GW1--06297_Well Construction - GW1_20230926

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W.E__ CON, 1 '
' CONSTRUCTION ---.-,-..._...-.•..,.__.__ I .
Ibis loan cen be rued for sin gle or multiple,wells FOE lutemTl Use ONLY:
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1.Well Contractor Inforulation: 1
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Mitchell Dean Cook ' ;i r r - , _ �' —� - -- —--
r(4'r`'zsti F' :WfiNES,: ^xi<: ^.�- , :r:.•-:--_-•_..,, -
Well Contractor Name
FROM TO "r` DESCRIPTION
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SCRIPTTON
2043 A p rr .)/: ft - _ _ ____
NC Well Contractor Certification Number -, 1 1
"rRRonf '{ �e e.(;t VAN :..A�`..-- <:. ,�,._.:
Dennis F•iallan(i Well Drilling, Inc - ` Wit-'--
. - 'CFIiCKNESS MATERIAL
Company Name •
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4-3.:1N1!( It=(?•A fPf(r.'(1Z;PU$W4'(keoi arnica;cl'as'z1b8' ' MFi'.
FROM To h_:..,, PZi7F::[i.;M :++:E''I :,_
2.Well Construction Permit#: r,`.0,a,23._L' DIAMFlF;R rfI1CKNESS MATERIAL
List all applicable well permits(i.e,County,State,'Var'ianrc,Ijeotion,etc.) -r._----_...__. --_^ft. ft.
3.Well Use.(check well use): ft. - ft. r iq. ---------
Wa ter pply Wcll: _ __ ___ {_,"17;'.S�(`•RF FfVr•;-" .-_T :.,-$.-----1r.; .::,,,,:•:cr r.,...k, -_ �:,,.._._
FROM_ ^rn`: _ ,•:,:.::.
....a;::._..:x.:�_,.�.;.:;.use:..r.,..,:,,r.,.r..a'a,,,...•:.- , ... ..
-�DIA�iFTER fit.OTSIGE THICKNESS f,tATER1AL
f_lAgriculhrral f-7MucicipaVPublic ft. ft." Mi.
°Geothermal(Hcating/Cooling Supply) fJ'Residential Water Supply ft. ^ft• M i.
❑hidustrinl/C, Pl Y(single)
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ammercial
SupplyC:1Residential-Water (shared) --)e 9101"''` :.r,;' , =•
CJlrrigutinn - . oat >.To'r :,:;.. .r i:.':,.3.` a=` z�%r;.,;".,;:; �
... _..._ . -:EMI, }� EMPLACEM ENT METIIOQ&AMOIIMr
Nan-Water Supply Well: __- .____._... , ft: , ft.
°Monitoring [.7Recovery eft: �, rt.
Irijectioo Well: __ -_ " _--_ •-i'7`+� g.,,A.fe_9'__.Are,.0s�__�
.' ft. ft.
1.7Aquifar Recharge I_7Groundwater Rrmediation ^1. r `" j. c•:•;. •
9 S Fliotvi Nei V.
.Z;.._.. .E"r to lf�ab:i'' >r:. - ; :
C A uifer Storage Recovery 0Sulinily I3arrier ._-, __MATERIAL EMPLACEMEigMFl-4in -.
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IJAquifer'fr t rt. _ft, C
LIStorniwater Drainage • _.._.._. _ ._,
..:
C1Experimental'1'cchnology ClSubsidence Control •
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ft. ft._ `- - _ _ —__..
[)Geothermal(Closed Loop) C,.1•l• ':Oyil)R (Ii1t3#6(()'t`>:{atfacH tit :'` 3 " 'i° 't>•• ;�<
raetf F7sor11 TO ( Yli crib l.iiti(corFiugde:94 i'Y.u"r tkI:p;,crai<re< ,..;
, _0Geothermal Neatin Coolie Return) °Other(explain widerb21 Remarks) - '-ft. DES(RlprtUN{color�ha»Ioau solVrocktype,Rralns;�,ctr,
4.pate Well(s)Com feted: ft. ft. i •
Se.Well Location: "` f' ----Ft. I� t_ ,y ��,
ft. ft _ , _ ►. '.- , ter L."V"1 . r :a
Facility/Owner• Name AA/A• ^ --^ ft. ft. //�� ((��
Facility InH(if applicable) '_..____.._' L £* Sl_2V.23_.___�..__..
