GW1--06305_Well Construction - GW1_20241022

WgI,,IL CONSTRUCTION RFCOR1) - -�-- -
flris fo (with,:m d for singleor muhiplc wells For Intrnigl Use ONLY T Tom- __ ��
'rt.Well Contractor Information:
Mit(:hell Deani .
_ __.._.____�,
Cook • dq,WAT:ERt%QNES' _ I' I""'
. Well Cooh•ac(ot Name �- FROM TO �� DESCRIPT70N
20�3A. . . •p%n,. .5f f rL:. + f _
. - c-Ypa•ft `I �,1t ' .1 1 .. --
NC Well Contraru+t(rnificaiimi Number 15 OUTER(A iNC,(for multi-cased wells)OR.WNER Ir'ap leable . •'
FRQMT, TO -DIAMETER S_--.PP ERIA'_ ".'_'t_.._."-
Dennis Holland Well-Drillt Inc- . " -- rRicKl�Ess_�T MATERIAI"�_
----- ,-.__._____._.--_.. a•• ri, �. rI '•I: io; , 1 /
(:ompuny Name. ����' �' •1.6;INNER'I;ASIN.G OR::-T 1FVCi' eotherm 1 � • �i �
` FROM Tp closcd,loo
2,Well Construction Permit ll,_• _ M_,_
a
DIAMETER ' ITfICKNESS MATERIAL
Li.0 all applicable well peewits(i.e.Coiiiiiy,Smrr., u `,��wn ate `' -- ""' -f t' ft, I,'id.
3.Well Use(check well use 1 _ • ^'
Water Supply Well:. -� — FROM ___ 'ri___..-,-DIAh1F:TER SLOT.SliE-TIIICKNRSS TMATERIA1,
(7A(;rieulnieal ' IJMtmicipal/Public ft. lb in.
r:ICleotiturinni(Pleating/Cooling Supply). 7 sidentinl Writer,Supply(single.) _ ft. -"�^It- -'__-- in. -" ""-
Ulndusu'ial/(:;onimerciil (_Iltesidential Witter Supply(shared) 18.'rJRUUT�'�_-__'�j"•--"� _ - _..-
0Irrittitioil _FRQh1 _TO�.., hIAYER1Alm. - EMPLACEMEIYr MtJTIIQDh AMOUNT
• Non-Water Supply Well: �"� __ __ ' 0 -, fL��)-+ fL �i ,c .5.
CJ
DNI0I1iloring ^ ft, ~fr, • -
____� 11Rncovery
Injecting Welir ,— __—_T. _,._____ ,,,.._. �._._,: . , •
- ft. ft.
DAquifer Recharge - D(,ioundwater R.emediatiun .19.• AND/GRAVEL PA(K`Ifa' li'cable
()Aquifer Storage and Recovery FROM TO TT _ h1ATERIAlI, EM P LAC6M t:FITM ETR O U-"--"`
,I:/Salinity Farrier . n. 'ft.
_
DAquifer'lest U)Slonnwater Drainage. -- —_.,. - _,,._,__-,-.__ __..___
11l xperimental'frchnolo, ft.. ft.
Technology IDSubsidenee Control __
O(:it.olhern)al((:lased Loop) 2Q:DRILLING LOpaattacb'adititionaI shoots ifnecosSisr� � _ .
P) ll(racer FROM _ TO DESCRIYTION-•,(color,hudorss,wlUrock tax,gain tizel nlc.)_
('Geothermal(Heating/Cooling Return) 'DOther(explain under 1121 1kt:works) ft. ft. '
fi.
4, Date Well(s)Completed: r/a -/ Well UN/- /VA '- ---- �.- -_.I. ___.,_..._-__._-___-._____ __-_
Sa.Well Location: • - _
Facility/OwncrNanie . - Fociiity IDH(ifepplicablc) ---• - ..-_.....__. _._ _. __ • _• ___......._....._.._
. , ft. fi.
!'J2 L�'/ , , _._..,..._ . -- m -. _._-_, .-_-..._...-_ __.__._._..__.._
OCT 2 ' c024
Physical Address,City, -_ -:.-_..._,-._._._ r• .y + -
'
end Zip y ��- =;z _ �s_rr+.• ...
yA [7!� 21,REMARKS „ r ..J
[Y O: _ _._._
Comity P(Vel Identification No.(PIN) _-_ _�"-~
r
•
Sb.Latitude and Longitude in degreeslmioutes/seconds or decimal degrees: -_ _ _ _____- -----__._._._.__.
