GW1--04198_Well Construction - GW1_20240717

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��r r� \� RESIDENTIAL ESIDENTIAL WELL CONSTRUCTION RECORD
k� ,,�_ North Carolina Department of Environment and Natural Resources-Division of Water Quality
41,
.6 "`' WELL CONTRACTOR CERTIFICATION# 3489 230189
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 54
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 185 To 205 From 310 To 311
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 0 To 140 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 0 To 20 Ft. BENTONIT GRAVITY
SITE WELL ID#(if applicable) I From To Ft.yQBAC-IS
WELL CONSTRUCTION PERMIT# 162585 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: DEEP GAP COUNTY WATAUGA Depth Size Material
From To Ft.
OFF HEMLOCK OFF LAKEVIEW OFF DICK WATSC From To Ft.
(Street Name.Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
Slope Valley Flat Ridge Other
(check appropriate box) 11. DRILLING LOG
May be in degrees. From To Formation Description
LATITUDE 36.23583N minutes.seconds or 0 130 DIRT
LONGITUDE 81.52489W in a decimal format 130 185 GRANITF
— — 185 205 QUARTZ
Latitude/longitude source: X GPS Topographic map 205 240 SHALE
(location of well must be shown on a USGS topo map and 240 290 GRANITE
attached to this form if not using GPS) 290 310 GRANITE QUARTZ MIX
5.WELL OWNER 310 311 VOID
311 325 GRANITE
OWNER'S NAME
DIANE KRADEL
STREET ADDRESS 340 N ACADEMY ST r"' :'•
MOORESVILLE NC 28115 �"��D
City or Town State Zip Code JUL 1 7 2024
( 704 )_ 657-1735 -
Area code- Phone number 12. REMARKS: Ir o:1:-si°`1,1 a-r:. -.g Ur.
2 GPM 185-205 D'f/ca9G4,'
6.WELL DETAILS: 4 GPM 310-311
a. TOTAL DEPTH: 325
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: 60 FT. RECORD HAS BEEN PROVIDED TO HE WELL OWNER.
(Use"+"if Above Top of Casing)d. TOP OF CASING IS 1 FT.Above Land Surface" / , 4 G- ZZqQ
*Top of casing terminated at/or below land surface may require SIGNATU OF C RTI I D WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
e. YIELD(gpm): 6 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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