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Home My WebLink AboutGW1--05225_Well Construction - GW1_20240903 W��-I=! 5,TL CTION RECORD - ---- ----_ _ _ ___� This one can he used for single or multiple walla Fur Intenl4l llse ONLY r -i'l.Well Contractor Information: _ Mitchell Dean Cook la;�vATER-%ONL+Sm'_'_' - WellW FROM T0 Dk3('.RA ii-et ^ Cnntrnclnr Name -^--�'. "_"_""_'^. •-•-- '-._....._"._"..�...._-_"'._""' - n, ft. _ _ NC Well Camractl>((.rnificetion Number I5.CIUTER 4:ASING. for:multi-cased•wells Zit Lin ..ifap°°°��'liable r Drilling, FROM �TO S �' •� MATE--•-__...-.__ - L•�ennlS Fi011and WP.II _ TO DIAMETER 'rfIICKNESS MATERUI. Inc. .ft. ;n. ia. - Company Nnrur. �� "� "' '.11.6;INN(i•R CA11NG OR<T_UBUVCtcotherma .closed-loop). 2,Will Construction Permit/: OG/' G / FROM T(! DIAMETER THICKNESS MATERIAL l.i.n rdl applicable well permits l.e.Coon CFZ l ,',•'"'''^_._ _-,- ft, ft. la. ^' / ( ty,,Slate, Variance,lnjeclion,ell..) •„-- — ^ 3,Well Useft. ft.- — itr._ ._____..._._..__ (check well use.):Well: _.__ _ __ _ l7.SCRiittN_ _. __.__..1.-Water Simply _._--- FROM _Tf)'-" ^DIAMRTF:R _ SLOT SIZE ' TIIICKNRSS MAATERIAI,-- (]Agricultural OMtmicipal/Public rt. rt. in, ClGeothennal(Heating/Cooling Supply) .tiidcnlial Water Supply(single) TM ft. —1 ft,^" in, '_ -_ 0lndustrial/(.:ommercial ,�,U�tdential Water Supply II 18.CRUU 1'' 'R'_�`-'' -"MJ�`'' t 1 y(Shnl'Cd) roo ..73 .. hIA.reit' :. EMPLAceM ENT MCTIIoD h AMOUNT Non-Water Supply Well: -- , fr. 3 n. Pcw�f/ PP Y Well: ___ �c • ft' ft. • u. )dugs+ (7Mction We _.___.� IJRecovery _ _ Injecting Well: - _— — ft. �' ft. �' DAquifer Recharge ('.)Groundwater R.entediatiun .19,SAND/GRAVEL PACK ifa licgble ()Aquifer Storage and Recovery (:)Salinity Barrier FROM TO MATERIAL __. EMPLACEhsENTMFTHOB t]Aquifer'lest ft. ft. L')Stormwntcr Drainage ,,_ __-_-_...__. l7Fxperirnental Technology. R. It. lJ`iubsidnncc Control _ UCie.0lhennal((:lased Loop) .20;DRIId.(N(:LUG.jattocb'additional shoots if noosed• Li Tracer FROM_ TO DESCRIPTION,Act)I hardline,s,woitrock I7Peteratn the,etr.L• 0(ieothermal(Heating/Cooling Return) DOthet'(explain under N21 Rt:mnrks) ft' TMft. 4, Date Well(s)Completed: r 8/ � -_ ft. fry - �^ _ D O ellIDN /V /Z/4 — ft. ._.• ft_-.._.__ _. Sa.Well Location: — _ _,,-;-- ft ft. V s Facility/Owner Name Fncili —" �f� ty lDN(if applicable) ---•---•-.__.. ...._.. _._.-_. _._._.. �.. LUz-4--_..._...._..... ft. n. Physical ddress,City,and Zip 21.REMARKS • County Parcel Identiliention No.(PIN) "" T�' - -_ . ..-._._ _. _ _ _-- _ Sb.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: -:T_ __ _ _. _________-...__,_-.-.__ 22.Certification:(if well field,nice laUlong is sufficient) ? -2 - --40 -/Z• -,46 i 't-c.-:... /�_._l,124eit.._ gei'T. e:S.ems-.z ,44 Signature of Certified Well Contractor Dntc G.Is(are)the well(s): tABefneanent or C:I'I'cmpnrary Oy signing this form,l hereby certify that the well(s)wax(were)consuvcved in accordance with 1 SA NCAC 01C.0100 or I SA NCAC 02C.0200 IV¢B Construction Standards and that a 7. Is this a repair to a0 existing well: ( Yes or i �_ copy of this record has been provided to the well owner. I/this is a repair,fill out known well construction it foraanion and explain the nature of the repuit•under 1121 remarks section ar on the hack of this form. 23.Site diagram or additional well details: You may use the back ot'this page to