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Home My WebLink AboutGW1--05226_Well Construction - GW1_20240903 VV.E L CONSTRUCTION RECORD __., 'this form can be used for single or multiple wells For Internal the ONLY:______ NLYRT___ —� r^ r 1.Well Contractor Information: Mitchell Dean Cook ----- — —] - 14•N'1tTER%ONES - ----. e FROM TO- DR3(RiPTTON Well Contractor Name -^- _ .. _ -' +^ - 2043 A .� , ft.' !'i r ft. NC Well Comractut Crnifiestion Number 15.QUTER(;ASBVG. for:multi,er ed wells'AR;LINE "Ifnilablc -' [tennis Holland Drilling, FPROM T TO S-"' � --..._,� - Well Drilling, Inc, DIAMETER 1FIICKNESS MATERUL. ---^- •-...._..._,..... ,_. --fl. '`�^ rl, .6-, in, Company Naror. ^-^--- ---- _.T i •ib:INNER @A1NC ORiTUB ...• enthermaLc red-o0 2,Well construction Per / FROM MTO _ DIAMETER MATERIAL min/k 1/ '>�� list all applicable well penults(lee.Conn r` etc) '-.•--^-..-_-__..... -fr, ft. io. ry,.State. Varinrrce,lnjrctlon,err..) __,.•,••' _ - 3.Well Useft, ft, _� -_.io.- '---- (checkwell use): Water Supply Well: - -`-- 17.SClthbfV_._....____. __ �- ` - _ _._.-- _mot flu- -DIAMETER SLOT SIZE TIIICKJeESS MATERIAL. - ALtrlelttlllfAl LJMtuticipal/Public ft. ft. in, fJ --- ClGeothennal(Heating/Cooling Supply) 7 .sidential Water Supply(single) ,-- ft. -___ft. ,-__._ in. '-' Olndustrinl/Crnnmetciat I1Residei tial Witter Supply tl Ig,f;RUUT-'•--- ---- -- I I y(shared) _ _ Curti:All011 _PROM �YO _ arA7ER1AhT Eat PLACEMEr' METHOD A AMOuorT el Non-Water Supply Well: - �, r ft. y , ft. �� - L- °Monito ing ./- R^ ®--/ fr. .e�. .f /� �J� °Recovery Injecting Wcll: _.__.__....- .- ...-_-..- ft. ft. __ °Aquifer Recharge CJGroundwater R.emecliation 19,SAND/GRAVEL.PACK Ifs tic ble .� -"-' (°Aquifer Storage and Recovery -�� a -) ---^ (:]Salinity Barrier FROM TO MATERIAL EMPLACEMETITMETHOD� l]Aquifer'lest ft. ft. _._. C3Stonnwater Drainage --- _ ()Experimental Technology CJSubsidence Control ft, ft, 'T' C3CieothcrmAl(Clued Loop) L�Tracer .20;DRII.ANG L.UG{attach'additional sheets If oeeesi �_• FROM_ TO DE.SCRIPTION•••(roler,hard rie,_roiOTtkr7Pe,p'dnriu,r---' °Geothermal(Heating/Cooling Rotting_ I:300w(explain under N21 Remarks) ft. ft, • 4, Date Well(s)Completed: r.OS-.2,J,,12j[Well IDI, /14 �� ft. fr ��- _ -_� _�__ Sa.Well Location: ft. ft. n vq -.. M Facility/gwncr Name. •"'•_ P (t Facility ION(if applicable) -._.rt_.. ....__..__._._f 1_•_._...._......_...._.....�_.__._._..._..._.��.i_.�� i...�V>?.� ft. ft. Physical Address,City,anti Zip _ L':.,_. '-:,�y.._-- /�� ram. 21,REMARKS •-•.[•'0^L4(1lC�iylr,Z �.�t 7i.Ca;C�7.1..��. .-._. ._ ._.-.._ --__-..._.._____._..__ - -..__ .__._...._.. County Parcel Idrmilit atirnt Na.(PIN) -�-^ -' -^'_.- _ Slt,Latitude and l,00gitudc in degrees/minutes/seconds of decimal degrees: _vT —^^-..___.._..-..._---'-'��-T-_ 22.Certification:(if well field,one IAVIcing is sufficient) o ,9'23 ". Signature.of Certified Well Contractor pact (i. Is(are.)the well(s): tlpefmaoent ot• f,'ITcmpnrary iiy signing tnis Joan,I hereby certify that the well(s)was(were)constructed in accordance with/SA NCAC OIC.0/00 or ISA NCAC 02C.0200 1Pell Construction Standards and that a 7. Is this a repair to an existing well: (°Yes or kritlir copy of this record has been provided to the well owner. l/t1Us is a rapist;fill out known well construction information and expluin the mimic of the lttpulr wide,'till remarks.scuts/odor on the hack of this form. 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:_1 _ construction details. You may also attach additional pages if necessary. For multiple iigeciion or non-water supply wells ONLY with the rattle construc6m6 you con submit one form. SUBMITTAI.,INSTUCTIONS 9.Total well depth'bclow land surface: 9•d.•'t ' .._.(ft,) 24a. ):gf„I 11 Wells: Submit this form within 30 days of completion of well Pat multiple wells list all depths if different(example-.I a 100'and 2)/00') construction to the following: -•V �Q_ .•• -_____^- (ft.) Division of Wale,'Resous,'ee.5,Information Processing Unit,Static water level below top of easing: l(water level ir above casing.use 1617 Mail Service Center,Raleigh,NC27699-1617 I I.Borehole diameter: _. _.-- (in.) 24b. Foi.l.n.jsmjon Wells ONLY: In addition to sending the form to the Address in Rnt�3ry 1.4a above, also submit a copy of this firm within 30 days of completion of well 12.Well construction method;,•_ construction to the ti>Ilowitug: (i c.auger,misty,cable,direct push,sic.) _ �"-_ — Division of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY WELLS ONLY: ___ 1636 Mail Servire Center,Raleigh,NC 27699-1636 13A,Yield(gpnt)„,__ /Cj •• Air lift 24c.For Water Supply&Injection Wells: Method of test:__•-,._.____.___.-..._.. . Also submit one copy of this form within 30 days of completion of I;its,Disinfection type:•M„&•_M Amount:,12 oz. well consbction to the county health department of the county where - .__._.__...-_.—_..."__ constructed. Revised August).01 1 Form OW-1 North Carolina Department of Environment and Natural Resources••Division of Water Resources Qloteet • • �� •m I Macon County 1830 Lakeside Dr p Franklin,NC 28734 Public Health (828)349—2490(Office)o r ; SGh /1 / — (828)349—4136(Fax) WELL CONSTRUCTION AUTHORIZATION f f� /- 3 3 l./ Owner Sandra Rangel Perez WEL _ 111623-P SEP 112323-S Location TBD Azalea Rid.e Rd PID 6573756718 ACREAGE 0.98 Directions Murphy Rd,L onto Mashburn White Rd, R onto Patton, L onto N Blaine Branch Rd, L onto Azalea Rdg Rd property on R past#117. Design Sin.le-Family Well Permit Type New Construction Expiration Valid for 60 Months -t 0 . �oc c ��a9 . ,p_a <cc � 9c.�eJ Driveway +rl Pa S b°, N. �a � o J�o Ica G Q' �o ° e c. `Q "zo) jai e .\d'o IP/Power Pole t 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, 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. January 11, 2024 ' /w._ Issue Date Trevor Justic EHSi 3294