GW1--02990_Well Construction - GW1_20240513

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!"'�,' ' . : RESIDENTIAL WELL CONSTRUCTION RECORD
Sf,gt :. Wig •
��y✓ a t North Carolina Department of Environment and Natural Resources-Division if Water Quality
'r4¢0_<4.,,''' WELL CONTRACTOR CERTIFICATION# 3489 2410071 .
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1.WELL CONTRACTOR: f. DISINFECTION:Type IHTH Amount 112
RICKY HUFFMAN
g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 0 To 425 From 630 To 660
DEWEY WRIGHT WELL& PUMP CO., INC From 790 To 794 I. From To
Well Contractor Company Name ' From To From To
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STREET ADDRESS PO BOX 308 7. CASING: ,' Thickness/
Depth Diameter Weight Material
BOONE NC 28607 From f) To , Ft.
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 ,Ft.
SITE WELL ID#(if applicable).
.4 „ - From- -- -To- . -"0-Ft" — " -- ---------
WELL C01\ISTRUCTION PERMIT#216554 From To l'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 4/25/2024 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: DRILL DEEPER AVERY Depth fa --�tkhateialr .
COUNTY From To , Ft. `'`--t,-a'11.• > v.(^"`r "
LOT#G38 EAGLES NEST OFF 194 OFF 184 OFF 1( From To ' Ft. -
A.t
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft. MAY 15 2024
TOPOGRAPHIC/LAND SETTING: i Iri:`vrn"&.E;-- ,7 -d;• .:_FWI I t Slope Valley, Flat Ridge Other
(check appropriate box) 11. DRILLING LOG PQ-x_r ._,
May be in degrees, From To , Formation Description
LATITUDE _ - minutes,seconds or 0 425 EXISTING
LONGITUDE in a decimal format 425 540 C-1RANITF
— — 540 570 RED GRAN-I_TF
Latitude/longitude source: X GPS Topographic map ' 570 630 GRANITE
(location of well must be shown on a USGS topo map and 630 660 GRANITE QUARTZ MIX
attached to this form if not using GPS) 860 790 GRANITE
5.WELL 01NNER `` 790 794 BROWN SHELL
794 820 GRANITE
OWNER'S NAME BILL SERATA 820 850 RED GRANITE
STREET ADDRESS
12150 28TH ST N 850 885 GRANITE
ST PETERSBURG FL • 33716
City or Town State • Zip Code -- •
( 727 )- 403-6331 -
Area code-"Phone number, 12. REMARKS:
2 GPM 0-425 (EXISTING)
6.WELL DETAILS: 2 GPM 630-660 ;,
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a. TOTAL DEPTH: 885 1 GPM 790-794 '1' . '
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: 340 FT. RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
• (Use"+"if Above Top of Casing) - • / 'I
d. TOP OF CASING IS 1 FT.Above Land Surface* - , (1 �� 2u��
*Top of casing terminated at/or below land surface may require SIGNATURE F CERTIF?r WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. II
RICKY HUFFMAN ,
e. YIELD(gpm): 5 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
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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. 1
Rev.3/07

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