The URL can be used to link to this page

Home My WebLink AboutGW1--05955_Well Construction - GW1_20241009 , • ' , :',,.,.,. ." • ,.- , , • • . , • W.ELL_,.,,..t.CONSTRIJC____TION RECORD •, .., !. 'FiTs7b7,.;a0 be uscd for siugle or multiple 411s..----- For)nterytal Use ONLY: I I' . . . r . • - I.Well Contractor Information; . - • ' , , . i 1 . ••- , . . . • - ---,-------•--f..-:,--.4----:-.„. 4 ,I- . . . . • Mitchell Dean Cook , -.14.WATER,ZONEL."':: • -T.7-------,----- - -,...,_1------- ,....,_:.:...„...,......____________...„._;...........„• . . .. .. .. :-Fiom ...Tb-L-7 .--'. ,DESCRIPTION 4-...."---J--7----4-..4-t."------*--- . Well Contractor Name ' ' ' . . . • 741-g-ft. gio-, ft. . 1 t, . . :... ' 2043 A '' ' ''' ' '' . ' ' • ._..___._......___._....___ . , • -474:-- -CT- :!'_, NC,Well Cootracfut Certification Number . • , . • . j..,.Oul.r..12•CASING..floptimilti;a7sed•Wells ZitTLINE 'it:p"Ilea' ble)_,----- , . . - . Dennis Holland Well Drilling; Inc. • J_Lt9..A,L____, T6-7.7, , DIAMETER__, THICKNESS 8 . MATEROC-7--- , A'. ft, „0,,, s•ft, ,,,,:!,,?-• ,'id. - . . , (-..'---:oniwin-y..--.Nnni..,.4-..:-..-..--......--.........---_,..__.,-,.-_-__.-_ -_,._:,,..-_____,_..,_,...__,..._ .16;INNER'OASIN.G DR.ITURKilkCcadtrctial..eleretHeo .-... -- 7- "..---- . _., . .. ...„E_Rolf,,, —To- , DIAMETER-- THICKNESS MATERIAL .---- 2.-Well CofistrUCtion Pertnitll: 4 : . . 6--) 1„..1--..-1,.V---, i Uri cell applicable well permiti Bat,C;unty,State.-FaZnee,In.jectidn,e(r) .1 1— f I. • .' in. • -------.-,-------.---- ---....- - " . • . . —' 3.Well Useft ft (cheek.well use): '' ' • 17.S'ir:Ii-141N---"----4-------4;+vc . -------"---"-----'•- •-'---- wa ter supply well: ----------.... , ---....-„--------...._17.0..M___ •r`o 77-:n 1 nnt Ei.i:na.:: ______SLOT'SIZI .iiiiict7N-Ess ntantiliir. _. ........_ 0 Agricultural Illyltuticipal/Ptiblic 1 . °Geothermal(1.1eatinpieooling Supply) VkK-J ,sidential Water Supply(sinp,le.) ft. ---- ------- ----- ---- , 0 Industritil/Commercial ----,.--,,--n-A-,,,-------,- -------, —, --- LiReSidentinl Water Supply(shared) -••-!!!!..!!..`1-"="4l-..., -• • 1z7.,'•I '''. - - •-• '-' .4,----; -77-7. . ryin,T...1").t. _,_ Ea1P1.6.CEMErg ME..10D 6.701Our.t- El Irriiation • No„-IYate.rTt7p, p1717a--------------------.— l'''? 4 rt. P4P1-. . 2 - . ............„._..... ..- /c,...%., 47 ../, °Monitoring . ORecovery __,•• • IL 62o '11 4kL,14,e,..-it4. . '---64-6c- .....____________,---. ---•-"--- ---..,....... injecirorTR-17------- ft. ft. e • P 0Aquifer Recharge - f..)Orotinciwater R.emediation -.19.SAND/GRAVEL PAg_Ktitipitica 14e).•,.- .. . 77". _____ ()Aquifer Storage and Recovery •OSalMity Barrier . • FROM TO _ MATERIAL,• _' EMPLACEMENT METH-WT.__ °Aquifer Test :.,' LAtdrinwater Drainage ---• ----‘-'— . --______ __ft. rt. I: ! °Experimental Technology 0:311bsidenee Ccintrnf . . °Geothermal(Qlosed Loop) .26;DRILLING LOG:(altileb additio sh nal ebts If ttecestial_.• ---..... ----7— . OTr ace r . . FROM _ TO DESCRIPTIOnrolor,hm,soiVrock Izpcorrl;Azt:etc.):-. • OGCOIllpf11111110ill113 1304111) . gather(explain under ti2L Remarks) ft, •. P. • '—...• ft. .' ft; II ' , - • I 4. Date Well(s)Completed: r, 69./,. ...2.*ell um /V 4, . . . ::,:•----•--•,-----J.-----.-----,-,--.-z.-?------- , Sa.Well Location: ' • . ... . ft -4..._;...... ..4.- ;,L-• i .,',t,„-4.. i, • , . m•-••• - `1 ility/Owner Name qt,Y_E 1.)Z cl kei-il . __________...,..,....„.-_____.____.....„•7---,--- -,_;-,--------- ...,....,.. ___&24,..--,-...____,....'',1: .,,• ft- - ft' I, Di, I 0• 9 2024 • ..,...:.........................______......_.........„•7.--...J.E4.1Z::"..Et.