GW1--04901_Well Construction - GW1_20240816

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'� r 4� RESIDENTIAL WELL CONSTRUCTION RECORD
4 North Carolina Ihharl ilent ol I.ns ironment and Natural Resources-I)is ision of Water Qualit4,1;_lj • .e.
WELL CONTRACTOR CERTIFICATION# 3489 240092
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 128
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 290 To 348 From 560 To 610
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 68 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. 18 BAGS
WELL CONSTRUCTION PERMIT#022111 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 8/1/2024 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#ES-52 EAGLES NEST OFF RIPPLING WATER 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 _ — 36.19984N minutes,seconds or 0 12 DIRT
LONGITUDE 81.90547W in a decimal format 12 58 SOFT SHFI I
— — 58 145 GRANITE
Latitude/longitude source: X GPS Topographic map 145 188 RED GRANITE MIX
(location of well must be shown on a USGS topo map and 188 210 SHELL
attached to this form if not using GPS) 210 290 GRANITE
5.WELL OWNER 290 348 RED GRANITE MIX
348 560 GRANITE
OWNER'S NAME JAVIER CRUZ C/O TOM EGGERS CC 560 610 RED GRANITE MIX
STREET ADDRESS 9872 NC HY 105 SUITE 1 610 705 GRANITE
W
BANNER ELK NC 28604
City or Town State Zip Code Ft 'Y•-=V -�
( )
828 963-7000
Area code- Phone number 12. REISIARKS: AUG 1 2024
6.WELL DETAILS: 6 GPM 290-34$ ithis.L.V : -”.•5•Csi;•.J ;dry
a. TOTAL DEPTH: 705
4 GPM 560-610 1,;','t.E12I.-G
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: 50 FT. RECORD AS BEEN PROV ED TO THE WELL OWNER.
(Use"+"if Above Top of Casing) t'���/1
d. TOP OF CASING IS 1 FT.Above Land Surface* U `� �'""'�
*Top of casing terminated at/or below land surface may require SIGNAT RE OF C IFIED 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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