GW1--05472_Well Construction - GW1_20240912

RESIDENTIAL WELL CONSTRUCTION RECORD
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w<r North Carolina Department of Environment and Natural Resources-Division of Water Quality
'4* F� '�a- WELL CONTRACTOR CERTIFICATION# 3489 4r06O
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1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 67
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 330 To 331
- From To
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 77 'Ft. 6 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 4Ft.-.18 BAGS --_ - __
WELL CONSTRUCTION PERMIT# 185007 From To !FL
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 +;Ft. in. in.
DATE DRILLED 9/5/2024 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 FlV a`Tetlal'.r,:: ~,
From To Ft. `L.- b' L.
J-1-I,.%
LOT#4 OFF SIGNATURE RIDGE RD OFF WORLEY From To Ft. �+
' (Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft. J E P 2024
TOPOGRAPHIC/LAND SETTING: Ir,r:gr.A;t ra Prrx. _
Slope Valley X Flat Ridge Other DANCtittOG
(check appropriate box) 11. DRILLING LOG
May be in degrees, From To Formation Description
LATITUDE , — 36.19955 minutes,seconds or 0 3 DIRT
LONGITUDE 81.82901 in a decimal format 3 170 GRANITE
— — 170 185 GRFFN GRANITF
Latitude/longitude source: X GPS Topographic map 185 310 GRANITE
(location of well must be shown on a USGS topo map and 310 330 GRANITE QUARTZ MIX
attached to this form if not using GPS) 330 331 VOID '
5.WELL OWNER 331 405 GRANITE
OWNER'S NAME JON BARNETTE 1.
STREET ADDRESS 309 EISENHOUR ST
ELIZABETHTON TN 37643 -
City or Town State Zip Code
(423 )- 895-1473
Area code- Phone number 12. REMARKS:
20 GPM 330-331
6.WELL DETAILS:
a. TOTAL DEPTH: 405
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: 80 FT. RECORD HAS BEEN PROVIDED O THE WELL OWNER.
(Use"+"if Above Top of Casing) Q
d. TOP OF CASING IS 1 FT.Above Land Surface* q. 'r ��
*Top of casing terminated at/or below land surface may require SIGNATU�E OF CE I D WELL CONTRACTOR DATE •
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN 1
e. YIELD(gpm): 20 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. 1 , Rev.3/07
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