GW1--04193_Well Construction - GW1_20240717

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RESIDENTIAL WELL CONSTRUCTION RECORD
Noah Carolina Department of I:m ironment and Natural Resources-Dis ision of Water Quality
," •R WELL CONTRACTOR CERTIFICATION# 3489
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 125
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 128 To 140 From 395 To 440
DEWEY WRIGHT WELL& PUMP CO., INC From To
From 610 To 660
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 308 7. CASING: Thickness/
Depth Diameter Weight Material
BOONE NC 28607 From 1) To 85 Ft. 8 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. 32 BAGS
WELL CONSTRUCTION PERMIT#407131 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 6/12/2024 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: BLOWING ROCK couNTY WATAUGA Depth Size Material
From _To Ft.
OFF PARKWAY PEAK OFF STATEVIEW OFF SAMI 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 — 36.15865N minutes,seconds or 0 76 DIRT
LONGITUDE 81.60496W in a decimal lixmat 76 128 GRANITF
— — 128 140 QUARTZ
Latitude/longitude source: X GPS Topographic map 140 370 GRANITE
(location of well must be shown on a USGS topo map and 370 395 SHALE
attached to this form if not using GPS) 395 440 GREEN GRANITE
440 610 GRANITE
5.WELL OWNER 610 660 GRANITE QUARTZ MIX
OWNER'S NAME MARK SCHELLHORN CIO TOM EGGI 660 705 GREEN GRANITE
STREET ADDRESS 9872 HWY 105S STE 1
-
BANNER ELK NC 28604 iWM
City or Town State Zip Code — %a 7--... .,', -T J r
( 828 )_ 963-7000 JUL 1 i L024
Area code- Phone number 12. REMARKS:
2 GPM 128-140
6.WELL DETAILS: Irl4b"Tr.rt�-t : s..r a�"�t3lj!
705 2 GPM 395-440 p�f;�3�C��
a. TOTAL DEPTH: 2 GPM 610-660
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: 70 FT. RECORD HAS BEEN PROVIDE TO THE WELL OWNER
(Use"+"if Above Top of Casing)
96
d. TOP OF CASING IS 1 FT.Above Land Surface` ^ (c,— (S���
*Top of casing terminated at/or below land surface may require SIGNATUR OF CER D WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
e. YIELD(gpm): 6 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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