GW1--02989_Well Construction - GW1_20240513

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RESIDENTIAL WELL CONSTRUCTION RE •ORD
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2 North Carolina Department of Environment and Natural Resources-Division i f Water Quality
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`�_ : WELL CONTRACTOR CERTIFICATION# 3489 23,0144
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1.WELL CONTRACTOR: f. DISINFECTION:Type I NTH Amount 136
RICKY HUFFMAN g. WATER ZONES(depth):.
Well Contractor(Individual)Name From 330 To 3851 From To
DEWEY WRIGHT WELL& PUMP CO., INC From To i 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 n To 92 : 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--=— KFt 20 BAGS- - _-._- - --
WELL CONSTRUCTION PERMIT# 115809 From To II 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 4/29/2024 From To Ft. in. in.
TIME COMPLETED 03:00 AM PM X From To Ft. in. in.
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4.WELL LOCATION: 10.SAND/GRAVEL PACK: R F:-: P
COUNTY
CITY: BANNER ELK AVERY • Depth , Size d "MaieriaP--i V
From LOT VR2 EAGLES NEST OFF ANTLER RIDGE OFF From To • ' Ft. MAY 1 S 2024
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) . . From To Ft. C 1,-;',:,,!;',,'-,.. t
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TOPOGRAPHIC/LAND SETTING: -• i, Vi'V�:r•.1L.ty
X Slope Valley Flat Ridge Other 11. DRILLING LOG •
(check appropriate box)
May be in degrees; From To Formation Description
LATITUDE ; — 36.210622 minutes,seconds or 0 70 SHELL ROCK
LONGITUDE 81.926905 in a decimal format 70 80 DIRT'MI In
— — 80 195 GRANITE
Latitude/longitude source: X GPS Topographic map 195 210 GREEN GRANITE
(location of well must be shown on a USGS topo map and 210 330 GRANITE .
attached to this form if not using GPS) 330 385 GRANITE QUARTZ MIX
385 -460 GRANITE '
5.WELL OWNER 460 490 SHALE I
OWNER'S NAME TROY LINNA 490 540 GRANITE QUARTZ MIX
540 565 GREEN GRANITE
STREET ADDRESS 642 SPICE BOTTOM TRAIL 565 805 GRANITE
BANNER ELK NC 28604
City or Town State Zip Code
( 828 )_ 773-7568 -
Area code- Phone number 12. REMARKS:
6.WELL DETAILS:
a. TOTAL DEPTH: 805 t
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: 100 FT. RECORD HAS BEEN PROVIDED TOT E WELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 . FT.Above Land Surface* I ��G 0/0
*Top of casing terminated at/or below land surface may require SIGNA RE F CERTIFI ELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
e. YIELD(gpm): 1 • METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
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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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