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Home My WebLink AboutGW1-2021-02255_Well Construction - GW1_20210722 i WELL CONSTRUCTION RECORD For Intomgl Use ONLY: < This form can be used for single or multiple%veils 1.Well Contractor Information: Mitchell Dean Cookv . FROM TO DESCRIPTION Well Contractor Name 7 ' ft 7. 2043 A ft ft i NC Well Contractor Certification Number FROM TO DIAMETER THICKNESS MATERIAL Dennis Holland Well Drilling, Inc. 'zp ft ft in. Company Name "t1'.. t >E`11rCs1 IlyCs°O rllUB .6z !'e i los b -` MI `s�:;'� FROM TO DIAMETER THICKNESS MATERIAL 2.Well Construction Permit#: 0 '7 D��J -/0 ft ft In. LIsI all applicable well permits(t.e.County,State, variance,Infectlon,etc) M ft in. 3.Well Use(check well use): _ ''.1.I# .Z11t ;�, i'a'{�.r""�r'; >' -r.`t•¢if;�?�� ,,•'t Water Supply Well: FROM TO DIAMETER I SLOT SIZE THICKNESS MATERIAL ❑Agricultural ❑MunicipaUPublic ft. ft in. ❑Geothermal(Heating/Cooling Supply) sidential Water Supply(single) ft. ft ❑Industrial/Commercial ❑Residential Water Supply(shared) ❑Irri alien FROM TO MATERIAL I EMPI.ACEMENTMETHOD&AMOUNT ft. fr. Non-Water Supply Weli: ❑Monitoring ❑Recove ft. ft. Injection Well: ry ft ft. ❑Aquifer Recharge ❑Groundwater Remediation :s' ./, ' vb .Yt�IC31&'f%` r h° •t: �; � 4#¢ ❑Aquifer Storage and Recovery ❑Salinity Barrier FROM ft, ft.To MATERIAL EMPLACEn1ENTMETHOD ❑Aquifer Test ❑Stormwater Drainage ft ft ❑Experimental Technology []Subsidence Control ❑Geothermal(Closed Loop) ❑Tracer FROM G+10 ; DESCRIPTION s (col t..x=`�� FROM TO DESCRIPTION color,bardn aoll/rock ralnaiu etc. ❑Geothermal (Heating/Cooling Return ❑Other(explain under#21 Remarks) ft. ft ft. rt s,. 4,Date Well(s)Completed: 07-I S•Zi'Well ID# ft ft ,, .. e 5a,Well Location: ft. ft W.rLLJ-A A M e ` n=im ft. tt JUL Ad Facility/Owner Name Facility lDN(ifapplicable) u �) ft ft 9 nIr�CCf:SI �. _ 92 7 Brv.M& r_itY Zee/. t tr� •- Physical Address,City, Zipf 11AaCaA 4.5 876X IV-,i / Q County Parcel Identification No.(PIN) e , .h amo Q , 5b.Latitude and Longitude In degrees/minutes/seconds or decimal degrees: 22.Certification: (if well field,one lat/long is sufficient) .Q4 aS32 N�..�°. SRO •21'� w _lyl.�� =.� �'�,' z_� 07-15-20.21 Signature of Cortified Well Contractor Date 6.Is(are)the well(s): Eferm anent or ❑Temporary By signing this form,I hereby certify that the well(k)was(were)constructed In accordance with 1 SA NCAC 02C.0100 or 1 SA NCAC 02C.0200 Well Construction Standards and that a 7,Is this a repair to an existing well: ❑Yes or 97ITo— copy of this record has been provided to the well owner. If this is a repair,fill out known well construction information and explain the nature of the repair tinder#21 remarks section or on the back of thisform. 23,Site diagram or additional well details: You may use the back of this page to provide additional well site details or well S.Number of wells constructed: construction details. You may also attach additional pages ifnecessary. For multiple infection or non-water supply wells ONLY with the same construction,you can submit one form. SUBMITTAL INSTUCTIONS 9.Total well depth below land surface: � (ft,) 24a, For Ali Wells: Submit this form within 30 days of completion of well For multiple wells list all depths jjdifferent(example-3 200'and 2 a 100') construction to the following: 10.Static water level below top of casing: fa (ft,) Division of Water Resources,Information Processing Unit, Ifwater level Is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: 6" (in.) 24b.For Injection Wells ONLY: ink addition'to sending the form to the address in Rota 24a above, also submit a copy of this form within 30 days of completion of well 12.Well construction method: Rotary construction to the following: (i.e.auger,rotary,cable,direct push,etc.) Division of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 13a.Yield(gpm) ''L 0 Method of test: Air lift 24c.For Water Supply&Injection Wells: 13b,Disinfection type: H Also submit one copy of this form within 30 days of completion of H Amount: 12 OZ. well construction to the county health department of the county where constructed. Form GW-1 North Carolina Department of Environment and Natural Resources-Division of Water Rasoiures Revised August 2013 ' Macon County ' REPAIR EXISTING WELL |� ��|` �� U�U� CONSTRUCTION AUTHORIZATION 41 � �� / o��°: x PRIVATE DRlNKING WATER WELL Single-Family Well, Residential 6279 Bryson City Road 28N,turn into Cowee Baptist parking lot,take driveway to right of cemetary,take right before first house,to end Permit Conditions Well shall be constructed in compliance with all NCAC2C Rules. � Maintain minimum setbacks asapplicable. Wellhead must bo constructed tn meet current requirements. ` Permit\y for the purpose of drilling existing well deeper. Diagram (Not to Goaio) Permitted Septic System Well to be drilled deeper House Driveway Property Une This permit is valid for a period of five years except that it may be revoked at any time if it Is determined that there has been a material change In any fact or circumstance upon which the permit is issued. Well location,installation,and protection must meet state regulations.The well shall be Inspected and-approved by Macon county Public Health before it is put into use. The location of the well indicated by MCPH is to provide protection from possible sources of contamination. Flow volume(well yield)Is NOT guaranteed at any site by MCPH, A WELLHEAD O]MPLGTlON INSPECTION MUST UE APPROVED BEFORE u POW ER ' WE��P�C�l�D SERVICE. PLEASE SCHEDULE AVVELLHEAD INSPECTION AFTER PUMP lNS|8LL8KUn \