GW1--02929_Well Construction - GW1_20240513

• .:43.-/xi--;8..
RESIDENTIAL WELL CONSTRUCTION RECORD
1 e' North Carolina Department of Environment and Natural Resources-Division of Water Quality .
'"' ,," WELL CONTRACTOR CERTIFICATION# 3489 230128
-- I I
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 97 .
RICKY HUFFMAN i' '
g. WATER ZONES(depth):
Well Contractor(Individual)Name From 285 To 295
From To
•
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 n To 138 Ft. 6 1/4 188 GALV
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 j Ft. BENTONIT GRAVITY I
SITE WELL ID#(if applicable)___ l _
From To i Pt. 38 BAGS
WELL CONSTRUCTION PERMIT#382106 From To I F.
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. i in.
DATE DRILLED 4/10/2024 From To Ft. in. in.
TIME COMPLETED 03:00 AM PM X From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
BOONE WATAUGA Depth Size Material T; '^---.j
CITY: COUNTY From To Ft. t,".�..=k '' le r.:.:�,,
OFF RUSS CORNETT OFF DIAMOND RANCH OFF From To • Ft. •
MAY 1-'2024
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING: i tr`.;r;:_''^-, ?-�-cr-t.-.• �, •
Slope Valley X Flat Ridge Other j, Ci-(;;'3siC,
(check appropriate box) 11. DRILLING LOG
May be in degrees, From To I Formation Description
LATITUDE , _ 36.18503N minutes,seconds or 0 128 DIRT CLAY
LONGITUDE 81.70545W in a decimal format 128 285 C,RANITE
— — 285 295 QUARTZ
Latitude/longitude source: X-GPS Topographic map 295 340 GRANITE QUARTZ MIX
(location of well must be shown on a USGS topo map and , 340 430 GRANITE .
attached to this form if not using GPS) 430 440' GREEN GRANITE
440 505• GRANITE
5.WELL OWNER I
OWNER'S NAME DAVID MOSES CIO LARRY NORRIS r
STREET ADDRESS 1467 BIG HILL RD
BOONE NC 28607 '
City or Town State Zip Code
(828 )_ 963-0011 A . .
Area code- Phone number 12. REMARKS:
1 GPM 285-295 i
6.WELL DETAILS: .
•
a. TOTAL DEPTH: 505 — - -- .
b. DOES WELL REPLACE EXISTING WELL? YES NOX I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,WELL CONSTRUCTIONS NDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 20 FT. RECORD HAS EEN PROVIDE TO ilrli LL OWNER.
(Use"+"if Above Top of Casing) i
d. TOP OF CASING IS ' 1 FT.Above Land Surface*
*Top of casing terminated at/or below land surface may require SIGNATURE 0 CERTI 1E01 E CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HU FMAN ; ` ,
e. YIELD(gpm): 1 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL '
II
i
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. t Rev.3/07

i 1.p 1.\ , .
Ul
fovr'''
i Meg.,
P ) .
•
•
•
•
Ai. _ e
i j. •-
•
pia an 'al 1 Loa-n�a� ��.