GW1--03627_Well Construction - GW1_20240613

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ESIDENTIAL WELL CONSTRUCTION RECORD
�z North Carolina Department of Environment and Natural Resources- Division of Water Quality
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WELL CONTRACTOR CERTIFICATION# 3489 240041
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 43
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From To
From 210 To 245
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 50 Ft. 6 1/8 350 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
- . - - - From Q . To 20. Ft. BENTONIT GRAVITY
SITE WELL ID#(if applicable) From To Ft. 19 BAGS
WELL CONSTRUCTION PERMIT#404504-2 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 6/1/2024 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: DRY HOLE COUNTY WATAUGA Depth Size Material From To Ft. �-.l ►—........
.;*..�.J �"
`.,. ,.—
1454 DUTCH CREEK RD OFF 194 OFF BROADSTC From To Ft. i`��' '
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft. JUN 1•S .2024
TOPOGRAPHIC/LAND SETTING:
Slope Valley Flat Ridge Other r^1-
(check appropriate box) it DRILLING LOG [[��J�,
May be in degrees. From To Formation Dest7rip i "
LATITUDE , — 36.18013 minutes,seconds or 0 41 DIRT
LONGITUDE 81.79119 in a decimal format 41 210 GRANITE
— — 210 245 SHALE
Latitude/longitude source: X GPS Topographic map 245 390 LIGHT GREY GRANITE
(location of well must be shown on a USGS topo map and 390 440 GREEN GRANITE
attached to this form if not using GPS) 440 490 SHALE
5.WELL OWNER 490 730 GRANITE
730 770 GREEN GRANITE MIX
OWNER'S NAME SCOTT STUDEBAKER C/O PHIPPS C 770 1005 GRANITE
STREET ADDRESS 425 COL. FRANCIS RD
CRUMPLER NC 28617
City or Town State Zip Code
( 843 )_ 615-4178
Area code- Phone number 12. REMARKS:
5 GPM 210-245
6.WELL DETAILS:
a. TOTAL DEPTH: 1005
b. DOES WELL REPLACE EXISTING WELL? YES NOX I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C.WELL CONSTRU TION STANDARDS.AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 800 FT. RECORD H BEE P VIDE O THE WELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface* V- h4
*Top of casing terminated at/or below land surface may require SIGNATU OF ER ED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
e. YIELD(gpm): •5 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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