GW1--02317_Well Construction - GW1_20240410

.
-
rT,� ,•�.
, •
°�,
, .� ry RESIDENTIAL WELL CONSTRUCTION RECORD
t * i- North Carolina Department of Environment and Natural Resources-Division lof Water Quality
h -1 i
"n w" °:r}'' WELL CONTRACTOR CERTIFICATION# 3489 230103
1.WELL CONTRACTOR: f. DISINFECTION:Type!'HTH Amount 111
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 175 To 240, From 560 To 585
DEWEY WRIGHT WELL&PUMP CO., INC From To From To
' Well Contractor Company Name From To I. From• To
STREET ADDRESS PO BOX 308 7. CASING: I Thickness/
Depth Diameter Weight Material
BOONE 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
- --- SITE-WELL-ID-Of-applicable) 1. .--- - From 0 To 20 Ft. BENTONIT GRAVITY
Fiom To I Ft. 20 BAGS -- -___ -__• -
WELL CONSTRUCTION PERMIT# 168204 • 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 From To Ft. in. in.
TIME COMPLETED 03:00 AM PM X From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: BOONE COUNTY WATAUGA Depth Size Material
I _
From To Ft. ___
676 PINEVIEW DR OFF HOWARDS CREEK CHUR( From To Ft. k k FI 91 I"'-«t.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To I Ft.
TOPOGRAPHIC/LAND SETTING: I' APR 1 0.2074
X Slope Valley Flat Ridge Other
11. DRILLING LOG
(check appropriate box) I. Illit4,^ S-!rn? ,. -,L, i.
May be in degrees, From To • , Formation Des5tpya,,�
LATITUDE — 36.246348 minutes,seconds or D 50 DIRT ° ''��
LONGITUDE 81.659119 in a decimal format 50 175 GRANITF '
—— 175 240 GRANITF QUART7 MIX
Latitude/longitude source: X GPS Topographic map 240 290 SHALE
(location of well must be shown on a USGS topo map and 290 430 GRANITE
attached to this form if not using GPS) 430 485 SHALE
5.WELL OWNER 485 560 GRANITE QUARTZ MIX
560 585 . GREEN GRANITE
OWNER'S NAME RUSSELL SIGMAN 585 640 GRANITE
STREET ADDRESS 676 PINEVIEW DR .
BOONE NC 28607 1
City or Town State Zip Code
8( 17 )_ 253-2262 i ,
Area code- Phone number 12. REMARKS: i
.25 GPM 175-200
6.WELL DETAILS: .75 GPM 560-585
a. TOTAL DEPTH: 640
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 BelowITop of Casing: 100 FT. RECORD HAS BEEN PRO IDED TO THE WELL OWNER.
(Use"+"if Above Top of Casing) 1
! I l -
d. TOP OF CASING IS ' 1 FT.Above Land Surface* r o '/5'.202 ?
*Top of casing terminated at/or below land surface may require SIGNAT E OF CE FIED WELL CONTRACTOR , DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
e. YIELD(gpm): 1 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
I
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt., Form GW-1a
1617 Mail Service Center—Raleigh, NC 27699-1617 Phone No.[phone] ext 568. { Rev.3/07
i

( 1'Q go/
elZpli
1 OE f z
•
..7% 5® �-
7/fig)7$ F')t o otI
- S ,oil