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HomeMy WebLinkAboutGW1-2021-04437_Well Construction - GW1_20210811 V[L'LL CONSTRUCTION REM�... rGW-1) FOI bterad USe + L Well Contractor Information: . 7. M I V Avw, '14.WATFdtZOMM.... won Coouacoor Name FROM TO IDESCBZtON95, �v L' ; o��,p(1 "T R R y NC wen ComaciozCaml3omba 15..0U7ERCAMN(; fw.multieasedwebs OR Tam u�tih a'1L� �Gn � ilf FROM TO D1 M8I8S MMEN M MAMiAL t1 � 1 C R R is 2.WeII Construction P #: 1 1� l V U ` 3 J 6 1 4 3 CAgQiG OR TII�iG - aFcersrmeteL mamma _= Ltsrad ask weD Permits!£e U1G Cormry Sodr< Yariarmq ere) .t R Co Q R a -(— 3.Wen Use(cheek via met R 8 1a aPPa7 ; Waters Well:- •:1.: ::.. •...:.:,�.;>.:-<:::.: _ :��,::= 'v'�r �:,. MM TO DIAMSFFBB SLOTSILB IffiGI;i�S s^;us�er•T DAgticultmal ❑Municipal/Puhlic R ❑C al(Heft*Coolmg supply) z*mdenLia1 water supply(single) s R in. 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'repab miler#21 r wwb sealon or on the bath of dasform 23.Site diagram or additional well detaa7s: S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construes info construction,e®ly 1 GW-1 is needed. Indic ite TOTAL NUMBER of wells. (add'see Over'in Remarks Bo)4 You may also attach additional pages ff necessary. 24.sUBMTTTAL INSTRUCTIONS 9.Total well depth below land surface:Foraad ( )� Submit this GW 1 within 30 days drpk we&list aff dgrks ifdfrrern(ample_3@200•and2oloff of well completion per the following: 10.Statue water level below top of casing, (R) 24a. For All Wells: Original form to Division of Water Resources (DW4 If waw ksd is above c=ft ire +- Information Ptoessing Unit.1617 MSC,Raleigh,NC 27699-1617 1L Borehole diameter. gym) 24b.For Injection Webs:Copy to DWR,Underground Injection Control(IUC) Program,1636 MSC,Raleigh,NC 27699-1636, hod- (2.Well='4�construction�puA 24c.For Water Supply_and Q�ur��O Geothermal wgetera��,Copy tO the ` ) =mty envammentat health,' coturty FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells Vrode oven 1 GPD:Copy to.DWR,CCPCUA 13a,Yield(gpm) Metkod of test Permit Program,1611 MSC, k 1 11 131L Disinfection type: Amount: Foffi GW-1 Naudr Camlim D%Mrtem ofFavnomaeatd Quality-Division of Wamr Resam= Revind 662018 Mc SWF q �o ROY COOPER • Governor NC DEPARTMENT OF _ HEALTH AND MANDY COHEN,MD, MPH Secretary HUMAN SERVICES MARK T. BENTON •Assistant Secretary for Public Health Division of Public Health Onsite Water Protection Branch July 19, 2021 David and Sophie Mugg 125 Big Hill Rd Boone,NC 28607 Re: Approval No. JMB2361 Private Well Constructed with less than 20' of Grout [Rule 15A NCAC 2C .0107(f)(1)] Property location: 187 Big Hill Rd Boone,NC 28607 Dear Mr. and Mrs. Mugg: On July 16, 2021 the On-site Water Protection Branch received your request for a variance from the Well Construction standards, Title 15A North Carolina Administrative Code Subchapter 2C .0100. The request for a variance concerns a water supply well that was constructed without meeting the requirement for having twenty feet grout. i Specifically, the variance request grants you permission to use a water supply well without twenty feet of grout. The well is existing and serves two homes. Based upon information provided by the Appalachian District Health Department, well contractor, and the property owner, it is my finding that based upon current conditions as the site exist today(as well as the current proposal for use of the structure) you meet the conditions necessary for approval of a variance,,as specified by 15A NCAC .0118 (a) (1) and(2). On that basis and if the following conditions are met, the requested variance is approved: 1) A packer liner shall be installed per with the well contractor's recommendation and done in accordance with the Well Construction Standards. The liner shall extend a minimum of five feet below the casing into the bedrock. 2) The well shall be sampled for the same parameters as a newly constructed well. After the initial new well kit, the well shall be sampled quarterly for colifortn-bacteria for one year. If samples indicate contamination, further repairs or treatmen6vill be necessary. NC DEPARTMENT OF HEALTH AND HUMAN SERVICES•DIVISION OF PUBLIC HEALTH LOCATION:5605 SIX FORKS RD,RALEIGH NC 27609 MAILING ADDRESS: 1632 MAIL SERVICE CENTER,RALEIGH�NC 27699-1632 www.ncdhhs.gov-TEL:919-707-5854-FAX:919-845-3972 AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER