GW1--07248_Well Construction - GW1_20231108

i'
.' ,.LL STATE 4
f } RESIDENTIAL WELL CONSTRUCTION RECORD
= t> a North Carolina Department of Environment and Natural Resources-Division of Water Quality,
•
_ WELL CONTRACTOR CERTIFICATION# 3489 230129
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 39
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 220 To 221
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 95 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:18-BAGS— -- -- - - --- - . - —
WELL CONSTRUCTION PERMIT#230811 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 11/1/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM II PM OX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: WEST JEFFERSON COUNTY ASHE Depth Size Material
From To Ft.
OFF BLUEBERRY HILL OFF DANIELS DAUGHTER ' From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING: -
X Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box) 11. DRILLING LOG
May be in degrees, From To Formation Description
LATITUDE — 36.32796N minutes,seconds or 0 86 DIRT
LONGITUDE 81.42159W in a decimal format 86 130 GRANITE
— — 130 148 SHALE •
Latitude/longitude source: X GPS o Topographic map 148 220 GRANITE
(location of well must be shown on a USGS topo map and 220 221 VOID ,
attached to this form if not using GPS) 221 245 GRANITE
I
5.WELL OWNER I
OWNER'S NAME KEITH NOLEN r--.. p . r-7
STREET ADDRESS 2843 MOOSE GANTT TRAIL Lr '° ' 'I .ayy C.'i '"
CROUSE NC 28033 NOV 8 2023
City or Town State Zip Code
( 980 )_ 241-0764 Ir-c:.. - .,::: P',... -:J 12•111
Area code- Phone number 12. REMARKS: DV`""-'`
C.
25 GPM 220-221
6.WELL DETAILS:
a. TOTAL DEPTH: 245
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 PROVIDED TO THE WELL OWNER.
(Use"+"if Above Top of Casing) ?
d. TOP OF CASING IS 1 FT.Above Land Surface* c 'ittRA L.- t(_/ ����
*Top of casing terminated at/or below land surface may require SIG OF CER ED,WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN j
e. YIELD(gpm): 25 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
i
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. I ' Rev.3/07

•P
X141443114tr I
ettbl
•
-.1
Yeerl
r-bik
•
0 416
I 07006
„ir.,s 440
st).!
.
.• .
'To
A
7.‘
lc:Ye tki; Rzi
. .
cis i
•
• •
• • •
•
.• %
- Vqa-1
_ :_ •
• ---