GW1--07623_Well Construction - GW1_20231204

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4 .:.• RESIDENTIAL WELL CONSTRUCTION RECORD
v > �' North Carolina Department of Environment and Natural Resources-Division'of Water Quality
`'*3u «„ '`i' WELL CONTRACTOR CERTIFICATION# 3489 230164
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1.WELL CONTRACTOR: • f. DISINFECTION:Typer HTH Amount 39
RICKY HUFFMAN g. WATER ZONES(depth):,
Well Contractor(Individual)Name From 230 To 233 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 121 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 v Ft. BENTONIT GRAVITY
SITE WELL ID#(if applicable) _
_ From --- - To- i Ft: 19 BAGS-
WELL CONSTRUCTION PERMIT#397809 i
From To i 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 11/7/2023 - From . To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM IIX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK: •
CITY: WEST JEFFERSON COUNTY ASHE Depth Size Material
From - To Ft.
OFF BIG TREE OFF BLACK BEAR INN OFF BALD I\ From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft. .
TOPOGRAPHIC/LAND SETTING:
X Slope II Valley 0 Flat 0 Ridge fl Other ,
(check appropriate box) 11. DRILLING LOG
LATITUDE 36.36227N_ May be in degrees, From To Formation Description
minutes,seconds or 0 110 DIRT
LONGITUDE— — 81.54607W in a decimal format 1110 185 0 160 GRANITE
Latitude/longitude'source: X GPS 0 Topographic map 185 230 GRANITE
(location of well must be shown on a USGS topo map and 230 233 VOID ,
attached to this form if not using GPS) 233 235 SHALE
235 245 GRANITE •
5.WELL OWNER I I
OWNER'S NAME BEST VENTURE DESIGNS
STREET ADDRESS 398 MTN AIRE LN
WEST JEFFERSO NC 28694
City or Town State Zip Code .• _,, �, °
(336 ).. 977-2811
Area code- Phone number 12. REMARKS: Y J !- 2023
30 GPM 230-233 ,,
6.WELL DETAILS: / I tf: ,;;c_ ->^.,i1 '�: ai:;�••sa.tji' ii':
a. TOTAL DEPTH: 245 r.s,r:d ;lz: G`
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 0
c. WATER LEVEL Below Top of Casing: 60 FT. RECORD HAS BEEN PROVIbED TO THE WELL OWNER.
(Use"+"if Above Top of Casing) / l
d. TOP OF CASING IS 1 FT.Above Land Surface* - "� .! , -?--��3
*Top of casing terminated at/or below land surface may require SIGNATU OF CERTI 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
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Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
Form GW
1617 Mail Service Center—Raleigh, NC 27699-1617 Phone No.[phone] ext 568.s . Rev.3/07-1a
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