GW1--05470_Well Construction - GW1_20240912

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'4.›..., AESIDENTIAL WELL CONSTRUCTION RE lO.RD
J t North Carolina Department of Environment and Natural Resources-Division of Water Quality
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'"`xx,L,%•,- WELL CONTRACTOR CERTIFICATION# 3489 2 01153
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1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 106
RICKY HUFFMAN g. WATER ZONES(depth)'
Well Contractor(Individual)Name From 380 To 465 ;' From 675 To 676
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 27 Ft.F 1/6 350 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# From To Ft.'
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth I Diameter Slot Size Material
j 3.WELL USE(Check Applicable Box): Residential Water Supply X From _ To Ft. in. in.
DATE DRILLED 8/19/2024 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 AVERY Depth Size Ma%ri,�` ..
From To 1 Ft. %,.r .�ifA '
85 TIMBER ROCK TRL(LOT N12) OFF EAGLES NE From To !Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft. SEP 1 2 2024
TOPOGRAPHIC/LAND SETTING: IriJ:�r�itiP,� �tC.r�
Slope Valley X Flat Ridge Other `g Unit
11. DRILLING LOG t r•,� .
(check appropriate box) I p/i u LU{,
May be in degrees, From To Formation Description
LATITUDE , — 36.198999 minutes,seconds or 0 175 GRANITE
LONGITUDE 81.918540 in a decimal format 175 205 RFDC,RANITF
— — 205 380 GRANITE
Latitude/longitude source: X GPS Topographic map 380 465 GRANITE QUARTZ MIX
(location of well must be shown on a USGS topo map and 465 470 BROWN SHELL
attached to this form if not using GPS) 470 610 GRANITE
610 620 PINK GRANITE
5.WELL OWNER 620 - 675.' GRANITE
OWNER'S NAME ALYSHA HERRERA C/I_NICHE D_ E S_IC_ 675 ' 676 VOID
STREET ADDRESS
1559 WITHERS DR 676 705 GRANITE
DENVER NC 28037
City or Town State Zip Code
7( 04 )- 425-1600
Area code- Phone number 12. REMARKS:
1 GPM 380-465
6.WELL DETAILS: 14 GPM 675-676 I
a. TOTAL DEPTH: 705 i
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: 200 FT. RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
(Use"+"if Above Top of Casing) /!�� - y
d. TOP OF CASING IS 1 FT.Above Land Surface* r h4 I o J27 �6X
*Top of casing terminated at/or below land surface may require SIGNATURE OF RTIFIED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
e. YIELD(gpm): _15 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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