Initwrr, -con r'r'^ :31.;;Y
STREET ADDRESS PO BOX 1219 D;.�•.;,:_;;�,µ`+
BOONE NC 28607
City or Town State Zip Code
( 828 )_ 773-7561 ,
Area code- Phone number 12. REMARKS:
EXISTING WELL-2 GPM
6.WELL DETAILS:
a. TOTAL DEPTH: 665 38 GPM 648-650
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: 100 FT. RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface*
i.2-a6.zy
*Top of casing terminated at/or below land surface may require SIGNATUR OF CER I DWELL CONTRACTORI DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
e. YIELD(gpm): 40 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
{ ,
Submit the original to the Division of Water Quality within 30 days. Attn:Informatii n Mgt., Form GW-la
1617 Mail Service Center—Raleigh, NC 27699-1617 Phone No.[phone] ext 568. i . Rev.3/07

i .
•
k
r.1
apo,7 ?f . \,..
i
sa,ac4�'►+.
°0t) ` a
N-- .1::513.-15 . . . .
i o� .
o
,gl
11,
4.1
-'/ e -
- - .o
-I
fi
1/6/2,4
y
\J 1L
413") :LI - .. • ... .
10
Lia bU%iI