GW1--02991_Well Construction - GW1_20240513

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'1. •'.• , . RESIDENTIAL WELL CONSTRUCTION RECORD.
`, F� 1 i North Carolina Department of Environment and Natural Resources-Division bf Water Quality
• arm ,,," WELL CONTRACTOR CERTIFICATION# 3489 24p030
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1.WELL CONTRACTOR: f. DISINFECTION:Type,IHITH Amount 70
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 180 To 220 From•340 To 350
DEWEY WRIGHT WELL& PUMP CO., INC From To i. 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 O To 85 Ft. 6 1/4 188 GAI V
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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
SITE WELL ID#(if applicable) From 0 To 20 Ft. BENTONIT GRAVITY
- - - - From • --. . -To - - LF1.--22 BAGS- - - - .- - -
WELL CONSTRUCTION PERMIT#215954 From To I'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 4/22/2024 From To Ft. in. in.
TIME COMPLETED 03:00 AM , PM X From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK: �' ,M1'" ,.=r, .,3
Depth Si {.�-6 M teFial; r": ?-
cITY: ELK PARK 'COUNTY AVERY g
From To I Ft.•
SAMANTHA SPRINGS OFF CURTIS CREEK OFF 1 From To I,Ft. MAY 13 r}?
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)' From To .•Ft 1 Dr•
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TOPOGRAPHIC/LAND SETTING: • £%t ir;.i (sr.;7
Slope Valley X Flat Ridge Other VA/CAW, -1(check appropriate box) 11.DRILLING LOG i;
May be in degrees, From To Formation Description
LATITUDE _ 36.15012N minutes,seconds or 0 30 DIRT MUD
81.92183W in a decimal format 30 73 RROWN SHFI I
LONGITUDE_ _ 73 180 GRANITE
Latitude/longitude source: X GPS Topographic map 180 220 GREEN.GRANITE
(location of well must be shown on a USGS topo map and 220 340 GRANITE
attached to this form.if not using GPS) 340 350 GRANITE QUARTZ MIX
350 365 GRANITE
5.WELL OWNER i
OWNER'S NAME FREDA GREENE r - _
STREET ADDRESS 273 HICKORY LN , c .
•BOONE NC 28607 '
City or Town State Zip Code --
( 828 )- 266-5472 .
Area code- Phone number 12. REMARKS:
2 GPM 180-220
6.WELL DETAILS: 3 GPM 340-350 +,
a. TOTAL DEPTH: 365 .
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) � . - I / J
d. TOP OF CASING IS 1 FT.Above Land Surface* • i ^tiJ
*Top of casing terminated at/or below land surface may require SIGNATURE�F CERTIFI D WELL CONTRACTOR DATE •
' a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
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• 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. Rev.3/07
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