GW1--01142_Well Construction - GW1_20240216

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� y RESIDENTIAL WELL CONSTRUCTION RECORD
u' g, North Carolina Department of Environment and Natural Resources-Division of Water Quality
-- WELL CONTRACTOR CERTIFICATION# 3489 210057
1.WELL CONTRACTOR: - f. DISINFECTION:Type HTH ' Amount 54
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 210 To 220 From 278 • To 279
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 160 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 I Material Method
From 0 To 20 ` Ft. BENTONIT GRAVITY
_ --—- SITE=WEL-L lD=#(if-applicable)- ,-- - - - -- From To I Ft. 17 BAGS
WELL CONSTRUCTION PERMIT#763644 From To i Ft.
OTHER ASSOCIATED PERMIT#(if applicable) •
‘ 9. SCREEN: Depth . Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply'( From To Ft. in. in.
DATE DRILLED 2/2/2024 . From To ' Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM OX From To ' Ft. in. in.
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4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: LINVILLE COUNTY AVERY Depth Size Material
From To ' Ft.
104 L&C LN OFF GRASSY PRONG RD. OFF ROSE 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 II Ridge 0 Other '
(check appropriate box) 11. DRILLING LOG ,
May be in degrees, From To I Formation Description
LATITUDE — _ 36.03538N minutes,seconds or 0 150 DIRT '
LONGITUDE ;81.80983W in a decimal format 150 210 GRANITF
— — 210 220 GREEN GRANITE
Latitude/longitude source: X GPS o Topographic map 220 278 GRANITE
(location of well must be shown on a USGS topo map and 278 279 VOID
attached to this form if not using GPS) 279 300 GRANITE
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5.WELL OWNER I , -
OWNER'S NAME LESTER AND NANCY EARP ! � ;�' ka'
STREET ADDRESS 2131 EDGEWOOD DR `�"�''L'>?Vt "� ,�
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GRANITE FALLS NC 28630 Ft-h 1 e [UZ4
City or Town State Zip Code
( 828 )_ 396-4905 ptgaiwz::Pn?r=; -An;;U
Area code- Phone number 12. REMARKS: ,
• 2 GPM 210-220
6.WELL DETAILS: 13 GPM 278-279 1
a. TOTAL DEPTH: 300 I 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: 40 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* ��' a-a`c2d2
*Top•of casing terminated at/or below land surface may require
S GNATURE F 24RTIFI'
(IVELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 20.0118. RICKY HUFFMAN I 1 '
e. YIELD(gpm): 15 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.. Rev.3/07
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