GW1--01489_Well Construction - GW1_20240312

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r 1F r RESIDENTIAL WELL CONSTRUCTION RECORD
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4,v� North Carolina Department of Environment and Natural Resources-Division of Water Quality
:`:«.:,',0 WELL CONTRACTOR CERTIFICATION# 3489 230095
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1.WELL CONTRACTOR: f. DISINFECTION:Type HTH _ Amount 85
RICKY HUFFMAN g. WATER ZONES(depth): .
Well Contractor(Individual)Name From 245 To 270 ' From 430 To 460
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. H 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
_` From 0 To-20 : Ft. BENTONIT . GRAVITY
-- ----- SITEWELL--ID=#(if-applicable) — — __ _ -
_'_ - - - ---
From 'To `! t. 19 BAGS—
WELL CONSTRUCTION PERMIT#391574 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 X From To ' Ft. in. in.
DATE DRILLED 2/29/2024 From To Ft. in. in.
TIME COMPLETED 03:00 AM PM X From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:. , ,----;;,;a ��„
CITY: WEST JEFFERSON' COUNTY ASHE Depth Size rkil'ilk-- vd j• .E:
From To Ft.
LOT#41 OFF TOMAHAWK OFF STONE BRIDGE OF From To ' •Ft. MAR 1 2 20Z4
• (Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To ,Ft.
TOPOGRAPHIC/LAND SETTING: infeFi a:ien Prr,s&z.b+ a l,nY.
Slope Valley X Flat Ridge Other DVICtiLSOG
(check appropriate box) it DRILLING LOG
LATITUDE 36.348536 May be in degrees, . From 30 To DIRT' Formation Description
minutes,seconds or 0
LONGITUDE 81.560157 in a decimal format 30 208 (=,RANITF
— — 208 245 SHALE _
Latitude/longitude source: X GPS Topographic map 245 270 GRANITE
(location of well must be shown on a USGS topo map and 270 360 SHALE
attached to this form if not using GPS) 360 430 GRANITE
430 460 GREEN GRANITE
• 5.WELL OWNER 460 505 GRANITE
OWNER'S NAME TONY ELLER ' .
STREET ADDRESS PO BOX 870
WEST JEFFERSC NC 28694 -
City or Town a State Zip Code .
3( 36 )- 877-7225 ,
Area code- Phone number 12. REMARKS:
1 GPM 245-270
6.WELL DETAILS: 4 GPM 430-460
a. TOTAL DEPTH: 505 . I I
b. DOES WELL REPLACE EXISTING WELL? YES NOX •
I DO HEREBY CERTIFY THAT THISIWELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,WELL CONSTRUCT! TANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 100 FT. RECORD HA BEEN PROVID D TO WELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface' '3_1_2
02sti
*Top of casing terminated at/or below land surface may require SIGNATUR OF CERTIFI ELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN ( '
e. YIELD(gpm): 5 . METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
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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
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