GW1--06824_Well Construction - GW1_20231023

SrA7po-
i -.y'y 1 ' ,.. . RESIDENTIAL WELL CONSTRUCTION RECORD
�
7�'''i
-. North Carolina Department of Environment and Natural Resources-Division of Water Quality
•.
"."":` WELL CONTRACTOR CERTIFICATION# 3489 230047 '
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 85
RICKY HUFFMAN g. WATER ZONES(depth).
Well Contractor(Individual)Name From 545 To 600 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/
BOONE NC 28607 Depth Diameter Weight Material
From 0 To 40 Ft. 6 1/P 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
SITE WELL ID Cif applicable) From 0 To 20 Ft. BENTONIT GRAVITY
' From To Ft. 18 BAGS _ __
WELL-CONSTRUCT-ION-PERMIT#-313524 - - — - From — To 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 10/16/2023' From To Ft. in. in.
TIME COMPLETED 03:00 AM O PM OX From To Ft., in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: LANSING COUNTY ASHE Depth Size Material
From To Ft.
OFF MCNEIL RD OFF HWY 194 OFF 88 OFF 194 0 From To 'Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
O Slope 0 Valley X Flat 0 Ridge .0 Other
(check appropriate box) 11. DRILLING LOG'
LATITUDE 36.28992 May be in degrees, From To Formation Description
— — minutes,seconds or 0 30 DIRT
LONGITUDE 80.29437 in a decimal format 30 260 GRANITE
260 290 SHALE
Latitude/longitude source: )4 GPS 0 Topographic map 290 545 GRANITE
(location of well must be shown on a USGS topo map and 545 600 GRANITE QUARTZ
attached to this form if not using GPS) 600 705 GRANITE .
5.WELL OWNER Ir'; _ --- . .,,
SCOTT CHICCARELLOI ' ( ""�
OWNER'S NAME - - r ..:
STREET ADDRESS 535 FLY FISHER DR OCT 3 3 2023
SALISBURY NC 28147
l
City or Town State Zip Code l'"`'"�=�'cn °'r -`�" ?Ilrx
( 828 )_ 963-3199
Area code- Phone number 12. REMARKS:
1 GPM 545-600
6.WELL DETAILS:
a. TOTAL DEPTH: 705
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOX I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,WELL CONSTRUCTION STANDARDS,
c. WATER LEVEL Below Top of Casing: 300 FT. RECORD HAS BEENHE PROVIDED TO T WELL OWNER.D THAT A COPY OF THIS
(Use/'+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface* Z.P.12:., aiLt_(it•414. ) /O-/Z-�Q• F CTIF
*Top of casing terminated at/or below land surface may require SIGNATURE WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
e. YIELD(gpm): 1 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

ja 1y�.�
/
•
...,,.�
o - —
���• '.
I.
•
'1 ti
!Z' . ''1. - i .:, .,.• . . .
'y
. . .. • • Jr..,
i