GW1--02927_Well Construction - GW1_20240513

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a ` • RESIDENTIAL WELL CONSTRUCTION RECORD •
, t , North Carolina Department of Environment and Natural Resources-Division of Water Quality
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.,;;"^•'",' WELL CONTRACTOR CERTIFICATION# 3489 240035
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1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 96
RICKY HUFFMAN g. WATER ZONES(depth)t I
Well Contractor,(Individual)Name • From 365 To 366 II From To
- DEWEY WRIGHT WELL& PUMP CO., INC From To l' 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 100 'Ft. R 1/8 350 PV(:
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., Material Method
From 0 To 20. 'Ft. BENTONIT GRAVITY
SITE WELL ID#(if applicable) e
From .To Ft. 19 BAGS -
WELL CONSTRUCTION PERMIT#183469 From To /Ft
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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 4/8/2024 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
From To I Ft. -,
LOT#5 BOULDER CREEK OFF RUSS CORNETT/DI From To : Ft. t 'C.* . �., ; k�,I ,L,;'!.•,.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To • Ft.
TOPOGRAPHIC/LAND SETTING: I MAY 1 - 2024
Slope Valley X-Flat Ridge Other
11. DRILLING LOG lr,`,:r:;.-_�';'� '-',c•,W-a'-< +
(check appropriate box) 4 �T
May be in degrees, From To Formation Descri Ion.,;3O;
L LATITUDE _ 36.18890N minutes,seconds or 0 91 DIRT f '
LONGITUDE 81.70903W - in a decimal format 91 180 GRANITF •
— 180 210 SHALF
Latitude/longitude.source: X GPS Topographic map 210 340 GRANITE
(location of well must be shown on a USGS topo map and 340 365 GREEN GRANITE
attached to this form if not using GPS) 365 366 VOID') I
366 410 GRANITE
5.WELL OWNER 410 440 • SHALIE I -
OWNER'S NAME KEN CHAPMAN 440 600 GRANITE
STREET ADDRESS 228 WHEATBERRY HILL DR I'
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MATTHEWS NC 28104 -
City or Town State Zip Code
( 704 )_. 621-8612 -
Area code- Phone number 12. REMARKS:
10 GPM 365-366 ;,
6.WELL DETAILS: r •
a. TOTAL DEPTH: 600 . i
b. DOES WELL REPLACE EXISTING WELL? YES NOX I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,WELL CONSTRUCTIONISTANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: .120 FT. • RECORD HAS EEN PR VIDEO TiT`E WELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface*
Ci-/1-209
*Top of casing terminated at/or below land surface may require SIGNATURE C RTIF D ELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN I I
e. YIELD(gpm): 10 METHOD OF TEST' AIR PRINTED NAME OF PERSONICIONSTRUCTING,THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information n Mgt., Form GW-la
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. I Rev.3/07
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