GW1--04902_Well Construction - GW1_20240816

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fi %,:'. RESIDENTIAL WELL CONSTRUCTION RECORD
5. . rf'% ,6 North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 3489 240076
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 95
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 198 To 205 _
From 472 To 475
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 40 Ft. A 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#(i(applicable) From To Ft. 18 BAGS
WELL CONSTRUCTION PERMIT#022155 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 08/2/2024 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-78 EAGLES NEST OFF LANDS END TRL From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To _Ft.
TOPOGRAPHIC/LAND SETTING:
X Slope Valley Flat Ridge Other
(check appropriate box) 11. DRILLING LOG
May be in degrees. From To Formation Description
LATITUDE , — 36.194183 minutes.seconds or 0 8 DIRT
LONGITUDE 81.907689 in a decimal format 8 32 RROWN SHFI I
— — 32 198 GRANITE
Latitude/longitude source: X GPS Topographic map 198 205 QUARTZ
(location of well must be shown on a USGS topo map and 205 340 GRANITE
attached to this form if not using GPS) 340 370 SHELL
5.WELL OWNER 370 430 GREEN GRANITE MIX
430 472 GRANITE
OWNER'S NAME NICHOLAS WYATT C/O TOM EGGER 472 475 VOID
STREET ADDRESS 9872 NC HWY 105 SUITE 1
. BANNER ELK NC 28604 _ .�,o ••• --•1
City or Town State Zip Code '•�-L'�--% t,f
L.1
( 828 )_ 963-7000
Area code- Phone number 12. REMARKS: AUG 1 1 2024
2 GPM 198-205
6.WELL DETAILS: tr/e.' .c.v.r? it r.t''T'�1 .1 Urtit
a. TOTAL DEPTH: 475
48 GPM 472-475 �'AC,`c211*�:c�
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: + FT. RECORD HAS EEN PROVIDE 0 THE WELL OWNER
(Use"+"if Above Top of Casing) r ^
d. TOP OF CASING IS 1 FT.Above Land Surface* r 7- d0aLf
*Top of casing terminated at/or below land surface may require SIGNATURE F RT _D WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
e. YIELD(gpm): 50 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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