GW1--05469_Well Construction - GW1_20240912

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RES.I.DENTIAL WELL CONSTRUCTION RECIORD
' Noh Carolina Departmnt of Environment and Natural Resources-Division oil Water Quality
WELL CONTRACTOR CERTIFICATION# 3489 230'112
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1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 49
RICKY HUFFMAN g. WATER ZONES(depth):.
Well Contractor(Individual)Name From 230 To 231 i From To
DEWEY WRIGHT WELL&PUMP CO., INC From To I 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 O To 36 Ft. 8 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 I Material ,Method
• From 0 To 20 Ft. BENTONIT GRAVITY
SITE WELL ID#(if applicable) From To Ft. 19 BAGS
WELL CONSTRUCTION PERMIT# From To Ft.l
OTHER ASSOCIATED PERMIT#(if applicable) i.
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply X - From To it. in. in.
DATE DRILLED 8/20/2024 From To Ft. in. in.
TIME COMPLETED 03:00 AM PM X From To Ft.' in. in.
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4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: BANNER ELK COUNTY AVERY Depth Size Material
From To Ft.
LOT S83 OFF TALON TRAIL OFF TALON TRAIL OF ' From To ,iFt. ^• "' "-. -11 'A -^--.t
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To IFf. . `:.:Le 1.,�4 *4A II—L)
TOPOGRAPHIC/LAND SETTING: SEP 1 2 2024
Slope Valley X Flat Ridge Other -
(check appropriate box) 11. DRILLING LOG
May be in degrees, From To Fdrtftutfc7rtifiDasiaript c: v UrtY,
LATITUDE , _ '36.198836 minutes,seconds or. 0 10 DIRT DWOa`5.O(
LONGITUDE - 81.923644 in a decimal format 10 26 SHFI I
— — 26 110 GRANITF
F Latitude/longitude source: X GPS Topographic map 110 160 RED GRANITE
(location of well must be shown on a USGS topo map and 160 180 GRANITE
attached to this form if not using GPS) 180 216 RED GRANITE
216 230 GRANITE
5.WELL OWNER 230 231 VOID 1, '
OWNER'S NAME JEFF DUDAS C/O PALMER CONSTR 231 370 GRANITE
145 WINTERBERRY TRAIL 370 400 GRANITE QUARTZ MIX
STREET ADDRESS 400 465 GRANITE
BOONE NC 28607
City or Town State Zip Code
( 828 )- 773-3864
Area code- Phone number , . . 12. REMARKS:
20 GPM 230-231 ,
6.WELL DETAILS:
a. TOTAL DEPTH: 465 .
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: 220 FT. R ORD H BEEN P OVID TO THE WELL OWNER.
(Use"+"if Above Top of Casing) • Q
d. TOP OF CASING IS 1 FT.Above Land Surface* u �rJ2 �
*Top of casing terminated at/or below land surface may require SIGNA RE OF TIFIED WELL CONTRACTOR i
DATE
a variance in accordance with 15A NCAC 2C• .0118. RICKY HUFFMAN
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e. YIELD(gpm): 20 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
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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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