provide additional well site details or well 8.Number of wells constructed: 1____ construction details. You may also attach additional pages if necessary. For multiple injection or non-water supply wells ONLY with the sante construction,you can submit one form. SUiBMiTTAL,INS'l'UCTiONS 9.Total well de(ith below land surface: ?aver,. ... ,—(ft.) 24a. jry All Wells: Submit this form within 30 days of completion of well Fur multiple wells list all depths!f different(example-.t rt 200'and 2 l00') consuUClion to thin following: 10.Static water level below top of casing:-•M_ P !-,__-____(ft.) Division of Water Resources,Irifonnation Processing))nit, II waler level in above casing,use"+" 1617 Mail Service Center,Raleigh,NC 2'1699-1617 11.Borehole diameter: 6— (in.) 24b. For Injec(ion Wells ONLY: In addition to sending the form to the address in RQt�ry 24a above, also submit a copy of this loan within :10 days of completion of well 12.Well construction method:. conxuuction to the titllowing: ------- (i.e auger,lately,cable,direct push,cu:,) __ _ Division of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY WELLS ONLY: - r 1636 Mail Service Center,Raleigh,NC 27699-1636 13e.Yield(spat) Air lift 24c.for Water Suppler lnjectioo Wells: _..__. Method of test:__._.._...__._._--.�......._ Also submit one copy of this firm within 30 days of completion of 13b.Disinfection type: hi & Mwell construction to the county health department of the county where ..- _....___. Amount:.1?•t_4!„._....._.._._. ._._. .�_..-._._._—_ constructed. Revised Aunusl 2D1? Form OW-1 North Carolina Department of Environment and Native]el Resources••Di`isioni of Water Resources oOtec-t • 0rr •m Macon County 1830 Lakeside Dr Franklin,NC 28734 . Public Health (828)349—2490 o�y sa/J envirovm@maconnc.org WELL CONSTRUCTION AUTHORIZATION Owner Anthony Degina WEL 080924-1 SEP N/A Location TBD Highlands Gate Rd—Franklin,NC PID 7522271025 ACREAGE 4.4 Directions Highlands Rd to Cardinal Ridge Rd,stay R on Highlands Gate Rd; lot on left across from Gorge View Dr. Design Shared Well Permit Type New Construction Expiration Valid for 60 Months V Nail Nail �� Nail 43, 11' v's" Well Area Utility Box. 83, 69 ® Existing Well Utility Box Diagram not to scale Permit Conditions 1) Well shall be constructed in compliance with all 15A NCAC 02C rules. 2) Maintain all minimum setbacks,were applicable. 3) Abandon neighboring well in accordance with 15A NCAC 02C.0113(b).Submit form GW-30 to MCPH upon completion. 4) When well and pump are completed,contact MCPH for inspection. 5) Water samples are required for all new well constructions.Contact MCPH for fees and scheduling. The issuance of this permit by MCPH in no way guarantees the issuance of other permits.The property owner is responsible for checking with appropriate governing bodies in meeting their requirements.This permit is subject to revocation if the site plan,plat,site,or intended use changes.All rules in 15A NCAC 02C Well Construction Standards are incorporated by reference into this document,including any subsequent amendments to those rules,and shall be adhered to.Please contact MCPH for inspection when well head and pump installation are completed and you are ready to place well into service. Any person abandoning a well must submit to MCPH Form GW-30 upon completion. August 12, 2024 Issue Date —Cha len, REHS 3258