GW1--05848_Well Construction - GW1_20230912

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i, t RESIDENTIAL WELL CONSTRUCTION RECORD
6 ': l:e' • moo',' North Carolina Department of Environment and Natural Resources-Division of Water Quality
•" ) WELL CONTRACTOR CERTIFICATION# 3489 220193
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1.WELL CONTRACTOR: f. DISINFECTION:Type fHTH Amount 0
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RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor-(Individual)Name From To I. , From To
DEWEY WRIGHT WELL& PUMP CO., INC From To i . From To
Well Contractor Company Name From To i From To
STREET ADDRESS PO BOX 308 7. CASING: Thickness/
Depth • Diameter Weight Material
BOONE NC • 28607 From 0 To 80 Ft. 6 1/R 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 ;Ft. BENTONIT GRAVITY
--- - - -- -SITE WELL ID#(if applicable) _ _. _ _1-9-
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From To i Ft. 19 BAGS
WELL CONSTRUCTION PERMIT#373374 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 EX From - To Ft. in. in.
DATE DRILLED 8/31/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM[I PM IIX - From To :Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: DRY HOLE ASHE -Depth Siz ,( atgrial
COUNTY From To . Ft. 1 7 gib_)
595 KANAWHA DR OFF BOGGS RD OFF 163 OFF: From To ' • Ft. 2(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft. SE P 1 2023
TOPOGRAPHIC/LAND SETTING:
0 Slope 0 Valley I Flat LI Ridge 0 Other Intara, ien?ram. #rt O
(check appropriate box) 11. DRILLING OVIOJek0a
LATITUDE 36.35847N May be in degrees, From To Formation Description
— — minutes,seconds or 0 68 DIRT :.
LONGITUDE 81.43408W in a decimal format 68 190 GRANITE
— — • 190 260 SHALE '
Latitude/longitude source: X GPS a Topographic map 260 330 GRANITE
(location of well must be shown on a USGS topo map and 330 370 GREEN GRANITE
attached to this form if not using GPS) 370 540 GRANITE
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5.WELL OWNER 540 580 SHALE
580 705 GRANITE
OWNER'S NAME RICHARD EHRHART
STREET ADDRESS 595 KANAWHA DR i
WEST JEFFERSO NC 28694
City or Town State Zip Code - _ --
( 704 )- 905-8898 -
Area code- Phone number 12. REMARKS:
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6.WELL DETAILS:
a. TOTAL DEPTH: 705
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: 705 FT. RECORD HAS EEN PROVI EDT T E WELL OWNER.
(Use"+"if Above Top of Casing)
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d. TOP OF CASING IS 1 ' FT.Above Land Surface* a6a3
*Top of casing terminated at/or below land surface may require SIGNATURE F C RTI WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN '•
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e. YIELD(gpm): 0 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-la
1617 Mail Service Center—Raleigh, NC 27699-1617 Phone No.[phone] ext 568. Rev.3/07

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