GW1--04197_Well Construction - GW1_20240717

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1 ltESIDENTIf L WELL CONSTRUCTION RECORD
ti `. i yx g North Carolina Department of Environment and Natural Resources- Division of Water Quality
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WELL CONTRACTOR CERTIFICATION# 3489 230111
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 66
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 50 To 180 From 270 To 310
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 58 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 Ft. 19 BAGS
WELL CONSTRUCTION PERMIT#368172 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 7/9/2024 From To Ft. in. in.
TIME COMPLETED 03:00 AM PM XFrom To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: BANNER ELK COUNTY WATAUGA Depth Size Material
From To Ft.
LOT#63 MONTEAGLE OFF SHAWNEE OFF GUAL1 From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
Slope Valley Flat Ridge Other
(check appropriate box) 11. DRILLING LOG
May he in degrees. From To Formation Description
LATITUDE — 36.193947 minutes.seconds or 0 12 DIRT
• LONGITUDE 81.846248 in a decimal format 12 50 BROWN SHFI I
— — 50 180 SaRANITE
Latitude/longitude source: X GPS Topographic map 180 195 QUARTZ
(location of well must be shown on a USGS topo map and 195 270 GRANITE
attached to this form if not using GPS) 270 310 GREEN GRANITE
5.WELL OWNER 310 330 GRANITE QUARTZ MIX
330 360 SHALE
OWNER'S NAME PALMER CONSTRUCTION INC 360 440 GREEN GRANITE MIX
STREET ADDRESS
145 WINTERBERRY TRAIL 440 500 GRANITE
BOONE NC 28607
City or Town State Zip Code ` i V E D
( 828 )_ 773-3864
Area code- Phone number 1,2. REMARKS: JUL 1 7 2024
2 GPM 50-180
6.WELL DETAILS:
8 GPM 270-310 int-; .'w::r 1 A'r.rsi¢r -g lief
a. TOTAL DEPTH: 500 DI{:a SGs1
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: 180 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 J1� W4474,t_
J 1.�a•c262y
`Top of casing terminated aUor below land surface may require SIGNATURE�OF CER WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
e. YIELD(gpm): 10 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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