-:1 ;1",-..7.,:,:47c7,g.t:ATiiii.c Fac Fuca itS,Ifni(if upplicatile) .., • • ft. Physical Address,City,and Zip ------ - '-* - — ------- ' 21.REMARKS 47 ....,:i.a..8...,23_,E.LX2S-,,---. . -- --7 ---! -j— -------- County - Parcel idergificatio.n No.(PIN) --- - ---------- I -1 i - Sb,Latitude and Longitude in degrees/minutesiseconda or decimal degrees: Orwell field,-ona laVlong is sufficient) 21.cutifi„d„, 2z_e ,-2113 42,7_1_&L.." . w ..,z2 i,.t-‘,..X.,,g/Z..._ .a4...- lf Sr.. • 6.7 -204f1 _ , SiOatui-e of Cot:titled Well Corioacitor - . Date 6, Is(are)the wet*); fAkfrrianc.nt or f.:ITemporary . By signing this fern!, /hereby certify that the well(s)was(were)constructed in accordance with ISA NCAC 02C.0100 or ISA NC/iC 02C.0200 Well Construction Standards mid that a 7. Is this II repair to an existing well: (Wes or kriNir- copy old*record hos been provided to the well owner, . • If this is a rapoir,1111 out known tver/C011SilliCflOil WM-motion and t%splafit doe nature Of the 23.Site diagram or additional well'details: repair under 112i rental:Its saction neon the bark of this:form. You may use the back or this page to provide additional well site details or well ' 1 B Number of wells constructed . "COnstructiOn details. You may attach additional pages if necessary. . : - . For multiple injection or non-water supply wells ONLY with the stone construction.you aan l• submit one form. SUBMITTAL INSTUCTIONS I 9.Total well delith,below land surface: 5%5..1 _(1.) 24a. For All Wells: Submit this form within 30 days of completion of well Po,inuitipte wails An all depthsydifferem resomple,.1@,200'and 27@l00') — cpnstructinft to thn l'9110wini;:.-[ , 'II , . ,. . . .' ' .I Dii,i8iftii Or Wn'ter Reiour ces,.InformationProcessing,Unit, 10.Static water level-beloW,top of casittg:•-,;_;_if;t2.0.,_1'.',..:'..''';'.J,..__' _VI A •• ,. . ." 1617 Maul Service Center.,Raleigh,NC27699-.161.7 I.1 water leve/Is casing,use u“.." ' .- •-•. -- . • -•:•; •.‘,. .. ... . .6. - - 11.Borehole diameter: (in.) _ 24 b. Forleisztjon Wells ONLY: In addition to sending dn-1,fortn to ille..addorrs%.,,,ti:tu c.o 24a.nbove,•also subiit it'n'cooy"or this I tbriii''Within.30 day 'of complcum 12.Well nstruction method;,.._. Ro!ary. ____________ construction to lite tbllowing: 11 (i.e.anger,rolaiy,cable,direct push,eta.) Division of Water Resources;Underground Injection Control Program, • FOR WATER SUPPLY WELLS ONLY: . , i- . _ . - ----' '''' 77 1636 MailService Center I ,Raleigb;NC 27699-1636 • I - Air lift 24c.Fur Water Supply&Injection Wells: 13n.Yield(gpm)_. j:,2_ ______.-Method of test; ..... - Also submit one copy of this form Iwithin 30 days of completion of & H . I-1 we cOnstruction to the county health department of the county where ? OZ Ar „ 13b. Disinfection type:.._______,.......„,,,_ Amount: ,1..n._...._.,...,.......,..._... ll - constructed, . ,........., Form GW-I Ninth Carolina Department Of Environment and Natural Resources..Division of%Mt ReSC111JVCS r Revised A must 2613 • Sr-3 7 .-3 2. x, •Q,toect:� go "4", m Macon County 1830 Lakeside Dr 2 Franklin,NC 28734 p yy Public Health (828)349-2490 %'d a�0 envirovm@maconnc.org • WELL C NSTRUCTION AUTHORIZATION • • , Owner Le.eck f✓I er E'i 2aD`-}�A .WEL • Location C ( 0�19t2`�—I SEP oyS2� Directions .b c�yy7 vi.'� 1 ('2-4 PIDO yf„SC,R93C, ACREAGE 2,p1 44 •Design S; .,to Te,...::.l W e.N dr- Ex'iration Flu /2 e29 w PA troposer) f___ "1 j�rotose,D I cq e e S" IS \NNT, N.,3 l use 15;kc ` • O - L° K . • II ._... -- 1 1 1 \ See e 1 ArNA-3ro 1 \ \ Are\ \ S e e.1c NI• • v -\ • �1 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 I5A NCAC 02C Wei/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. . 81u i2-zye-----7.,� Issue Date Tc s 11'l o vt��(�i't^ . 2s~K z`93