GW1--06825_Well Construction - GW1_20231023

`� by RESIDENTIAL WELL CONSTRUCTION RECORD
x 5� �p" North Carolina Department of Environment and Natural Resources-Division of Water Quality
"47.;°;> WELL CONTRACTOR CERTIFICATION# 3489 230,029
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 49
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 170 To 200 From 270 To 271
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 1 Diameter Weight Material
BOONE NC 28607 From,(1 To 88 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. 19 BAGS____ _
WELL'CONSTRUCTION PERMIT#365178 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 10/12/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM OX From To Ft. in. _ in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: JEFFERSON COUNTY ASHE ' Depth Size Material
From To . Ft. •
OFF WOODLAND VALLEY OFF WOODLAND SHOF From To ' Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From ' To Ft.
TOPOGRAPHIC/LAND SETTING:
0 Slope 0 Valley X Flat 0 Ridge 0 Other
(check appropriate box) 11. DRILLING LOG
May be in degrees, From To Formation Description
LATITUDE — — 36.38678N minutes,seconds or 0 79 DIRT
LONGITUDE 81.40832W in a decimal format 79 110 GRANITE
— — 110 . 120 SHALE
Latitude/longitude source: X UPS 0 Topographic map 120 170 GRANITE
(location of well must be shown on a USGS fopo map and 170 200 GRANITE QUARTZ
attached to this form if not using GPS) 200 270 GRANITE ';"'.,--..:3----- , :7,-.3g,
270 271 VOI DI ' 0 IL.�,,,,,•n F't,> =
5.WELL OWNER 271 305 GRANITE
OWNER'S NAME ISABEL VEGA C/O MASTERCRAFT C oCT � 'Cr
STREET ADDRESS PO BOX 134
WEST JEFFERSO• NC 28694 — lit .' f., ,, P,.:.,:-.%2-74 IJr,a
C i k.z.S ...Iii"
City or Town State Zip Code
(336 )_ 877-7735 .
Area code- Phone number 12. REMARKS:
' 2 GPM 170-200
6.WELL DETAILS: 305 23 GPM 270-271 •
a. TOTAL DEPTH: I
b. DOES WELL REPLACE EXISTING WELL? YES 0 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 OV DED THE WELL OWNER.
(Use"+"if Above Top of Casing) . 'I23
d. TOP OF CASING IS 1 FT.Above Land Surface' a" �a✓j��3��
*Top of casing terminated at/or below land surface may require SIGNATUR F C RT D WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118.•s RICKY HUFFMAN
e. YIELD(gpm): 25 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
I
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt.,
Form GW-1a_
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.3/07

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