GW1--07250_Well Construction - GW1_20231108

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RESIDENTIAL WELL CONSTRUCTION RECORD
'5' a North Carolina Department of Environment and Natural Resources-Division of,Water Quality
"�=��,,0? ' WELL CONTRACTOR CERTIFICATION# 3489 230158
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 67
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 350 To 352 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 94 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#382058 From To Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply ID( From To Ft. in. in.
DATE DRILLED 11/2/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM O PM OX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: CRUMPLER COUNTY ASHE Depth Size Material
From To Ft.
OFF AK MORRIS OFF SHARON SWEENEY OFF AL From To Ft. -
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
X Slope 0 Valley II Flat 0 Ridge El Other
(check appropriate box) 11. DRILLING LOG
May be in degrees, From To 1 Formation Description
LATITUDE _ 36.10122 minutes,seconds or 0 16 DIRT I
. LONGITUDE 81.38173 in a decimal format 16 180 GRANITF
— — 180 230 SHALE
Latitude/longitude source: X GPS o Topographic map 230 300 GRANITE
(location of well must be shown on a USGS topo map and 300 325 SHALE
attached to this form if not using GPS) 325 350 GRANITE
350 352 VOID I
5.WELL OWNER 352 365 GRANITE
OWNER'S NAME ROGER ROYALL _ _ --
STREET ADDRESS 159 CYPRESS LANDING DR
MOORESVILLE NC 28117 ev Y^' i' '`' , "''-_
. .. s..:.;I , I,— f
City or Town State Zip Code -
( 336 )- 708-8527 NOV ;) b 2023
Area code- Phone number 12. REMARKS:
40 GPM 350-352 Ir`;;r7;:='4.c,p?e-
6.WELL DETAILS: L`•'%t..:._.. �• "� :'i
a. TOTAL DEPTH: 365
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: 40 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' ' /(3-120-23
*Top of casing terminated at/or below land surface'may require SiIGNAUR OF ER f IED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.01-18.' .. - RICKY HUFFMAN
•
e. YIELD(gpm): 40 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Informatil n Mgt., Form GW-la
1617 Mail Service Center—Raleigh, NC 27699-1617 Phone No. [phone] ext 568. , Rev.3/07

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