GW1--07246_Well Construction - GW1_20231108

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RESIDENTML WELL CONSTRUCTION RECORD
t"� North Carolina Department of Environment and Natural Resources-Division o Water Quality -
`*;:, . WELL CONTRACTOR CERTIFICATION# 3489 230084
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 56
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 185 To 210 From 278 To 279
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
BO. ONE NC 28607 From 0 To 105 Ft. 6 1/4 188 GALV
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) _ _, From To Ft. 22 BAGS
WELL CONSTRUCTION PERMIT#371927 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 10/31/2023 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 BIRCHWOOD OFF OAKWOOD OFF MT JEFFE From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
0 Slope 0 Valley 0 Flat 0 Ridge 0 Other 11. DRILLING LOG
(check appropriate box)
May be in degrees, From- To ' Formation Description
LATITUDE — — 36.38892N minutes,seconds or 0 90 DIRT GRAVEL
LONGITUDE 81.47036W in a decimal format 90 185 GRANITE
— — 185 210 GRANITE QUARTZ
Latitude/longitude source: X GPS o Topographic map 210 278 GRANITE
(location of well must be shown on a USGS topo map and 278 279 VOID ,
attached to this form if not using GPS) 279 325 GRANITE
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5.WELL OWNER
OWNER'S NAME RICHARD ALDRIDGE
STREET ADDRESS 49 SHORT ST
WEST JEFFERSO NC 28694 -_ .-A• ^
fin_ ,.r_ ;-ti
City or Town State Zip Code
( 828 )_ 964-5449 NOV S 2023
Area code- Phone number 12. REMARKS:
2 GPM 185-200 1 In`, rrn i^n Pr,-,.^ . t :3 Ui i
• 6.WELL DETAILS: 8 GPM 278 279 D'r." `A
a. TOTAL DEPTH: 325 i
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: 50 FT. RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
(Use"+"if Above Top of Casing)
r
d. TOP OF CASING IS 1 FT.Above Land Surface* 1/—I Z013
*Top of casing terminated at/or below land surface may require SIGNATU E OF CE IED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.011,8. RICKY HUFFMAN j
e. YIELD(gpm): 10 • 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-1a
1617 Mail Service Center—Raleigh, NC 27699-1617 Phone No.[phone] ext 5681 , Rev.3/07

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