GW1--07245_Well Construction - GW1_20231108

-',a SIA7cc*. ,
..M1YY
r,., •
w.v`�,�y '• RESIDENTIAL WELL CONSTRUCTION RECORD
p a North Carolina Department of Environment and Natural Resources-Division off Water Quality
�e;r ,
WELL CONTRACTOR CERTIFICATION# 3489 230027
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 130
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From To
From 410 To 480
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 28 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
SITE WELL ID#(if applicable) From 0 To 20 Ft. BENTONIT GRAVITY
-- From To Ft. 19 BAGS __
WELL CONSTRUCTION PERMIT#240093 From To !Ff.
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 10/18/2023 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: WEST JEFFERSON COUNTY ASHE Depth Size Material
— From To Ft.
OFF HARTZOG FORD OFF CANOE GAP OFF IDLE' From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
II Slope 0 Valley X Flat 0 Ridge 0 Other
(check appropriate box) 11. DRILLING LOG
May be in degrees, From To Formation Description
LATITUDE _ 36.31997N minutes,seconds or 0 3 DIRT
LONGITUDE_ _ 81.42286W in a decimal format 380 280 0 GRANITE
Latitude/longitude source: X GPS 0 Topographic map 410 480 GREEN GRANITE
(location of well must be shown on a USGS topo map and 480 630 GRANITE
attached to this form if not using GPS) 630 690 GRANITE QUARTZ
5.WELL OWNER 690 705 GRANITE _
I
OWNER'S NAME PAMELA KELLER JOHNSON
STREET ADDRESS 1869 ROLLINS DR
CATAWBA NC 28609
City or Town State Zip Code l '' ..,'-'1.,--l; jr I j
( 828 )- 320-2872
Area code- Phone number 12. REMARKS: NOV 0 8 2023
2 GPM 410-480
6.WELL DETAILS: In=t'.rr on Prr J I r;i
a. TOTAL DEPTH: 705 z:,�,•;;• ._;;..";-1
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: 40 FT. RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface* JU—Z~)0/3
*Top of casing terminated at/or below land surface may require SIGNATUR OF CER F D WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN '
e. YIELD(gpm): 2 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. J Rev.3/07
/ .
, • /

^ .
<��
��
�
� . ~-~'_
� /
\
`. -__-�
�
^ ~ L�*^�/� 6�/
� /~ .~.�~~~ .~'
� '
�� �
. �� ��
`\ �] \
\ �� �-
^\ \ ''^/y
` l '
` ' '�z.�,�'
.
!
/
|
,
,
- - - - -- '--' 1- '-' -- -' -r' ' � - - -- - -- -
. � � \q
� � � ��
`�
` `
�
.
��
-___--_--_�__- �. �
�� ---- -� ' -- --' -' ' - ---- '— � m,^c_"
° 4�\ \ /
� .