GW1--00081_Well Construction - GW1_20231228

=fi t .' ,., RESIDENTIAL WELL CONSTRUCTION RECORD
'a..= , , a North Carolina Department of Environment and Natural Resources-Division of Water Quality
" Z", r WELL CONTRACTOR CERTIFICATION# 3489 230052
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 54
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 120 To 160 From 270 To 271
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 40 Ft. 6 1/6 350 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 1 Material Method
SITE WELL ID#(if applicable) From 0 To 20 Ft. BENTONIT GRAVITY
- - = _ —From—- To---- Ft. 20-BAGS •=—
WELL CONSTRUCTION PERMIT#369233 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 12/5/2023 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: WARRENSVILLE COUNTY ASHE Depth Size Material
From To Ft.
OFF GLEN MILLER OFF STAGGS CREEK OFF HW From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
B Slope 0 Valley X Flat 0 Ridge 0 Other •
(check appropriate box) 11. DRILLING LOG
May be-in degrees, From To Formation Description
LATITUDE , — 36.49887 minutes,seconds or 0 10 DIRT
LONGITUDE 81.57547 in a decimal format 10 30 SHALF
— — 30 120 GRANITE
Latitude/longitude source: X GPS 0 Topographic map 120 160 GREEN GRANITE
(location of well must be shown on a USGS topo map and 160 220 GRANITE
attached to this form if not using GPS) 220 245 SHALE,
245 270 GRANITE
5.WELL OWNER • 270 271 VOID ,
OWNER'S NAME NOBLE JAKE LLC/JIM HARRIS 271 325 GRANITE
STREET ADDRESS 5617 MARSH BAY DR
WILMINGTON NC 28409 - - . ,l,."'• '�`'.,it
City or Town State Zip Code Orr r V ..
( 910 )_ 520-0353 /23
lnfyr
Area code- Phone number 12. REMARKS: " .. T `-'"-, •
2 GPM 120-160 (�,"; `''`� lJ
6.WELL DETAILS: 18 GPM 270-271
a. TOTAL DEPTH: 325
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: 60 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* �J,4 t� ^/ l �J �"c,��
*Top of casing terminated at/or below land surface may require SIGNAL U • CER'( D ELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. I
RICKY HUFFMAN I
e. YIELD(gpm): 20 METHOD OF TEST AIR PRINTED NAME OF PERSON'CONSTRUCTING THE WELL
1
Submit the original to the Division of Water Quality within 30 days. Attn: Informati`n Mgt., Form GW-la
1617 Mail Service Center-Raleigh, NC 27699-1617 Phone No. [phone] ext 568. i Rev.3/07

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