GW1--03574_Well Construction - GW1_20240613

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RESIDENTIAL WELL CONSTRUCTION RECORD
`-` ,6 North Carolina Department of Environment and Natural Resources- Division of Water Quality a r
WELL CONTRACTOR CERTIFICATION# 3489 240077
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 46
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 265 To 266 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 160 Ft. A 1/B 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. 21 BAGS
WELL CONSTRUCTION PERMIT#216549 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 5/9/2024 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.
LOT#35 OFF WHITE FOX OFF SILVER SPRINGS D 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 _ 36.16721N minutes,seconds or 0 58 BROWN SHELL
LONGITUDE 81.89030W in a decimal format 58 82 DIRT Milt)
— — 82 149 BROWN SHALE
Latitude/longitude source: X GPS Topographic map 149 205 GRANITE
(location of well must be shown on a USGS topo map and 205 220 RED GRANITE
attached to this form if not using GPS) 220 260 GRANITE
260 265 QUARTZ
5.WELL OWNER 265 266 VOID
OWNER'S NAME DOUGLAS JENNINGS C/O VONCO 266 305 GRANITE
STREET ADDRESS 198 BUCK CREEK RD +.. ^;.+•-••
ROAN MOUNTAU' TN 37687 VA L;L'L '" t.i.✓
City or Town State Zip Code JUN 1 3 2024
( 828 )_ 260-1583
Area code- Phone number 12. REMARKS: ( ry r.i.4rn p•r,,s;yts;Fi ,14
6.WELL DETAILS:
a. TOTAL DEPTH: 305
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: 80 FT. RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
(Use"+"if Above Top of Casing) ry J
d. TOP OF CASING IS 1 FT.Above Land Surface* 51:f T�''`^r
*Top of casing terminated at/or below land surface may require SIGNATUR F*4.CLL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
e. YIELD(gpm): 30 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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