GW1--05851_Well Construction - GW1_20230912

r -: RESIDENTIAL WELL CONSTRUCTION RECORD
e 7 t t, ,p' North Carolina Department of Environment and Natural Resources-Division f Water Quality •
_,__ WELL CONTRACTOR CERTIFICATION# 3489 2300168
1.WELL CONTRACTOR: 'f. DISINFECTION:Type HTH Amount 67
RICKY HUFFMAN g. WATER ZONES(depth):
Wet Contractor(Individual)Name
From 220 To 240 _ From 330 To 375
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 68 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 Ft. BENTONIT GRAVITY
ITY
SITE WELL ID*Of applicable) From To i Ft. 18 BAGS
WELL CONSTRUCTION PERMIT#379257 From To • Ft. ,
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply 1K From To Ft. in. in.
DATE DRILLED 8/26/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM OX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: CRUMPLER COUNTY ASHE Depth Size Material
From To Ft.
342 WESTRA RIDGE OFF SMITHY RD OFF 16 OFF From To Ft. ,
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft. - -
•
.s
TOPOGRAPHIC/LAND SETTING:
0 Slope 0 Valley X Flat 0 Ridge 0 Other •-
(check appropriate box) 11. DRILLING LOG
May be in degrees, From To Formation Description
LATITUDE — — 36.526407 minutes,seconds or 0 59 DIRT
LONGITUDE 81.391444 in a decimal format 59 190 GRANITF
— — 190 220 SHALE
Latitude/longitude source: )G GPS 0 Topographic map 220 240 GRANITE QUARTZ MIX
(location of well must be shown on a USGS topo map and 240 310 GRANITE
attached to this form if not using GPS) 310 330 SHALE
330 375 • GREEN GRANITE
5.WELL OWNER 375 405 GRANITE
OWNER'S NAME DAVID&NANCY MITCHELL
�- r+.. T.... .,n
STREET ADDRESS 342 WESTRA RIDGE RD wT _t
CRUMPLER NC 28617
City or Town State Zip Code S E P 1 2 2023
( 919 )_ 720-1930
Area code- Phone number 12. REMARKS: inkrnv.tien P'rC-G s e.:g Ur t •
.5 GPM 220-240 DWQ/ G
6.WELL DETAILS:
a. TOTAL DEPTH: 405
. 3.5 GPM 330-375
b. DOES WELL REPLACE EXISTING WELL? YES O 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: 80 FT. RECORD HAS BEEN PROVIDED' TI,IE WELL OWNER.
(Use"+'.'if Above Top of Casing) �
d. TOP OF CASING IS 1 FT.Above Land Surface* Mi
*Top of casing terminated at/or below land surface may require . SIGNATU O CE I IED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
e. YIELD(gpm): 4 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
I
Submit the original to the Division of Water Quality within 30 days. Attn: Informati I n'Mgt., Form GW-1 a
1617 Mail Service Center—Raleigh, NC 27699-1617 Phone No.[phone] ext 568. 1 ' Rev.3/07

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