GW1--01491_Well Construction - GW1_20240312

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ti ,, 1 rn RESIDENTIAL WELL CONSTRUCTION RIL'CORD
,t %%xL North Carolina Department of Environment and Natural Resources-Division of Water Quality
a,.,,` WELL CONTRACTOR CERTIFICATION# 3489 230126
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 92
•
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 580 To 590 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 1 Diameter Weight Material
BOONE NC. 28607 From 0 To 40 : Ft. 8 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
SIT_C INELL.!D±r(if applicable)_ _ From 0 To 20 , Ft. BENTONIT GRAVITY
- — From' To j Ft. 18 BAGS
WELL CONSTRUCTION PERMIT#939701 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 2/12/2024 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: DRY HOLE COUNTY AVERY Depth Si. ,.----N(ateriaal `„.,
From To Ft. 4 ie,tl, .�; fir' a_
OFF ROCKY FACE OFF 19E OFF LICK LOG OFF S From To Ft.(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft. MAR 1 2 CO24
TOPOGRAPHIC/LAND SETTING: ��^^ ��t s
Slope Valley X Flat Ridge Other infi ien atiOn I • •x4-C�; tee.
(check appropriate box) • 11. DRILLING LOG DWQI•3'0G .�
May be in degrees, From To Formation Description
LATITUDE _ — 36.02802N minutes,seconds or 0 15 _ DIRT
• LONGITUDE 82.02106W in a decimal format 15 30 SOFT SHAI F
— — 30 270 GRANITE
Latitude/longitude source: X GPS Topographic map 270 490 SHALE
(location of well must be shown on a USGS topo map and 490 580 GRANITE
. attached to this form if not using GPS) 580 590 QUARTZ
5.WELL OWNER 590 905 SHALE
•
OWNER'S NAME LUKE MIGGS
STREET ADDRESS 780 ISAACS BRANCH RD
NEWLAND NC ' 28657'
City or Town State Zip Code
( 828 )- 205-7703
Area code- Phone number 12. REMARKS: :
.25 GPM 580-590
6.WELL DETAILS: r
a. TOTAL DEPTH: 905
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: 450 FT. RE ORD HA BEE R VIDED THE WELL OWNER. /
(Use"+"if Above Top of Casing) `/ I n ��7/�
d. TOP OF CASING IS 1 FT.Above Land Surface*
Ot ���oC7
*Top of casing terminated at/or below land surface may require SIGNATUR OF ER I WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
I
e. YIELD(gpm): .25 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-la
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. I Rev.3/07

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