GW1--02320_Well Construction - GW1_20240410

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��, ' RESIDENTIAL WELL CONSTRUCTION RECORD .
u.r ' ,R' North Carolina Department of Environment and Natural Resources-Division f Water Quality
'sn ,E ., },. . WELL'CONTRACTOR CERTIFICATION# 3489 230024 '
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1.WELL CONTRACTOR: 'f. DISINFECTION:Type IHTH Amount 76-
RICKY HUFFMAN 'g. WATER ZONES(depth):. .
Well Contractor(Individual)Name From 110 To 122 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 42 Ft. 6 1/4 188 GAI V
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-WELL-ID#(if applicable) From To —I-0-'37-BAGS
WELL CONSTRUCTION PERMIT#389873 From To r 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 4/2/2024 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:
BOONE WATAUGA • Depth Size fVlaterial
CITY: COUNTY z;
From To �' 'Ft. "': _ , o_....
OFF PINNACLE DR OFF EAST KING ST OFF HWY From To Ft. `' V --•-
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To I Ft. APR 1
0..2024
TOPOGRAPHIC/LAND SETTING: i; •
Slope Valley X Flat Ridge Other 11.DRILLING LOG I' In w,rn..,.,n?f--,,z1,"_,; L;
(check appropriate box) , E,tor lir'�,"
May be in degrees, From To P Formation Descnpf
. LATITUDE — — 36.22970N minutes,seconds or 0 30 DIRT GRAVEL
LONGITUDE - 81.69646W in a decimal format 30 110 ' GRANITF
— — 110 122 OUART7
Latitude/longitude source: X GPS Topographic map 122 180 • GRANITE QUARTZ MIX
(location of well must be shown on a USGS topo map and - , 180 230 SHALE,
- • attached to this form if not using GPS) 230 310 GRANITE ,
310 345 GRANITE QUARTZ MIX
5.WELL OWNER 345 405 GRANITE
OWNER'S NAME CURTIS &MICHELLE HUBBARD C/O I
STREET ADDRESS PO BOX 2826 , '
BOONE NC 28607 ,
City or Town • State Zip Code ,
( 828 j_ 406-1490 :
Area code- Phone number 12. REMARKS: I -
- 3 GPM 110-122 i
6.WELL DETAILS:
a. TOTAL DEPTH: 405 f
fit
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: 20 FT. RECORD HAS BEEN PROVIDED TO THE WELL OWNER. '
• (Use"+"if Above Top of Casing) .
R-t�4/
d..TOP OF CASING IS 1 FT.Above Land Surface*
*Top of casing terminated at/or below land surface may require SIGNATUREF 'E TIF ,WELL CONTRACTOR - DATE
a variance in accordance with 15A NCAC 2C.0118. iA
RICKY HUFFMAN •
e. YIELD(gpm): 3 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. f I Rev.3/07

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