GW1--05562_Well Construction - GW1_20240913

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. .,, RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
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"°'gyp "' WELL CONTRACTOR CERTIFICATION# 3489 240017
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1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 67
RICKY HUFFMAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 235 To 236
From 360 To 375
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 O To 148 Ft.6 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--1-9-BAGS —
WELL CONSTRUCTION PERMIT#AG WELL From To I 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 9/6/2024 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 WATAUGA Depth Size Material
From To Ft.
OFF DUTCH CREEK OFF HWY 194 OFF BROADS1 From To i Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To 'Ft.
TOPOGRAPHIC/LAND SETTING: i
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Slope Valley X Flat Ridge Other i•d'.:7 ::�,
(check appropriate box) 11. DRILLING LOG �1' Li
LATITUDE 36.19486N May be in degrees, 0 From 90 To DIRT Formation Desc'Fpf or1 : 2024
minutes,seconds or
LONGITUDE —
81.79069W in a decimal format 90 136 SHFI I Ir`--,-- �.
130_ 210 GRANITE '"•if J
Latitude/longitude source: X GPS Topographic map 210 235 ' QUARTZ C'`�'�vG ��'
(location of well must be shown on a USGS topo map and 235 236 VOID '
attached to this form if not using GPS) 236 360 GRANITE
5.WELL OWNER 360 375 GREEN GRANITE
375 405 GRANITE
OWNER'S NAME JD HAMBY _
STREET ADDRESS 1101 HAYNES ST STE 111 ,
RALEIGH NC 27604 . --
City or Town State Zip Code
( 919 )_ 801-4754
Area code- Phone number 12. REMARKS:
15 GPM 235-236 •
6.WELL DETAILS: 5 GPM 360-375
a. TOTAL DEPTH: 405
b. DOES WELL REPLACE EXISTING WELL? YES NOX I DO HEREBY CERTIFY THAT THIS WELL
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 BEEN P-•VID 7 TO THE WELL OWNER.
(Use"+"if Above Top of Casing) 4
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d. TOP OF CASING IS 1 FT.Above Land Surface* .I1 I I
*Top of casing terminated at/or below land surface may require SIGNATUR OF CER IED WELLICONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RICKY HUFFMAN
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. I Rev.3/07
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