GW1--02316_Well Construction - GW1_20240410

C
M., to 713,,�� RESIDENTIAL WELL CONSTRUCTION RECOdRD
, ,6,: North Carolina Department of Environment and Natural Resources-Division of Water Quality
^ ' WELL CONTRACTOR CERTIFICATION# 3489 220202
1
1.WELL CONTRACTOR: f. DISINFECTION:Type FitH Amount 49
RICKY HUFFMAN g. WATER ZONES(depth),• •
I
Well Contractor(Individual)Name
From 230 To 245 i , From 310 To 311
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 E NC 28607 From 0 To 60 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 I,Ft. BENTONIT GRAVITY
-- -- SITE-WEL-L-ID-#01-applicable) _---— - — - - _
From To IFt. 20 BAGS-- ---- - --
WELL CONSTRUCTION PERMIT#362366 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 X From' To Ft. in. in.
DATE DRILLED 3/12/2024 From To Ft. in. in.
TIME COMPLETED 03:00 AM PM X From To I Ft. in. in.
4..WELL LOCATION: 10.SAND/GRAVEL PACK: ,
CITY: BOONE COUNTY WATAUGA Depth Size Material
From To Ft. M .^.s=r f
OFF WESTIN WAY OFF RAINBOW-TRAIL OFF 194 From To Ft. t S.A.I.-..i a' I—` I .
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft. /I n p
TOPOGRAPHIC/LAND SETTING: /ir f\ 02024
Slope Valley X Flat Ridge Other 11. DRILLING LOG In'+ r -n P'=",a.,,,:nr L,-.;
(check appropriate box)
May be in degrees, i l`r oFl�T From To Formation Desc OG
LATITUDE _ 36.246621 minutes,seconds or o 50 DIRT
LONGITUDE 81.659396 in a decimal format 50 180 C;RAN ITF
— — 180 230 SHAI F
Latitude/longitude source: X GPS Topographic map 230 245 GREEN GRANITE
(location of well must be shown on a USGS topo map and 245 310 GRANITE
attached to this form if not using GPS) 310 311 VOID i
311 325 GRANITE
5.WELL OWNER I '
OWNER'S NAME LINA AMEZCUA i,
• STREET ADDRESS 279 NORTH PINE RUN.RD .
BOONE NC 28607
City or Town State Zip Code - • .
•
( 828 )- 773-7470
Area code- Phone number 12. REMARKS: I. '
.5 GPM 230-245 ,
6.WELL DETAILS: 5.5 GPM 310-311 1
a. TOTAL DEPTH: 325
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b. DOES WELL REPLACE EXISTING WELL? YES 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: 80 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* l Ij zG,4
'Top of casing terminated at/or below land surface may require SIGNATU OF CER ED'WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
e. YIELD(gpm): 6 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
III
Submit the original to the Division of Water Quality within 30 days. Attn: Informa#loin Mgt., Form GW-la
1617 Mail Service Center—Raleigh, NC 27699-1617 Phone No.[phone] ext 568. Rev.3/07
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