GW1--02931_Well Construction - GW1_20240513

. is
,( ,,A1f',-
�' RESIDENTIAL WELL CONSTRUCTION RECORD
'�Kya North Carolina Department of Environment and Natural Resources-Division of Water Quality
+1 U .c"
WELL CONTRACTOR CERTIFICATION# 3489 230178
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 70
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 340 To 365 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 105 Ft. 6 1/4 188 GAI V
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 - 1 Ft. 1414- BAGS ,-
WELL CONSTRUCTION PERMIT#383546 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 4/19/2024 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 Material
From To _Ft. _ ^ _ _ _
OFF WORLEY RD OFF OLIVER HILL OFF 194 OFF From To Ft. `A:e ;'e._. t r' ,_j
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.TOPOGRAPHIC/LAND SETTING: MAY 1 ' 2024
Slope Valley X Flat Ridge Other
(check appropriate box) 11. DRILLING LOG I x..,„..:, •,- -�;_,Z:7'1 t ti i,
May be in degrees, From To Form�tl6n De Gri tion•
.LATITUDE 36.19664N 0 30 DIRT �"`�'"
— minutes,seconds or
LONGITUDE 81.83481W in a decimal format 30 70 Mtlf7 C,RAVFI
— — 70 95 DIRT
Latitude/longitude source: X GPS Topographic map 95 160 GRANITE
(location of well must be shown on a USGS topo map and 160 170 SHALE
attached to this form if not using GPS) 170 290 GRANITE
5.WELL OWNER 290 340 _ GREEN GRANITE
340 365 GRANITE ,
OWNER'S NAME ROBERT LEIHBACHER 365 405 GRANITE
STREET ADDRESS 1921 WORLEY RD
BANNER ELK NC 28604
City or Town State Zip Code
( 828 )_ 963-3043
Area code- Phone number 12. REMARKS:
6.WELL DETAILS:
a. TOTAL DEPTH: 405
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: 60 FT. RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
(Use"+"if Above Top of Casing) •
d. TOP OF CASING IS 1 FT.Above Land Surface* do2q
"Top of casing terminated at/or below land surface may require SIGNATU OF CER I ED WELL 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
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

• ...,
•i...:,-
/al 2 . C 7-c-'
f-----e) -6.--:,,,, .•-•
_,- ,.....
.
- • .
. . . ,
i•,•
0
: • L
cb .
. . •
. .
. . . •
ii95( 3• C
. ,
• _ ____ _______
•
•
. . .
C:1
. ..,
N '
. .
ilq) Q21
. 1
..."
• E,,.....,
. .
• A
z.p.,
ta 0
.z. .
. . -,,.,....... • •. , . . .
. .
. .
. :r. . .
. .•
. 1
' .. • • : Pi-19r'
. . • . .
. . • ,00 •
: .
. . .
. . ,N,•
ci, •tc,i' .
•
•. • G fi , N
4 Vil G • •
. .
.
•
1 _ CQ't u • ot: IA , ..
. . .
te ..a N• .