GW1--04196_Well Construction - GW1_20240717

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{ fi ,:- RESIDENTIAL WELL CONSTRUCTION RECORD
i North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 3489 240078
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 165 To 178
From 280 To 310
DEWEY WRIGHT WELL& PUMP CO., INC From 340 To 365 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 0 To 108 _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
SITE WELL ID#(if applicable) From 0 To 20 Ft. BENTONIT GRAVITY
From_ To Ft. 17 BAGS
WELL CONSTRUCTION PERMIT#407290 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 6/19/2024 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.
OFF MAMIE COOK OFF APPLE CREEK OFF RUSS From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
Slope Valley Flat Ridge Other 11. DRILLING LOG
(check appropriate box)
May be in degrees, From To Formation Description
LATITUDE , _ 36.06618 minutes,seconds or 0 70 DIRT
LONGITUDE 81.38653 in a decimal format 70 78 GRANITF
— — 78 97 DIRT
Latitude/longitude source: X GPS Topographic map 97 165 GRANITE
(location of well must be shown on a USGS topo map and 165 178 PINK GRANITE
attached to this form if not using GPS) 178 230 GRANITE
5.WELL OWNER 230 280 SHALE
280 310 GREEN GRANITE
OWNER'S NAME BILL MOORE 310 340 GRANITE
STREET ADDRESS 166 MAMIE COOK RD 340 365 GRANITE QUARTZ MIX
-
BOONE NC 28607
City or Town State Zip Code
—mil ate.���Lf
( 828 )_ 264-3817
Area code- Phone number 12. REMARKS: JUL 1 7 2024
2 GPM 165-178
6.WELL DETAILS: 1.5 GPM 280-310 Irk:4 ,-^ram:-.'W.*
a. TOTAL DEPTH: 365 D'. :e SC.;
.5 GPM 340-365
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: 40 FT. RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
(Use"+"if Above Top of Casing) /,
d. TOP OF CASING IS 1 FT.Above Land Surface* G��O°r�Y
'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): 4 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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