GW1--04946_Well Construction - GW1_20240816

Wes. ONSJIKT rzN',CORn �� _._ _ �__�
This form ran he used for sheltie or multiple wolls pow Intemgl rise ONLY: -"--
‘• Well Contractor information:
Mitchell Dean Cook Iq.W TER'/.OIV)5 '^" ---.�. ____...
FROM_ TO-_,...DE3(RIP•. ....... r _..' _._
Well Contractor Neste - - _
2043 A
ft. ft.
NC Well Cnotrertot Certification Number -
r L be 15.()DYER CASINGar;multi-cased wells iii,LINE if ap luble� . ^-
DennlnJ Holland Well Drilling, , FROM---. TO DIAMETER THICKNESS MATERIAL.
, Inc. o , It. ,*, ,ft, I- -- --_ r _ ._ _._ . .____._ .w .. in. :a� �4,�
Company Namr, -^- �'��'"" • L6:INNER(ASING OR:TUS (:' et thermal..closed-too .
FROM TO _
2.Well Construction Permit//: O DIAMETER—, MATERIAL
list all applicable well permits(i.e.County, � _..... fL ft, in,
ry,State, Varimtce.,injection,ere.)
yT_-^— • - "^ft. ft. io. "---
3.Well use(chck well use): ) 17SRI537 O-__._ -_ __-",- ` _ - _ _ - -WaterSupply Well: FROM T ^ DIAMETER SLOT ill C NRST�A1FRTM_ , �°Agricultural JMtuticipal/Public ft• ft, in.I:IGeothennal Meeting/Cooling Supply) 7 sidenlial Water Supply(single) ft, ^- ft. -- in. '- "-' "
UlntlustriaVConunercial 11�FktSTtTential Writer Supply(shared) Ig.-GROUT•---.-•-..--..._..._,_.._..-� --- .
Uteri:atiot__ FROM •�'f0 TI AT ERIAL.T- EMPLACEM ENT METHOD h AMOUNT
Non-Water Supply Well: ______ _ _f_L
� r ft.
l7Monito ing °Recovry •ft. -
ft.
Injection Well: -- — h, ft.
OAquifer Recharge CJC)roundwater R.enlediation .1,9.SAND/GRA_YEL,PACK'iCq licable `�,--
°Aquifer Storage and RecoveryAE. )
I:)SRliniry Barrier FROM TO MATERIAL EMPLACEMs:NTMFTHQIi 1-
l]Aquifcr'I'est ft. ft.
C3Stornrwater Drainage. -• —___ -„-_,_-.
()Experimental Technulo It. ft. -�
f(Y °Subsidence Control
D(.ieothernlal(Closed Loop) Cameo .20;DRII ddN(:l.(>G�(attachiaitilitional sbceta If nacesl �.• ��
FROM TO DE,SCRIPTION_(rolor,ha drratoolY ck ripe,er'L,sizeoc.L1
°Geothc woal(Heating/Cooling Remo!. 00ther(explain under 1121 Remarks) ft. h.
d. Date Well(s)Completed: i , tV 4 , _ _
_ ft. _ ft._ � ���^-
t� �
SR.Well Location: — _____ - -
t t- .�!7y ys. -6/- -. �JC11L _ _� __ -..._- --- ._
fj ,. fs. ft.
