GW1--04903_Well Construction - GW1_20240816

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r RESIDENTIAL WELL CONSTRUCTION RECORD
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`= } '_ ' North Carolina Department of Ens ironment and Natural Resources- Di\ision of Water Quality
WELL CONTRACTOR CERTIFICATION# 3489 240142
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 73
RICKY HUFFMAN g. WATER ZONES(depth)
Well Contractor(Individual)Name From 235 To 270 _
From 610 To 612
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/
BOONE NC 28607 Depth Diameter Weight Material
From 0 To 80 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#(if applicable) From To Ft. 18 BAGS
WELL CONSTRUCTION PERMIT#224944 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 8/7/2024 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#F6 OFF HIGH VALLEY OVERLOOK OFF EAG 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 11. DRILLING LOG
(check appropriate box)
May be in degrees. From To Formation Description
LATITUDE _ — 36.216223 minutes.seconds or 0 40 -- DIRT
LONGITUDE 81.919528 in a decimal format 40 71 SOFT SHFI I
— — 71 210 GRANITE
Latitude/longitude source: X GPS Topographic map 210 235 GREEN GRANITE
(location of well must be shown on a USGS topo map and 235 270 QUARTZ
attached to this form if not using GPS) 270 390 GRANITE
5.WELL OWNER 390 450 RED GRANITE MIX
450 580 GRANITE
OWNER'S NAME MARC HELBEIN C/O SKYHOUSE 580 610 PINK QUARTZ
610 612 VOID i ..►,, '.r..,—' }
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STREET ADDRESS 2874 TYNECASTLE HY 612 615_ GRANITE '`•-- •'L.• 6r S•- i,•
BANNER ELK NC 28604 AUG 1 1074
City or Town State Zip Code -
( 828 )- 898-3717 Into r .i"`.r,. `•i7,fsns:- unit
Area code- Phone number 12. REMARKS: D'ftiCr.SC+Z
1 GPM 235-270
6.WELL DETAILS: 49 GPM 610-612
a. TOTAL DEPTH: 615
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: 250 FT. RECORD HAS BEEN PROVIDED T• HE WELL OWNER.
(Use°+"if Above Top of Casing)
_ �'8"�2�
d. TOP OF CASING IS 1 FT.Above Land Surface* •f✓i�
*Top of casing terminated at/or below land surface may require SIGNATU OF CER'J',' ID 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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