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Home My WebLink AboutGW1--06295_Well Construction - GW1_20230921 i WELL CONSTRUCTION J J cc)[ ) — - I• • 1is t oms can be used for single ar multiple wt•.11s For intern(1 Use ONLY: 31 " 1,Well Contractor Information: Mitchell _ _` _ •_--- ___ Dean Cook ' Well Contractor Name FROM •-TO DF-•,;SCRIP'I70N �" ` " `` "•- Nr.Well i ro,,,ra� ------ ft. ft. —____- —__.. torCcrtificetian bar �. :l nijItTi` TN or.mW r:e� Dennis ,- 5:�. ,GT�y(3s� • �(BTwe�"i.() r'71N �ff(},i"`�le�til'c ��-='�:??:2;_' Holland Well Drilling Inc. �FROAt DIAMRTF:R rFI1CKNESS MATERIAI comp�t,y Name _ .._.----'..,..._-.._.....___-__. ft.- ,y� n. if ,��, _ 61 I* tNs l i?;? uD:u� >,�Po'i s _. 2,Well Construction Permit H; �:.{g-• .hecm''`e�cli>$i;d=loo" +`;',�:, , '•.:,::.:�°•,.--'-' ..:, FROM _TO DIAMETER lr)1._:•.MATEe.•,A >:...?as- . ��,,,,��//�� THICKNESS MATERIAL List all applicable well permits(Le.Coa te y�`i .__.__-..._— _ ft. TM rt. j in. ry,Srrnc, Vnrlanrc,h jeclial,etc.) — _ 3.Well Use(check well use): ft. fr. Sri• -"" Water Supply Wcll: -- - -- _ 7 k7s:jRFF• ._. r ,E-r,>fi 17 rkt:Tt_4.7 .-7177.7;•..r..�..�_ FROM_ ^r0� .. .::.....i:•; ,";," ,.t^';;i":;,r.'.c.:imi, i ,._ •DIAAI FTER ; SLOT SIZE ,TII,ICKNESS MATERIAI,. f_lAgrieulhtral 17MunicipaVPublic ft. ft.1 in. I °Geothermal(Heating/Cooling Supply) °Residential Water Supply(single) fL ��ft. in. '- C1If1dlISlrlill/c oinine1'CIRI .;, .�....:.. ...... sidential'Water Supply Shur e.1R a4.T?: , ::a,•;:r,,:,g;y;:a:�t�;,.>�., :. -:r-- Cllrri.ution. ( e<I) .•FROM "_ �To^: `•-` ;,..x;'��;..: , :>,,+.�,.::,;.::• Yt�,�,'t'is�%��;.:.,: :; :.;. _' MATERIAL EMPLACEMENT. EMPLACEMENT METHOD&AMOtiHT Nou-Wa ter Supply Well: -' - -= ---- _..• : ft. �a + Tft. rya <2_�.hut __.. :-. ". C1Monitrn'ing - [:JReeovery , ft'_. '�_R. �� Injection Well: _ _. _.___ 4i ... __._ ,,, ? 1i41: i__ --'-•-G A-A ._ ft. ft. [.7Aquifer Recharge • (;7Groundwater Remcdiation <3 '• A 1' ' ClAqu Storage >1 Ste':N .%" �C':XFi `7 �� ..1?L�� z�,:,.,..t:.:-..,i::,,:.r•r-•--'-----r�*a�:•-T;•- ifer g and Recover ;I;.P GK. i a r ; „s;;.. . •: :,_ Y C75UIhlily l3arricr FROM TO MATERIAI:, EMPLACEMErMETHOD fJAquifer'fcst ft. r, C1Stormwater Drainage • OExperimentai'1'eclufology C]Subsidenee Control ft. ft. " ' °geothermal Closet :fit)o 1) x _ — --.:, (Closed hoop) [:1'1'rncer FROM I_•;Iqry h'O(k_(at itlIj fid'cfltRifili'ebfs:ttYu tads . ", rackmow:r: ,.< .; l.7geothermal Hearin Coolie Return) (70ther(explain tuulerN21 Remarks) -__. r0__._. __DESCRIPTION'(co19.0ardoCM,soiVrock ,grainArRSctr.__. 4.Date Well(s) ft. ft. Completed49;,2/=,7 Well 1DH _I'L 4 •___.. ---.•_-..- -__..-..-_._- ___ _=-g7 --_--_-.- D. - ft' " ( L�i C, 1. .^ Se.Well Location: __ >' 4.141__ _ le) ft. , SE A_.___ __._.. . Facility/Owner Name W fertility 117N(if applicable) - - - -..._...- _.__.___._._ _._.__.._ -,-____.. Physical Address,City,and Zip _ 'xZ:l' -?^r-r.^.�----st-^..r., ......r^�.^N cry---.-t,•-,. c--- county _..._... _-- .._.-_........__....._...,_.__..._._...._�.I� ..._ .�_ Parcel Identification No.