GW1--04970_Well Construction - GW1_20240816

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.% RESIDENTIAL WELL CONSTRUCTION RECORD
`5\ t � ,{. North Carolina Department of Ins ironment and Natural Resources- I)is ision of Water Qualits
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."r "` WELL CONTRACTOR CERTIFICATION# 3489 230083
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 57
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 295 To 296 From To
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 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 0 To 20 Ft. BENTONIT _GRAVITY
SITE WELL ID#(if applicable)_ From To Ft. 21 BAGS
WELL CONSTRUCTION PERMIT#381444 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 7/16/2024 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 ELK CREEK OFF OLD 421 S OFF 421 S 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
LATITUDE 36.17339N May be in degrees. From To Formation Description
— minutes,seconds or 0 12 DIRT
LONGITUDE 81.50277W . in a decimal format 12 38 SHFI L
— — 38 180 GRANITF
Latitude/longitude source: X GPS Topographic map 180 210 SHELL
(location of well must be shown on a USGS topo map and 210 270 GREEN GRANITE MIX
attached to this form if not using GPS) 270 295 GRANITE
5.WELL OWNER 295 296 VOID
296 325 GRANITE
OWNER'S NAME JOHN BRANDENBURG
STREET ADDRESS 113 HEADLANDS LN ,``. .'-; 1
CARY NC 27518 �.�'�l�
City or Town State Zip Code AUG 1 2024
( 919 )- 438-8176
Area code- Phone number 12. REMARKS: Ir,f:.: . '-r'-WK •y U :'
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6.WELL DETAILS:
•
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: 40 FT. RECORD HAS BEEN PR VIDE 0 THE WELL OWNER
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface* .kit. I�
*Top of casing terminated at/or below land surface may require SIGNATU OF CE IED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
e. YIELD(gpm): 30 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 clays. 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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