GW1--02318_Well Construction - GW1_20240410

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• : ' ', RESIDENTIAL WELL CONSTRUCTION RECORD
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5 a1i' 1; North Carolina Department of Environment and Natural Resources-Division o Water Quality
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•4`....a„ 's WELL CONTRACTOR CERTIFICATION# 3489 230120
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1.WELL CONTRACTOR: f. DISINFECTION:Type I ITH Amount 106
RICKY HUFFMAN • • g. WATER ZONES(depth): •
Well Contractor(Individual)Name
From 375 To 430 1 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 () To 37- •Ft. 6 1/8 35n 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-6-lD-#(if-applicable)- , :— 1— — — — From To �rf7`BAGS'
WELL CONSTRUCTION PERMIT#333354 From To I Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth I Diameter Slot Size Material
. 3.WELL USE(Check Applicable Box): Residential Water Supply X From To f Ft. in. in.
DATE DRILLED 3/7/2024. From To !'Ft. in. in.
TIME COMPLETED 03:00 AM PM X From To I Ft. in. in.
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4.WELL LOCATION: 10.SAND/GRAVEL PACK: ''
CITY: BOONE COUNTY WATAUGA Depth Size Material
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From To '' Ft. r �;• ..,r,
• 395 TRIVETTE BRANCH RD OFF DOE RIDGE OFF From To Ft. . N.F A-� y Y t ti'
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To ! Ft.• A n S
TOPOGRAPHIC/LAND SETTING: j, 11 3 2024
Slope Valley X Flat Ridge Other 11. DRILLING LOG Irfi4's„�•:,';t a,, .;,;,g,} g Ln8
(check appropriate box) ;'
May be in degrees, From To • Formation Dest npf�erpOG
LATITUDE _ — 36.254332 minutes,seconds or 0 20 DIRT
' LONGITUDE 81.700717 in a decimal format 20 180 GRANITE— — 180 240 SHALE
Latitude/longitude source: X GPS Topographic map 240 375 GRANITE
(location of well must be shown on a USGS topo map and 375 • 430 GRANITE QUARTZ MIX
attached to this form if not using GPS) 430 510 GRANITE
510 580 SHALE:
5.WELL OWNER 580 1005 GRANITE
OWNER'S NAME DALE WHISNANT • 1 '
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STREET ADDRESS 300 COUNTRY PLACE DR
BOONE NC 28607 -
City or Town " State Zip Code
( 828 )_ 268-1313
Area code- Phone number • ' 12. REMARKS:
.25 GPM 375-430 ..
6.WELL DETAILS: II
a. TOTAL DEPTH: 1005
b. DOES WELL REPLACE EXISTING WELL? YES NOX 100 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: 500 FT. RECORD HAS B EN PROVIDED TO T E ELL OWNER. '
(Use"+"if Above Top of Casing) Q . 9 3 �J
d. TOP OF CASING IS 1 FT.Above Land Surface* / I �1 r�G2
*Top of casing terminated at/or below land surface may require SIGNATUR F CE IFI ' ELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY H FFMAN '
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e. YIELD(gpm): .25 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
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