GW1--01088_Well Construction - GW1_20240216

•
...,,,,-STATE,;'
",. �, RESIDENTIAL WELL CONSTRUCTION RECORD
, , �p
`�^• ' North Carolina Department of Environment and Natural Resources-Division of Water Quality
• '` ` WELL CONTRACTOR CERTIFICATION# 3489 230,088
I •
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 19
RICKY HUFFMAN g. WATER ZONES(depth) '
Well Contractor(Individual)Name From 121 To 123 I' From To
DEWEY WRIGHT WELL&PUMP CO., INC From To I From To
Well Contractor Company Name From To I From To
STREET ADDRESS PO BOX 308 7. CASING: Thickness/
Depth i Diameter Weight Material
BOONE NC 28607 From 0 To 111) .Ft. 6 1/8 350 PVC
City or Town State Zip Code From To Ft.
(828 )-264-2651 From, To - .Ft.
Ft.
Area code- Phone number
2.WELL INFORMATION: 8. GROUT: Depth Material Method
From_0 To 20 ,Ft. BENTONIT GRAVITY
__-S[;T E-W€LL,ID#(ifapplicabfe) - - From To' — k BAGS -- ---- -
WELL CONSTRUCTION PERMIT# 183753 From To IFt.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth 1Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply IX From To i Ft. in. in.
DATE DRILLED 1/30/2024 From To Ft. in.' in.
TIME COMPLETED 03:00 AMU PM DX From To Ft. in. in.
4.WELL LOCATION: •
10.SAND/GRAVEL PACK: '
CITY: BOONE COUNTY WATAUGA Depth Size Material
From To - .Ft.
OFF HOLLWAY MTN OFF CHURCH RD OFF HWY ' From To . ° Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To I 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 _ 36.14283N minutes,seconds or 0 100 DIRT i '
LONGITUDE • 81.76188W in a decimal format 100 121 GRANITE
— — 121 123 VOIDI '
Latitude/longitude source: X GPS 0 Topographic map 123 140 GRANITE
j(location of well must be shown on a USGS topo map and I
attached to this form if not using GPS) I
5.WELL OWNER I (.�,_- 6'�.tip"o -.-.g.-
OWNER'S NAME JESSE PIPES I ; t L..`,e $11 >L�
STREET ADDRESS 329 CHURCH HOLLOW RD &I`H 1 r 20Z4
BOONE NC 28607
City or Town State Zip Code tnt rlr!'ti;i;n ; :;;,; _,2 UM
( 828 )_407-0737 CtcGJcac.x„
Area code- Phone number 12. REMARKS:
• 35 GPM 121-123
6.WELL DETAILS: I
a. TOTAL DEPTH: 140 •
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: 50 FT. RECO D HAS BEEN PROVIDED O THE WELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface* 31-404
*Top of casing terminated at/or below land surface may require SIGNATUR O CER I DWELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN 4
e. YIELD(gpm): 35 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 Mgt., Form GW-la
1617 Mail Service Center—Raleigh, NC 27699-1617 Phone No.[phone] ext 568. Rev.3/07

4Q,..17:179:2„e
(71)
\\:
-- — -- - Lin 106