(PIN) 1. - ^— Sb.Latitude and Longitude In degrees/minutes/seconds or decimal degrees: _ - "- --"" .....".._ Orwell field,one let/long is sufficient) 22.Certification: I 6.Is(are)the well(,): immanent or• °Temporary -. Siguauue o(Ccttificd-Wall Contractor . Date By signing this form, 1 hereby certi that the well(,)was(were)constructed in accordance with/SA NCAC 02C.0100 or 134 NCAC 02C.0200 Well Construction Standards and that a 7,Is this a repair to an existing well: °Yes or ARITIr copy aphis record has been provided to the well owner. If this is a repair,fill out known well construction information and explain the nature of the repair under 1121 remarks section or on the back of this fonn. 23,Site diagram or additional well details; 1 You may use the back of this page to provide additional well site details or well 8.Number of wells constructed: __ __ constiuctiolt details. You may also attach tddltional pages if necessary. For orltiple injection or nont•u'ater.wrpply wells ONLY with the sante construction,you can submit one foin. SUI1M3:1'_I'AL INS`I'(JCTIONS 9.Total well depth below land surface.: • - _ 46 _ __.._ ___...... _ (ft.) 24n. For AU Wells: Submit this form within 30 days of completion of well Par multiple wells list all depths if different(example-3@,200'and 2L100') construction to the following: 10.Static water level below top of casing:_ _.._ (ft.) Division of Water Resources;Information Processing Unit, //,rater level rsabove casing,use."•I•" '"' 1617 Mail Service Center,IRaleigh,NC 27699-1617 I1•Borehole.diameter; 6 (in.) 24b, For Injection Wells ONLY: In addition to sending the form to the address in Rota 24a above:, also submit a copy of this form within 30 clays of completion of well 12.Well construction method: r- - �_ _ constriction to the following: (i.c.angel,rotary,cable,direct push,etc.) • i• - _ _ — Division of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY WENS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 13n.Yield rm Method of test: Air lift 24c.For Water Supple&Injection Wells: +__ "'HAlsoub smit one copy of this form within;30 clays of completion of 13b.Disinfection type:_H M Amount: Q.Z. well constnlction.to the county health de!,artment of the county where -- ---- -- .__- _' ._ constructed. Eons CW-1 Noith Carolina Department of Environment and Natural Resources•-Division of-Water Resources, Revised Antrum J.el t Q�oteer, ' O q 1 ) Ci /`�� •m Macon County 35 /e• o! ,m Public Health W36 62-7 L �`S NEW WELL CONSTRUCTION 'cj a� { CONSTRUCTION AUTHORIZATION f L1 CA-Lt`i,--- L17'�'. :3 _�� _2 3 �� PRIVATE DRINKING WATER WELL f APPLICANTfOWNER Rick Willbur __ LOG# 040123-P OSWW# 040323-S INTENDED USE Shared Well, Residential _�_ _ i _ _ �_ PID # 6564932675 ACREAGE 2.12 LOCATION Tract 1 Calico Dr. DIRECTIONS Old Murphy Rd,to R on Kiser Rd to R on Calico Dr First driveway on R Permit Conditions . Well shall be constructed in compliance with all NCAC 2C Rules. Maintain minimum setbacks as applicable, including 100'from all septic system components. DiagrarniNot to Scale? ~f A.o. Proposed Well Area • � `P �S (10'x10') • • $.0 + m,, . es t- ►to' • 10'I` iv I 15'min Existing Gravel drive • 131' i Proposed 3 BDR ' Residence • lM 2 O 'sp-• Qto Re aen e 6q• I_ 63' Pro• �� ' • 126' —,• Sir t D Bat • 9'min 135'IIIg ''- _ __+ 9'min 102'I'IIg 0' Iq• r._ —_.102—III - --- -- 140•" ------ - j� \ g0 Proposed Drip Repair Area y 1 IO• '.-- -- / •164 (3,750 ft=needed,4500 ft'available space) i J' �m�� it l4Z' - —. 2' 00. A�i l� ?t.l�43'�,... 105� �_, N IP 4-f This permit is Valid for a period of five years except that it may he 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 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 site by MCPH. A WELLHEAD COMPLETION INSPECTION MUST BE APPROVED BEFORE FINAL POWER IS GRANTED OR THE WELL IS PLACED INTO . SERVICE. PLEASE SCHEDULE A WELLHEAD INSPECTION AFTER PUMP INSTALLATION. QUESTIONS? ( 28) 349-2490 Issue Date: 6/7/2023 Josh Wilson, REHSI 3227 __Authoiized State Agent