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Home My WebLink AboutGW1--03319_Well Construction - GW1_20240603 WEL,Ia CONSTRUCTION RECORI) For Inter*tine ONLY_ -- 'fltis form can be used for single or multiple wells 1,Well Contractor Information: Mitchell Dean Cook 14.WATER'/,ONES - ^_-"- FROM TO _ DESCIUPTION Well Contractor Name f + ft.— tZi t ft. ___.�__.-.— _^—T NC Well ContsarIsr Certification Number 1�T yy ER(:AMNGsfor multi-Cased wellal OR.LINE (if appiicablt�7 PROM TO DIAMETER_ THICKNESS I MATERIAL. _ _ Dennis Holland Well Drilling, Inc. ft: <<rr. in. Lsc z/ fayG Company Nana: - - __._�_____T-�_- .16.INNER CASING OR IUB G(geothermal:elated-loop) n 4_ FROM - T(l _ DIAMF(geOt THICKNESS MATERIAL _ 2.Well Construction Permit N:_, _� � Z-t___ �__.._.__,--, fr. fr. in. -' List all applicable well permits(i.e.County,State, Variance..Injection.eic..) _ _ a ft. ft. in. 3.Well Use(check well use): _. . _ 17.SCREEN Water Supply Well T-'- -FROM • �'r0�~ DIAMETER SLOT SIZE THICKASS MATERIAL, OA gricultural ft. ft. in. b l7Mwticipal/Public _____ --4-- C°Geothermal(1-Ieating/Cooling Supply) 7 sidential Water Supply(single) rt. rt. in. '-" __ ❑Industrial/(:onunercial L°Residential Water Supply(shared) I!'G.14-2 _ — "-T fllrtivitimi FROM TO h1p'retiAt. EMPLACF.MEKI METHOD&AM(Wr4T -- i ft. + ft. Non-Water Supply Well: _ '� L -se2;._' J"-�_- r!%n4,"�'�,,/ [Monitoring Li Recovery 3 e ft. �� r fr. _L fl/ 1 ' ,' /9,41,[ta. Injection Well: -'� ^� ft. '� ft. 0Aquifer Recharge (7Groundwatcr R.emediation 19.SAND/GRAVEL LACK(if Ypplicable). —_ FROM TO MATERIAL EMPLACEMENT FT MHOD+ OAqu ifer Storage and Recovery OSalinity Barrier fr. fr. °Aquifer Test L7Stormwater Drainage - ~ - --- ft. ft. °Experimental'l'echnology 17 Subsidence Control 20:DRILLING t�UC attach additional sheets if necwaa s_ liar_�_ _ ___ °Geothermal(Closed Loop) ❑Tr'aeer 'FROM TO �DF:SCRIPTIOncolor,hardness,a),I/rock Ir.LrainsixLetcj_ - flGeother mal(Heatins/Cooling Return) ❑Other(explain under N21 Remarks) ft. ft. "'-- __�� _ -4^ 4.Date Well(s)Completed: c o5_%.;�-.. IDN /V / _ -- -___ __-_ TR, ft. _ --. _ Sa.Well Location: ft. ft. -. till, 'a' •r it .• .J - RI i4 w c :,Lw et, ..�.. 1,.. ft. - fr. - Facility/Owner Name Facility lDH(if applicable) —..------- ._-. ...._._.__. ---__.....--._.-..rki. i_.IJ._�_.EQ.24_.—_.__..._.._ ._. ft. ft. j -=csa.'l e -LrP_te fia C4. -_ - ...__...--ft.------ ft.-....._-----Tfr v�Y:_•1'',fi^•.r 2 - J` --- [Y/ C,,gc3 Physical Address,City,mid Zip 1L REMARKST�� —T ^— --216.1a14.41______ (1)59,SgM 1 tO _....___________________ County Parcel Identification No.(PIN) Sb.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification: (if well field,one lat/long is sufficient) 356. 451 d8C-/f�. x?.; S.iG�GS IS. _ w 1�I '� c�lL_. -_- _-__ eP�� d 5-1..?. 0;1. 4 Silptature of Certified Well Conerartos Date 6. Is(are)the well(s): I4.12cf nanent or f7Temporary fly signing this form. I hereby certify that the well(s)wait(were)constructed in accordance with 15A NCAC 01C.0100 or 15A NCAC 0/C.0200 Well Construction Standards and that a 7.Is this a repair to an existing well: OYes or F.}Noo- copy of this record has been provided to the well owner. If this is a repair,fill out known well construction it larmation and explain the nature of the repair under#2/remarks.section or on the hack of this fortn. 