GW1--01136_Well Construction - GW1_20240216

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[� WELL CONSTRUCTION RECORD
° ,: ;'z; North Carolina Department of Environment and Natural Resources-Division oif Water Quality
,,,,,, WELL CONTRACTOR CERTIFICATION# 3489 220207
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1.WELL CONTRACTOR: f. DISINFECTION:Type 'HTH Amount 26
RICKY HUFFMAN ,
g. WATER ZONES(depth):
Well Contractor(Individual)Name •
From 115 To 120 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. R 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>WEL=L,ID:#(if-applicable) -- - = From To Ff. 20 BAGS
WELL CONSTRUCTION PERMIT#WP#704 From To f, Ft.
OTHER ASSOCIATED PERMIT#(if applicable) +
• 9. SCREEN: Depth j`Diameter Slot Size Material
' 3.WELL USE(Check Applicable Box): Residential Water Supply Co( From To Ft. in. in.
DATE DRILLED 1/29/2024 From To Ft. in. in. . r•
TIME COMPLETED 03:00 ' AMO PM 0X From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK: '
CITY: LENIOR COUNTY CALDWELL Depth Size Material
From To '• Ft.
7971 OLD SAMPSON RD OFF SAMPSON OFF PAR From To • I 'Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING: •
II Slope 0 Valley X Flat 0 Ridge 0 Other
(check appropriate box) 11. DRILLING LOG I
May be in degrees, From To Formation Description
LATITUDE — — 36.10759N minutes,seconds or 0 70 DIRT
LONGITUDE _ 81.532271N in a decimal format 70 118 . GRANITF
— — 118 120 VOID
Latitude/longitude source: X GPS 0 Topographic map 120 145 GRANITE
(location of well must be shown on a USGS topo map and !
attached to this form if not using GPS)
5.WELL OWNER I.
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OWNER'S NAME PHILLIP & BONNIE WILSON i ' R CE V D
STREET ADDRESS 2619 JACK FRANKLIN RD �i 3�
HILLSBOROUGH NC 27278 - - - FEB I 6 71174
City or Town State Zip Code
( 919 ).. 695-6185 . lal v,-7P4e't'_)•'''"-C,: *.g-
Area code- Phone number 12. REMARKS:
25 GPM 118-120 • • ,
6.WELL DETAILS:
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a. TOTAL DEPTH: 145
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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: 20 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*
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*Top of casing terminated at/or below land surface may require SIGNATUR 0 R FI D WELL CONTRACTOR DATE
a variance in accordance with 1'5A NCAC 2C.0118. RICKY HUFFMAN i ,
e. YIELD(gpm): 25 - 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:Inform ftion Mgt., Form GW-la
1617 Mail Service Center—Raleigh, NC 27699-1617 Phone No.(919)73377015 ext 568. ; Rev.3/07

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