. 'ft. ft,
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Physical Address,City,and Zip + T 1 ird-CI. I !',71; --:
1211'`I;SIvIplilfS,: _ ^^ a
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Camay . Parcel Identification No.(PIN) '_ ___ __._.___.. _ ___ __ _ ___,____
Sb.Latitude and Longitude In degrees/Minutes/seconds or decimal degrees: _ _ ____ _ T1 — — — _..__
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Orwell field,one Iat/b ag is sufficient)) 22. Certification:
3.S 16�..2 i-1 N'--- 4)-_ '/ W
.Signanue.of Certified Well•Cootractor ' • Date •
6.Js(are)the well(s): faucet or °Temporary
By signing this form,l hereby rertfjy that the well(s)was(were)constructed in accordance.
with/.SA NCAC 02C.0/00,ur 1.5A NCAC 02C.0200 Well Construction Stnnt/aids and that a
7,is this a repair.to an existing well: °Yes or iLQ•No ' copy of this record has been provided to the well owner.
If this is a repair,fill out know(well construction information and explain the nature of MI: •
repair under 121 remarks section or on the hack q/'Ibis form. 23.Site diagram or additional well details:
You may use the back of this page to Provide additional well site details or well
8.Number of wells constructed: ____ ___ construction details. You may also attadh additional pages if necessary.
For multiple injection or nor(-water supply wells ONLY with the same construction,you can j
submit one form. S1111MI'I"I'AI.1NS'1'l1C:TIONS
9.Total well depth below land surface: -.3(�3�__ ,_ _ (fr.) 24a. [ter Al] Wells: Submit this ti)rm within aU days of completion of well
•For multiple wells list all depths if different(example-3(a,200'and 2-6100') -� construction to the following: i
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ill.Static water level below top of casing: CJ _ (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"-r-'• "� 1617 Mail Service(enter,Raleigh,NC 27699-1617
11.Borehole.diameter: 6 _ (in.) 2Qb. For Injection Wells ONLY: In addition to sending the Form to rite address in
jl $
Rota 24a above, also submit a copy of this form within 30 days of completion of well
12.Well construction method: IN ___.__.__ cunstniction to the following:
. (i.c.auger,rotary,cable,direct push,etc,)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY:^__._- ____` T� 1636 Mail Service Center;Raleigh,NC 27699-1636
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•131,.Yield Im _, Air lift 24c.For Water Surpj&Injection Wells:,
(gI ) J._._:._._-_:___. Method of test:-_--__._.._,...___..
"' `"- Also submit one copy of this form within 30 days of completion of
13b.Disinfection type:_H$H_ ____•^ Amount:_12 U'• well construction.to the county health department of the county where
Form OW-1 .Nnnh t'nrntinn nnnn,I.nnnt nIUnvirnn,nrot and Natural Li,.cnnn•ne...ilivicinn nr Wnmr nncnurrne Review!Auousl Mil

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Y`r ,_ im--Macon County
Eo a.`'Public Health �i"" NEW WELL CONSTRUCTION
�' / oVh t?/Y C RUCTION AUTHORIZATION
PRIVAON51TE DRINKING WATER WELL
•? APPIICAIITJOYINER ',Robert ' LOG# 070323-P OSWW# 070923-S
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INTENDED USE .Single-Family Well,Residential PI D # 6578545697 ACREAGE Acreage
LOCATION TBD Bryson City Rd
DIRECTIONS Bryson Oty Rd to driveway going uphill on Rust past#9049 Bryson City Rd,Just before the Rose Creek bridge.
Permit Conditions
Well shall be constructed in compliance with all NCAC 2C Rules.
Maintain minimum setbacks as applicable,including 50'from all septic system components.
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Diagram(Not to Scale)
Proposed single ramily,\
1 1 *-----. well are. `r •
I 1 i >9'
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1 En.Neighboring I ? "3\� i
1 septiearea 1 �0
50 min 1
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i 1n �`\ .`t aWith
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u '"46' {el 5m arct—' 12'S,.w
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39' w,.,.,A
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Fix.Port 78' \Oltta\ 05'
• 0,min 78rZ3f9 \PI
7a� 9In\ttal \
1 g'on .ry' \
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13n 21.00 ft�`�0%707...
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g 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. Weil 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 slte by MCPH. •
A WELLHEAD COMPLETION INSPECTION MUST BE APPROVED BEFORE FINAL POWER IS GRANTED THE WELL IS PLACED INTO
SERVICE. PLEASE SCHEDULE A WELLHEAD INSPECTION AFTER PUMP INSTALLATION. QUE NHS?�(828 349-2490
30 2 23 Josh Wilson REHSI 3227 " horizedStateAgent
• Issue Date: 8/ / 0
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