GW1--05852_Well Construction - GW1_20230912

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ti ;, .: Ste_-'. RESIDENTIAL WELL CONSTRUCTION RECORD.
6 >r , 0., North Carolina Department of Environment and Natural Resources-Divisioniof Water Quality
'''�Z Z ' • WELL CONTRACTOR CERTIFICATION# 3489 230043
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 57
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 270 To 271 From To
DEWEY WRIGHT WELL& PUMP CO., INC From To 1 From To
Well Contractor Company Name From To i' ' From To
STREET ADDRESS PO BOX 308 ' 7. CASING: I, Thickness/
Depth • Diameter Weight Material
BOONE NC •
28607 From 0 To 70 Ft. 0 1/4 1£88 GAI V
City or Town State Zip Code From To Ft.
(828 )_264-2651 _ From To Ft.
Area code- Phone number
2.WELL INFORMATION: I 8..GROUT: Depth Material Method
From 0 To 20 !' Ft. BENTONIT GRAVITY
SITE WELL ID#(if applicable)__ From • To l` t. 65"BAGS ` -;. -. :_ • -' - - _ _
WELL CONSTRUCTION PERMIT#381100 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 IX .From To Ft. in. in.
DATE DRILLED 8/22/2023 From To Ft. in. in.
. TIME COMPLETED 03:00 AM 0 PM DX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK: '
CITY: WEST JEFFERSON COUNTY ASHE Depth Size Material
From To ' Ft.
OFF HARLESS OFF BUCK MTN RD OFF BEAVER From To Ft.
• • (Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To ' Ft.
• TOPOGRAPHIC/LAND SETTING:
' 0 Slope 0 Valley X Flat 0 Ridge,0 Other
(check appropriate box) 11.DRILLING LOG
LATITUDE 36.39403N•
May be in degrees, From To ;' Formation Description
— — minutes,seconds or 0 60 DIRT MUD
• LONGITUDE 81.50391 W in a decimal format 60 140 GRANITF _ -
- — 140 165 SHALE_
Latitude/longitude source: ) GPS 0 Topographicmap - 165 -• 260 GRANITE
(location of well must be shown on a USGS topo map and 260 270 GREEN GRANITE
attached to this form if not using GPS) 270 271 VOID 1 , ' •
271 305 GRANITE
5.WELL OWNER l ; _ .
OWNER'S NAME GREGORY LIPFORD - !.
STREET ADDRESS PO BOX 1042
• JEFFERSON NC • 28640 . •
City or Town State Zip Code 7,` is i 1 '""`'
( 336 )- 977-8201 J 4 k,_ E"' v c Li
Area code- Phone number 12. REMARKS: SEP 1 2 2023
25 GPM 270-271
6.WELL DETAILS: ,
a. TOTAL DEPTH: 305 f',8:icn Prrt•svar:�t✓r
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: 20 FT. RECORD HAS BEEN PROVID D TO HE WELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface* i UJ
*Top of casing terminated at/or below land surface may require SI NATUR OF ERTI E WELL CONTRACTOR DATE
/ a variance in accordance with 15A NCAC 2C:0118. RICKY HUFFMAN j 1
e. YIELD(gpm): 25 METHOD OF TEST AIR PRINTED NAME OF PERSONICONSTRUCTING THE WELL
I
•
Submit the original to the Division of Water Quality within 30 days. Attn: Information IMgt., Form GW-la
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 568. i . Rev.3/07

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