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Home My WebLink AboutGW1-2022-05994_Well Construction - GW1_20220617 , WELL CONSTRUCTION RECORll This form can be used f'or single or multiple wells For Iutcrnal Use ONLY; 1.Well Contractor Information: Mitchell Dean Cook 4,wnF�i.7(Nl✓s. _ .•:... FR M TO DCSCRD�TfON Well Contractor Name •> ft �lt%6� ft. 20•t J A s✓i ft. ft, NC Well Contractor Certification Nmnber 15'nUTNR,(}rtiSINC,for multi eb's'ail walla l)Ra)1NER{1 ' 1iWble _ PROM TO DLIMF,TER THICKNESS I MATERIAL Dennis Holland Well Drilling, Inc. 0, ft. `-� fr. 06 in. '51 Company Name 1NNR CAS11y('r OR"PIl$ING'`eot urmal,closed-!o8 FROM TO DIAMETER THICKNESS MATERIAL - List Well Construction Permit#:��..�, ;x-;� � tr. ft. in. List all applicable well perruirs(i.e.Coun%State, Variance,Injection,etc) ft. ft in 3.Well Ilse(check well use): WateY Stlpply WCII: FROM 1 TO DIAMETER I SLOTSIZE I THICKNESS I MATERIAL ❑Agricultural OMunicipal,'Public ft. fr. in. ❑Geothermal(Heating/Cooling Supply) C]Residential Water Supply(single) ❑Industrial/Commercial CnlResidential Water Supply(shared) "18 .CsROU.T _.:, FROM TO MATERIAL EMP[,ACF.MENT METHOD&AMOUNT ❑[rri ation Non-Water Supply Well: !} fr. ft. ;7;f�ir' ,�,r 4-• �G ; ❑Monitoring ❑Recovery S' t ?> —A . FOAquifer ection Well: ft. ft Recharge 00roundwater RemediationO tAVRI+PpGIC1 fia Itca a",• ❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO I MATERIAL. EMPLACEMENTMETHOD 1r. ft. 0Aquifer Test 03tonnwater Drainage OEx erimental Teclulole 1t fL p gY L-]Subsidence Control `,i20,DAIliliTN(.Ln•(r atrtich+ulilitrgariltsti`ects`rftrigcesse ' ❑Geothermal(Closed Loop) t:.l•l•raCer FROM TO DFSCRD'TION color,6ardo soil/rock t rain e+u etc. 00eothermal Heatin Coolin Return) UOther("plain tinder#21 Remarks) fr• ft. 1r. ft. 4.Date Well(s)Completed:/y/.,-�� Well ID# /F/i 5a.Well Location: fr. ft. ,4_ lctiy rr /av c— %m:L z!/ 7 ft. ft JUN 17 20 Facility/OwnerName FacilirylD#(ifoppliceble) -.- _ ft. ft. ft. rr. Physical Address,City,and Zip ,..+i.t }hit /t%i to �'<g 7 "`S'4,/S 1 v..2 County Parcel Identification No.(PIN) 5b.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification: field,one ladloug is sufficient) N rY-5I-C' , G '' W Signature ofCertificd Well Contractor Date 6,Is(are)the wells}: op manent or ❑Temporary By signing this faun,1 hereby earl fy that the we!!()was(were)constructed in nccw•dmrce with I SA NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards rind that a 7.Is this a repair to an existing well: CIYes .or EiNci copy of ibis record has been provided to the well owner. 1f this is a repair,fill our known well construction information and explain the nature of the repair under#21 remarks section or on the back ofthi,sfornr. 23.Site diagram or additional well details: You may use the back of this page to provide additional well site details or well F Number wells constructed: construction details. You nmy also attach additional pages if necessary. For multiple b jaction or non-water supply wells ONLY with the same construction,you can submit one form. SUBMITTAL INSTUCTIONS 9,Total well depth below land surface: 310 J ' (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well For multiple wells list all depths ifdf ferenr(example-3@200'and 2@1001 construction to the following: 10.Static water level below top of casing: 16 ' (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: 6n (tn.) 24b. For Infection Wells ONLY: In 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: rY construction to the following: (i.e.anger,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).,310 ^„ Method of test: Air lift 24c.For Water Supply&Injection Wells: '" —�-- Also submit one copy of this form within 30 days of completion of 13b.Disinfection type: H & H Amount: 12 oz• well construction to the county health department of the county where constructed. Fornu GW-I North Caroline Department of Euvironmcnt and Nantral Resources•-Division of Water Resources Revised August 201.1 Qiotecp *m Macon C o u n t y NEW WELL CONSTRUCTION PUbIIC Health � � CONSTRUCTION AUTHORIZATION t,fr. (sue I PRIVATE DRINKING WATER WELL f I Brian Horner • [�O�92�7221-P • 113120-5 l ,..•, --- -� ---- w:F.,.,, U��r1JlUc+ • •f Off Wa ah Road • 64W, R on.Old Murphy Rd., L on Wayah Rd., new gravel drive on L just past#3368, go across bridge to open field, DIRECRsite on_R side. Permit Conditions Well shall be constructed in compliance with all NCAC 2C Rules. Maintain minimum setbacks as applicable. " Well not to be subject to vehicular traffic. If 100'is not maintained to any septic systems then permit is void. Any questions call MCPH. i Diagram (Not to Scale) �..— Nantahala River iBrid,3 >2S- Concrete 251 ;•...... : 1 Monument Proposed 7L Well Area 42��^ 26' r 1 25'x 15' I L—————r r I ------ Ex.ST and PT on property that pumps to an easement area Proposed off ro Well Area #1 property. Proposed Driveway 22'x S' o 0 ti 30' ------ ------------, I Maintain 100'from I Neighboring septic I Systems Bush 10, Repair Area I 66' 'I I , 0 0 � I Initial I , Area t-------------------- Creek ..—..—..—..._..�..—••—• � ,1• _..—..�...^..—.._.. -- 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 he inspected and approved by Macon County MCPH is t provide protection From possible sources of contamination. Flow volume(well yield)is NOT ' i C o Intouse. The location of the well Ind cited by ( I � Public Health before it is put t P guaranteed at any site by MCPH. A WELLHEAD COMPLETION INSPECTION MUST BE APPROVED BEFORE FINAL POWER IS GRANTED OR THE WELL IS PLACED INTO QUEST IONS? 828 9-2490 R PUMP INSTALLATION - ( ) INSPECTION AFTER Q • LHEAD I . SE RVICE. PLEASE SCHEDULE titIssue Date: 1/10/2022. Tanner Stamey, REH 2.712 .• horized State Age . l I �