23.Site diagram or additional well details: You may use the hack of this page to provide additional well site details or well S.Number of wells constructed: ____�_ 1 construction details. You may also attach additional pages if necessary. For multiple infection or non-water supply wells ONLY with the same construction,you can submit one form. SUIIMITTAl.INSTUCTIONS 9.Total well depth below land surface: ...5"5_5 j�,_, (ft.) 24a. FQC••/ ll Wells: Submit this form within 30 days of completion of well Fur multiple wells list all depths if different(example-3@200'and 2(jl00') construction to the following: 10.Static water level below topof casing: _ ��tt (ft.) Division of Water Resources,Information Processing Unit, LG.___.____. 1617 Mail Service Center,Raleigh,NC 27699-1617 If wale,.level is above casing,use. "-." 6" 241). For Inie tion Wells ONLY: In addition to sending the form to the address in 11.Borehole diameter: (in.) 24a above, also submit n copy of this form within 30 days of completion of well 12.Well construction method: Rotary ._'_______ -_._.•.-_.,._..-_ construction to the Billowing:(i.e.auger,mussy,cable,direct push,etc.) Division of Water Resources,Underground Injection Control Program, FOR WAFER SUPPLY WELLS ONLY: - 1636 Mail Service.Center,Raleigh,NC 27699-1636 Air lift 24c.For Water Suppix&Injection,Wells., 13a.Yield(gpm)-..__ ,iii-d_.__.__.__. Method of test:___._____,_.___.__..._..-.._ Also submit one copy of this form within 30 days of completion of 1-1 & M well construction to the county health department of the county where 13b.Disinfection type:-____ Amount. 12 Qz•.,_...__ constructeu. - Form OW-I Notch Carolina Department of Environment and Natural Resources•-Division of Water ResourcesRevised August 2013 Qfotect `� •m Macon County 1830 Lakeside Dr Franklin,NC 28734 o J Public Health (828)349—2490(Office) °.d- 0 s> (828)349-4136(Fax) WELL CONSTRUCTION AUTHORIZATION Owner Richard and Victoria Luecht WEL 022024-1 SEP 025224-1/025324-1 Location TBD Lon• Rd PID 6593889116 ACREAGE 7.68 Directions Take Clarks Chapel to L onto Long Rd almost to end property is on the Right Design Shared Well Permit Type New Construction Ex.iration Valid for 60 Months • <>,(- u:�/ �``� N(i,, • Ex.-Well • n9 ••..a 40 i'raina •••.. IP 9e ... i i 12'= 16' 33' I I r--- . 17 i 0'Man I Well 110' o • 10 Area 411- Proposed c 10 \(\ S/rean) al / t1-8edrooi G f•P r 7jj Mouse 8: -, .0 3 10'Min_ , 1 I '' m _1 pi 3 a / / r) • 'f'�o 78' / / F �q 10'Min Oy. / / q f-- —►0,7 �, / , . � / , ^ , , cP_ `. 5 SO Min r/ i .�I?' • � �// /1S 1 4,N,b, �aI/�Min rf /•pSydO.Ne // ~/ $�' / iu Tte, / / g /•bNvpr i 26' Proposed --i ` / �� 7 F 1-Bedroom �' House A L Diagram not to scale Permit Conditions 1) Well shall be constructed in compliance with all 15A NCAC 2C rules. 2) Maintain all minimum setbacks,were applicable. Including 100'to all parts of Septic Systems. 3) When well and pump are completed,and home is ready for CO, contact MCPH for inspection. 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 apply for connection to power. Any person abandoning a well must submit to MCPH Form GW-30 upon completion. April 5, 2024 Chi, Issue Date Chaz Allen,REHSi 3258