GW1-2023-02913_Well Construction - GW1_20230420

WELL CONSTRUCTION RECORD (GW-1i For Internal Use Only:
1.Well Contractor Information:
Frankie L.Oliver :'-14.,NVATERZONES
Weil.Contractor Name FROM TO DESCRIII ION
3002-A 195 ff 371
448 524
NC Well Contractor Certification Number �"11 S.OUTF,9'CASING(for undti.cased welli)Ok.I,TNF.R'(jf,ap'livable)
Carolina Well Drilling FROM . I TO I DIAMETER THICKNESS 111AIIZ
0 ft' 1129 ft' 6 114 SDR21 PVC
Company Name INnIt CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: 22-446 FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well constniclion permits(i.e.117C,County,State,Variance,etc.) ft. ft. in.
3.Well Use(check well use): ft. ct. in.
,47.,SCREEN,,,
Water Supply Well: FROM TO DIANIFTER SLOT SIZE TfnCKNFSS -MATERIAL
_jAgricultural nMunicipal/Public ft. ft. in.
71Geothermal(Heating/Cooling Supply) [3Residential Water Supply(single) ft. ft. in.
:?Induscrial/Cominercial OResidential Water Supply(shared) 'I�8GROUT-,-,,],,�"-7,1'�, ," 7. 1.. '1�t', . I �,
zIrrigation FROM TO I MATERIAL EMPLACEMENT I%MTHOD&AMOUNT
Non-Water Supply Well: 0 129 Bentonite Pump(55)501b Sags
:lMomitoring DRecovery
Injection Well: ft.
D—Aquifer Recharge OGroundwater Remediation .
I.- 19.SAND/GRAvF CPACKCafappliciible)
11 IlAquifer Storage and Recovery 13Salinity Barrier FROM TO NUTERLILL EMPLACEMENT METHOD
Aquifer Test [3stormwater Drainage ft. ft.
Experimental Technology [3Subsidence Control ft. ft.
Geothermal(Closed Loop) nTracer 20.DRILLING LOG,(attach addifionaislicets;ifnecmsan),
Geothermal(Heating/Cooliqg Return) n Other(explain under 421 Remarks) FROM TO DFSCRTPTION(coin hardness,sontrock tyLw,grain size,etc.)
o ft. 12 Red Clay
4.Date Well(s)Completed: 2-22-23 Well ID# 12 "' 105 Brown Sandclay
Sa.Well Location: 105 ft. 115 Brown/Blue Rock,,--.
Edmund Rothschild 115 It. 550 ft' Granite ti !t—
Facility/Owner Name Facility ID#(if applicable) ft. ft. la gnnl)
8203 Skye Lochs Dr.Waxhaw 28173 Skyecroft Lot#136 ft. ft.
Physical Address,City,and Zip ft. ft. in C.iv,
Union 06-102-155 21.'RENIARKS
County Parcel Identification No.(PIN)
56.Latitude and longitude in degrees/itdnutes/seconds or decimal degrees: Well Variance Pen-nit#WV0300121
(if well field,one Jai/long is sufficient) 22.Certification:
34.59.536 N 80.43.495 W 2-28-23
6.Is(are)the well(s)OPermanent or OTemporary Signature of Certified Well Contractor Date
By signing this farm,I hereby certify that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: E3Yes or RNo with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
If this is a repair,fill our knois7z well construction irtibnnation and explain the nature of the copy of this reenrd har been provided in the well owner.
repair tinder#21 remarks section or on the back of this form. 23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well site details or well
construction,only I GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled: SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 550 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells lint all depths if different(example-3@200'and 2@100� construction to the following:
10.Static water level below top of casing: 38 (ft) Division of Water Resources,Information Processing Unit,
If water level is above casiykq,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6 (in.) 24b.For Injection Wells: In addition to sending the form to the address in 24a
Air Rotary above, also submit one copy of this form within 30 days of completion of well
12.Well construction method:
construction to the following:
(i.e.aug
er,rotary,cable,direct push,etc.)
Division of Water Resources,'Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Cenker,Raleigh,NC 27699-1636
13a.Yield(gpm) 65 Method of test: Air 24c.For Water Supply&Injection Wells In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: 70%HTH Amount: 36oz completion of well construction to,the county health department of the county
where constructed.
Form GW-I North Carolina Department ofErivirotimenral Quality-Division of Water Resourc., Revised 2-22-2016

