GW1--03570_Well Construction - GW1_20240613 (2)

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r RESIDENTIAL WELL CONSTRUCTION RECORD
iQ North Carolina Department oil:m ironmenl and Natural Resources- I>is ision of Water Quality
\� pL WELL CONTRACTOR CERTIFICATION# 3489 240018
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 52
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 142 To 148 From 268 To 269
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 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
SITE WELL ID#(if applicable) From 0 To 20 Ft. BENTONIT GRAVITY
From _To Ft. _19 BAGS _
WELL CONSTRUCTION PERMIT#AG WELL From To 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 5/24/2024 From To Ft. in. in.
TIME COMPLETED 03:00 AM PM X From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: BANNER ELK CouNTY WATAUGA Depth Size ,.Otlaterial-.4� ,.-.
From To Ft. t\' `0 • J r L.
OFF DUTCH CREEK OFF HWY 194 OFF BROADS1 From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft. JUN 1 3 2024
TOPOGRAPHIC/LAND SETTING:
Slope Valley Flat Ridge Other Inforn^.r ern 71-e,,cam.4 t.liti
(check appropriate box) 11. DRILLING LOG pl/y�3Crii
May be in degrees. From To Formation Description
LATITUDE _ — 36.19560N minutes,seconds or 0 _ 91 DIRT MUD
LONGITUDE 81.79922W in a decimal format 91 142 GRANITF
— — 142 148 BROWN SHELL
Latitude/longitude source: X GPS Topographic map 148 210 GRANITE
(location of well must be shown on a USGS topo map and 210 225 GREEN GRANITE
attached to this form if not using GPS) 225 268 GRANITE
5.WELL OWNER 268 269 VOID
269 272 QUARTZ
OWNER'S NAME JD HAMBY 272 300 GRANITE
STREET ADDRESS 1101 HAYNES ST STE 211
RALEIGH NC 27604 -
City or Town State Zip Code
( 919 )- 801-4754
Area code- Phone number 12. REMARKS:
2 GPM 142-148
6.WELL DETAILS: 13 GPM 268-269
a. TOTAL DEPTH: 300
b. DOES WELL REPLACE EXISTING WELL? YES 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) _ q (3
d. TOP OF CASING IS 1 FT.Above Land Surface* �-J() 20Z4
*Top of casing terminated at/or below land surface may require SIGNATUR OF CERTI WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
e. YIELD(gpm): 15 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

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