Facility/Owner ame `
fnciliry lDff(if applicable) __......_....___.....__.._-._..._._ _........._....... z a a.. ..fd.,, 1
n. ft. �_.__— .r�� ��. � �, a._
3`�`y`. .hi e�-✓<, _��ee•!j.0 4_ICm q d 6-44,.e�6,4 ..._ ft._ ft.- - - _— ___ _ /�I I( _1 � ._—._
Physical Address,City,and Zip -_._."._.,..___ _.__^v U �..�0�4
21.REMARKS _
1.t&i,7- 658a.9$4-2 ?'.S_'..1. ____._ ._�_-- ^_ ____.._..__ ir,`�,.:, „'-;. ?' -.TAn ,,'. Alt
(:nasty ---_-...-------- _-._.._.._.__.._ 0___-
Pmrel Identification No.(PIN) C'r'.c„�.+�
Sb.Latitude aid Longitude in degrees/mimute.s/seconds or decimal degrees: __ _ _ .-----" --- -�'---T--
(il'Well field,one IoUlong is sufficient) 22.Certification:
354 i/..-2 93, =a.> `'. 'o,43 7L5/ w ) 't' :iLk 11_._, _rta..—Seem.___. • a8 /3 --2c)•jY
Signature of Certified Well Contractor Date
6. Is(are)the well(s): pen-uncut or °Temporary
II),signing this firm, l hereby certify that the wells)war(were)constructed in accordance
with ISA NCAC 02C.0/00 or ISA NCAC 02C.0200 Well Construction Standards and that a
7.Is this a repair to au existing well: it Ycs or L9tY6- copy of this record has been provided to the well owner.
If this is a repair,fill ow known well construction it%oramtion and explain the nature of the
repair undo,-112/remark.,.cec(jo,,or on the hack of(history!. 23.Site diagram or additional well details:
You may use the back ot'this page to provide additional well site details or well
A.Number of wells constructed: ___ construction details. You may also attach additional pages if necessary.
For multiple inlrrtiun or non-water supply wells ONLY wish the same construction,you con
submit nor form. SUBMITTAL.INSTUCT1ONS
•
9.Total well depth-below land surface: 30 T(ft.) 24a. gr All Wells: Submit this form within 30 days of completion of well
rue mtdtiplc wells list all depths if different(example• 10200'and 2 r®/00') construction to the.following:
10.Static water level below top of casing: Q„o ^-,_ ____ _(ft.) Division of Water Resources,Information Processing Unit,
1(waterlevel irabovecasing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
I I. Borehole diameter: 6____� (in,) 21b. Fo1 Injcclion Wells ONLY: In addition to sending thi form io the address in
ary 2'la above, also submit a copy of this limn within 30 days of completion of well
12.Well construction method: • _ - anlsuuction to the ti)Ilowing:
(i.c.auger,many,cable,direct push,etc.) "
__ _ Division of Water Resources,Underground Injection Control Program,
h'OR y1'A'fFR SUPPLY WELLS ONLY: T _ _ 1636 Mali Service Center,Raleigb,NC 27699-1636
13a.Yield(gpm) 'z40 _•_• __._,. Metbod oAf test If-lift- - — 24c.For Water Supply&Injection Wells:
I`I Also submit ono copy of this form within 30 days of completion of
13b,Disinfection type:•-,•.•_,.,_•. Amount:• ? nZ, well constuctiot) to the, county health department of the county where
_ ..._..._._............. constructed.
Form OW-I North Carolina Department of Environment and Natural Resources••Division of\Water Resou rea krvisrd Auaust 7.01)

Qtotecr
�� •? Macon County •
1830 Lakeside Dr
Franklin,NC 28734
o S Public Health
[phone]
o, a�J [e-mail]
d
WELL CONSTRUCTION AUTHORIZATION
Owner Jeffry Epperson WEL 071324-1 SEP N/A
Location 344 Middle Skeenah Road, Franklin PID 6582342897 ACREAGE 8,3
Directions South Georgia Road, R Addington Bridge Road, R Middle Skeenah Road, L onto driveway just past Volunteer Fire Station
Design Shared Well Permit Type New Construction Expiration Valid for 60 Months
Y U
0
S
�n
x. House v
o
--Th
I x House I
'
1
arpon ,0 0 M\� '� I -_
P/L 2S�
40'
Proposed Well Area��0'x40' \
q6'
40'
30' it
120' a.
Ek.7' � •House 3
ill c
o
NI (1 'O
. >
LI
0
P/L i.
3
Noposed Carport
use
—
1 Septic Area i
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.
3) When well and pump are completed, 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 place well into service.
Any person abandoning a well must submit to MCPH Form GW-30 upon completion.
July 30, 2024 /kfJrs4i,, I4/IktDe .
Issue Date Anna Hokrein, REHSi 3384