GW1--04130_Well Construction - GW1_20240717

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RESIDENTIAL WELL CONSTRUCTION RECORD
\',( ," `' North Carolina Department of Ins irunment and Natural Resources-I)is isiun or Water Quality
WELL CONTRACTOR CERTIFICATION# 3489 240084
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 76
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 270 To 330 _ From 375 To 405 __
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 62 .Ft. 6 1/4 188 _ GALV
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 Ft. BENTONIT GRAVITY
SITE WELL ID#(if applicable) From To Ft. 17 BAGS
WELL CONSTRUCTION PERMIT# 135585 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 6/21/2024 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: TODD COUNTY ASHE Depth Size Material
From To Ft.
10432 HWY 194 From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
'
Slope Valley Flat Ridge Other
(check appropriate box) 11. DRILLING LOG
May be in degrees, From To Formation Description
LATITUDE — 36.31272N minutes.seconds or 0 54 DIRT MUD GRAVEL
LONGITUDE 81.60959W in a decimal format , 54 160 GRANITF
— — 160 210 SHALE
Latitude/longitude source: X GPS Topographic map 210 270 GREEN GRANITE
(location of well must be shown on a USGS topo map and 270 330 GRANITE QUARTZ MIX
attached to this form if not using GPS) 330 375 GRANITE
375 405 GRANITE QUARTZ MIX
D
5.WELL OWNER
OWNER'S NAME NICOLE ACUFF `
STREET ADDRESS 53 LOGGERHEAD DR `''t"')1 N
COLUMBIA SC 29229 - JUL 1 7 c024
City or Town State Zip Code
( 919 )_ 608-8453 — kterasuk•: '7,---1,,,.: Ufdt
Area code- Phone number 12. REMARKS:
C d ,.4
2 GPM- 270-330
6.WELL DETAILS: 1 GPM 375-405
a. TOTAL DEPTH: 405
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: 20 FT. RECORD HAS BEEN PROVI EDT HE WELL OWNER
(Use"+"if Above Top of Casing) //
d. TOP OF CASING IS 1 FT.Above Land Surface" 6-.a /�/-..?L V
*Top of casing terminated at/or below land surface may require SIGNATUR OF CERTI ED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
e. YIELD(gpm): 3 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. Rev.3/07

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