GW1--04131_Well Construction - GW1_20240717

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4 Dt�. RESIDENTIAL WELL CONSTRUCTION RECORD
0. North Carolina Department of Environment and Natural Resources-Division of Water Quality
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WELL CONTRACTOR CERTIFICATION# 3489 240081
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 108
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 228 To 229
From To
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 72 Ft. A 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
SITE WELL ID#(if applicable) From To Ft. 19 BAGS
WELL CONSTRUCTION PERMIT#839672 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 6/10/2024 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 AVERY Depth Size Material
From To _Ft.
OFF HORSE BOTTOM OFF DOBBINS OFF TYNEC, From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
Slope Valley X Flat Ridge Other
(check appropriate box) 11. DRILLING LOG
May be in degrees, From To Formation Description
LATITUDE , _ 36.16652 minutes,seconds or 0 63 DIRT
LONGITUDE 81.83631 in a decimal format 63 180 GRANITF
— 180 228 SHALF
Latitude/longitude source: X GPS Topographic map 228 229 VOID
(location of well must be shown on a USGS topo map and 229 410 GRANITE
attached to this form if not using GPS) 410 485 GRANITE GREEN GRANITE
5.WELL OWNER 485 510 SHALE
510 630 GRANITE
OWNER'S NAME CHRIS DELNEGRO 630 660 GREEN GRANITE MIX
STREET ADDRESS
22106 MARKET ST 660 700 GRANITE
CORNELIUS NC 28031 �"" e:+JED
City or Town State Zip Code "��
(678 )- 895-8483 JUL 1 ri 2024
Area code- Phone number 12. REMARKS:
6.WELL DETAILS: tr�fdr ++�'• °''.^am"4 tR _
a. TOTAL DEPTH: 700
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: 180 FT. RE RD HAS BEEN PROVID I TO T E WELL OWNER.
(Use"+"if Above Top of Casing) i
d. TOP OF CASING IS 1 FT.Above Land Surface* t ( 0W q
*Top of casing terminated at/or below land surface may require SIGNATU OF CERTIF I WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
e. YIELD(gpm): 1.5 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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