GW1--04969_Well Construction - GW1_20240816

} .._ RESIDENTIAL WELL CONSTRUCTION RECORD
'‘ ", IT 5' North Carolina Department of IA%ironment and Natural Resources-Division of Water Quality
\,` ;>/ WELL CONTRACTOR CERTIFICATION#
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 142
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 245 To 260 From 760 To 761
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 82 Ft. 6 1/8 35n 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) -
From To Ft. 19 BAGS
WELL CONSTRUCTION PERMIT#404452 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 7/30/2024 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 BOONE FORK OFF OLD TURNPIKE OFF SHU 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 _ — 36.16628N minutes,seconds or D 70 DIRT
LONGITUDE 81.74573W in a decimal format 70 230 GRANITF
— — 230 245 GREEN GRANITE
Latitude/longitude source: X GPS Topographic map 245 260 QUARTZ
(location of well must be shown on a USGS topo map and 260 480 GRANITE
attached to this form if not using GPS) 480 560 GREEN GRANITE MIX
5.WELL OWNER 560 730 GRANITE
730 760 GRANITE QUARTZ MIX
OWNER'S NAME
MICHAEL GREEN 760 761 VOID
STREET ADDRESS 1054 OTIS BLVD 761 805 GRANITE
SPARTENBURG SC 29302 f ,;;', J1-0
City or Town State Zip Code
( 864 )- 706-8451 AUG 1 24
Area code- Phone number 12. REMARKS: ,
4 GPM 245-260____ r^'""` -'y
6.WELL DETAILS: 6 GPM 760-761 Q'Icti.::.e1,w
a. TOTAL DEPTH: 805
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 P-OVIDED Ts THE WELL OWNER
(Use"+"if Above Top of Casing) ^ /,
d. TOP OF CASING IS 1 FT.Above Land Surface* f a ill__ _ �9\4,4 / �'�(��`�'
*Top of casing terminated at/or below land surface may require SIGNATU i
OF CERT'I D WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
e. YIELD(gpm): 10 _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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