ROY COOPER_ y
Governor
ELEABETH S.B1SE_R
Secretary
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
December 1,2022
Edmund and Beverly Rothschild
8203 Skye Lochs Drive
Waxhaw, NC 28173
Delivered via email to: [e-mail]
RE: Variance Request to Rule 15A NCAC 2C.0107(a)(2)(H)—
Separation distance between an Irrigation well and Other
sewage and liquid waste collection or transfer facility.
Well Variance Permit#WV0300121
8203 Skye Lochs Drive,Waxhaw
Union County
Dear Mr.and Mrs. Rothschild,
On December 1, 2022,the Mooresville Regional Office received the completed written request for a
variance to the well construction rules,specifically rule 15A NCAC 2C.0107(a)(2)(H),which specifies a
100-foot separation from "other sewage and liquid-wastewater collection or transfer facility".The
variance request is for the construction of an irrigation water supply well at 8203 Skye Lochs Drive,
Waxhaw, Union County.
The sewer line location and building limit the well location at the subject site. In order to provide
protection for the groundwater resource,the new irrigation well shall be sited no less than 50 feet from
the referenced sanitary sewer line and no less than 25 feet from the building as shown on the submitted
map denoted as"well area." Based upon the information that has been submitted, a variance to the
above-cited rule is granted. The variance will be effective from the date issued until December 1,2023.
Since the well will not meet the regulatory requirements,the following minimum additional
construction requirements will be necessary to mitigate any potential problems that could affect public
health,the ground water resource and/or the well's effective operation:
1. Galvanized steel casing with drive shoe shall be used,or PVC casing may be used if fitted
with appropriate shoe.
2. The casing shall extend into consolidated bedrock in accordance with the following table:
Depth to Consolidated Bedrock Minimum Depth of Casing
Less than 50 feet 15 feet into bedrock
50 to 100 feet 10 feet into bedrock
More than 100 feet 5 feet into bedrock
ry North Carolina Department of Environmental Quality I Division of WaiteriResources
®FM��/}� Mooresville Regional Office 1 601 East Center Avenue,Suite 301 1 Moo lesville,NC 28115
704.663.1699 NORTH CAR0104 �/

3. The entire length of the casing shall be grouted. A drill bit that is at least 4 inches greater
than the outside diameter of the casing shall be used to drill the cased portion of the well.
Grout shall be installed using a pump and tremmie pipe. The annular space to be grouted
shall be free of obstructions; if not,the grout must be placed to the maximum achievable
depth of the annular space and a well liner with packer must be installed 10 feet below the
casing and fully grouted. The final construction method shall be shown on the GW-1 Well
Construction Record
4. The well shall be used for irrigation purposes only and shall not be used as a potable water
supply.
5. The well shall not be plumbed into connection with municipal water currently serving the
property.
6. The well driller shall be certified by the North Carolina Well Contractor Certification
Commission as required by General Statutes 87-98.4,Title 15A NCAC 27.0101 and .0110.
7. The well shall be located approximately as shown on the provided map. The well is to be set
in a location no closer than 50 feet to the existing sanitary sewer and no closer than 25 feet
to the building.
It is my finding that the factors specified above are sufficient to satisfy the conditions for approval of a
variance as defined in 15A NCAC 2C.0118. A copy of this variance shall be attached to the required Well
Construction Record (GW-1). The granting of this variance is for the location of the well only, and in no
way relieves the owner or agent from other requirements of the North Carolina Well Construction
Standards,or any other applicable law, rule or regulation that may be regulated by other agencies. If
you are dissatisfied with this decision,you may commence a contested case by filing a petition under
G.S. 150-23 within sixty(60) days after receipt of the decision.
If you have any questions regarding this variance, please contact Edward Watson at 704-663-1699 ext.
2199 or by email at [e-mail].
Sincerely,
EADocuSigned by: i
aw 1 P
F161FB69A2D84A3...
Andrew H. Pitner, P.G.,Assistant Regional Supervisor
Water Quality Regional Operations Section
Mooresville Regional Office
Division of Water Resources
CC: Ed Eason, Union County EHS(via email)
®� North Carolina Department of Environmental Quality I Division of Water Resources
Mooresville Regional Office 1 601 East Center Avenue,Suite 301 1 Mooresville,NC 28115
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niamCAaouua ` 704.663.1699
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