GW1--05468_Well Construction - GW1_20240912

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:1'-'11`... RESIDENTIAL WELL CONSTRUCTION RECORD '
6( �-,' t�pJ North Carolina Department of Environment and Natural Resources-Division olj Water Quality
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,,•,.. ." WELL CONTRACTOR CERTIFICATION# 3489 240144 •
1 '
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 130
RICKY HUFFMAN g. WATER ZONES(depth): '
Well Contractor(Individual)Name From 185 To 210 : ' From 630 To 660
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: 1 Thickness/
Depth Diameter Weight Material
BOONE NC 28607 From 0 To 78 Ft. 6 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 sFt. 18.BAGS _ _
WELL CONSTRUCTION PERMIT#226852 From To IFt.
1 •
OTHER ASSOCIATED PERMIT#(if applicable) --
• 9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply X From To 1,Ft. in. in.
DATE DRILLED 8/13/2024 . 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 L Ft.
LOT#ES-39 EAGLES NEST OFF FIRESONG OFF F From To I Ft. , ,•”" "' T, _
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To II Ft. 4— `'IL: VC:ii
TOPOGRAPHIC/LAND SETTING: SEP 1 2 2024
X Slope Valley Flat Ridge Other ,
(check appropriate box) 11. DRILLING LOG
May be in degrees, From To Formati50: st#rpt n- ;=;g unt
LATITUDE , — 36.202444 minutes,seconds or 0 10 DIRT? na ;r'
LONGITUDE 81.906146 in a decimal format 10 19 SOFT SHFI I
— — 19 185 GRANITF
Latitude/longitude source: X GPS Topographic map 185 210 QUARTZ
(location of well must be shown on a USGS topo map and 210 275 SHELL
attached to this form if not using GPS) 275 440 QUARTZ
1 440 510 PINK GRANITE MIX
' 5.WELL OWNER 510 630 GRANITE
OWNER'S NAME MANGO TREE HOLDINGS C/O NICHI 630 660 PINK GRANITE ___
STREET ADDRESS 1559 WITHERS DR 660 705 GRANITE
DENVER NC 28037
City or Town State Zip Code
( 704 )_ 425-1600 ,
Area code- Phone number 12. REMARKS:
2 GPM 185-210
6.WELL DETAILS: 2 GPM 630-660 •
a. TOTAL DEPTH: 705
1.
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: 40 FT. RECORD HAS BEEN PROVIDED TS THE WELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface*
9il, / 6''' i�)624
*Top of casing terminated at/or below land surface may require SIGNATURE F CERTI I'2,WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN II
e. YIELD(gpm): 4 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. 1 ; Rev.3/07

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