GW1--03572_Well Construction - GW1_20240613

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ti'r�<< � � RESIDENTIAL WELL CONSTRUCTION RECORD
`!,.i, , North Carolina Department of Environment and Natural Resources-Division of Water Quality
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WELL CONTRACTOR CERTIFICATION # 3489 240008
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 35
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 82 To 96 From 135 To 136
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 O To 48 Ft. A 1/R 350 PVC
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#(f applicable) From 0 To 20 Ft. BENTONIT GRAVITY
From To Ft. 18 BAGS
WELL CONSTRUCTION PERMIT#404302 From To 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 5/14/2024 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 _Ft.
273 ALDRIDGE RD OFF 105 From_ To _Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
Slope Valley X Flat Ridge Other
(check appropriate box) 11. DRILLING LOG
May be in degrees. From To Formation Description
LATITUDE , — 36.14905W minutes,seconds or 0 12 DIRT MUD
LONGITUDE 81.79068W in a decimal format 12 39 RROWN SHFI L
— — 39 82 GRANITE
Latitude/longitude source: X GPS Topographic map 82 96 GREEN GRANITE
(location of well must be shown on a USGS topo map and 96 135 GRANITE
attached to this form if not using GPS) 135 136 VOID
5.WELL OWNER 136 185 GRANITE ` N i 1
OWNER'S NAME KENNETH TOWNSEND 1%'��+ut+' V CLi
STREET ADDRESS 393 ALDRIDGE RD - JUN 1 : 2024
BANNER ELK NC 28604
City or Town State Zip Code lnforx'4wafa `ri UNd
( 828 )- 260-1159
Area code- Phone number 12. REMARKS:
5 GPM 82-96
s.WELL DETAILS: 15 GPM 135-136
a. TOTAL DEPTH: 185
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 PROVID D TO THE WELL OWNER
(Use"+"if Above Top of Casing) .,
d. TOP OF CASING IS 1 FT.Above Land Surface" Ai. 9 -►r IYi
*Top of casing terminated at/or below land surface may require SIGNATUUUbbb(((E O CE ED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
e. YIELD(gpm): 20 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. Rev.3/07

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