(if wail field,sae lu lung is sufficient) 22,Ce1'tifteation: I
a ` ,``'` .� - � . L3 5.�" w •1 't'4-• c/.. ll__._1, �z'�-.-__C .e.i'_. Jo-Jo
Signature.of Certified Well Contractor •) ; Date
6.Is(are)the wells '( ): I &fmRgenf or f.;l'CCmpgt'aty fly signing this form, /hereby certify Olin'the we/I(s)was(were)constructed in accordance
with 15A NCAC 02C,0/00 or ISA NCAC 02C.0200 Well Construction Standards and thin a
7, Is this a repair to an existing well: t]Yes or r71vo - copy of this record has been provided to the well owner.
_ If this is a repair,fill Out known well construction it forn+n':cr,rind e.tpluir;he:ow,:of the -
repuir ander1121 remarks.se lion or on the hack of this loath
23.Site diagram or additional well details:
You may use the back at'this page to provide additional well site details or well
8.Number of wells constructed:_1____.____ _• ___ . construction details. You may also attach additional pages if necessary.
For multiple injeetiun OF non•water supply wells ONLY with the saute construction,you con
submit oars fora+. SUIIMITTAI.,INS'I'l_ICTIU_NS i' , •
9,Total well depth below-land surface: i/Q .5 _ ,T(ft.) 24a, ForAl1 Wells: Submit tli s'form within 30 clays of completion of well
For multiple wells list n/I depths if different(example.?(tr 20000'and 20,100') constuction to the.following: +I
10.Static water Icvel•tielo)v top of casing:_,�_ C7 �__,_,__,__ _(fi.) - Division of Water Resources',Information Processing Unit,
I(wnrer level is above casing.use. 1617 Iulail Service.Center,Raleigh,NC 27699-1617
24 II.Borehole diameter: -___ (in.) h.•For.lnjeclion Wells ONLY in addition to sending the form to the address if)
24a alinvc, also tiubmii a copy of this limn within 10 days of completion of well
12.Well construction method;`R•(.)t`Ir)/ •eonstiuction to the thlloiving:
(i.e.auger,rotary,cable,direct push,etc.)
Division'
of Water Resources,Underground.Injection'ControlProgehm, ,
Itnf111ATEU SUPPLY yYELL. ONLY: I(i36 Mail Service.':dater,-Raleigh NC,27699,I636 - ...
13a,.Yield(gpm) _ Method of test Air lift
._...__. ........._ 24c. For Water Suuly tYc Injection Wells _ _ .
Also submit ono copy of this f(Irm within 30 days of completion of
13b, Disinfection type:,I-I•&,_ -,H
Amount:, O7 well consuuetinn to the. i ounly he�Ith department of the county where
, ,..-,.,,--...._......_.._...,.._. constructed. I . .
i ,
Form OW-I Notch Carolina Department of Environment and Natural Resources•-Division of Walci'Rnsoiures Revised August 7.01:1
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m MaconCounty 1830 Lakeside Dr
o Franklin,NC 28734
rr Public Health (828)349—2490
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IMPROVEMENT.PERMIT& CONSTRUCTION AUTHORIZATION
Owner' ,Ann Sullivan SEP 044924-1 040324 1 L`ocation'-, On Right before 707 Kettle,Rock Rd PID',r 7439086298
v'Directions," From Highlands take Dillard Rd to R onto Kettle Rock Rd 1.36
'1,1'Design'', ;360 Gallons Per Day—DSE `Facility' 3 Bdrm—Residential—Max.6 People. . Permit Type, New Construction
Foundat o i' Not Specified - yVat4r, Proposed Single-Family Well/On Site -' Expiration ;Valid for 60 Months
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t���teat• 25 Mint` g� ,,� 041 '
Q ee. \SQO Io9 (Ip0 \ - - 1(� MCP tea '
ale
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Property
(The(474 34.
)
Diagram not to scale
Permit Conditions
1) Have NC-licensed septic installer facilitate installation of system, level and on contour.
2) Do not cut,grade,fill, build on,or otherwise alter designated septic areas.
3) Divert water lines and other drainage away from_drain-feld and-.tank.areas. _
4) Comply with ail applicable 15A NCAC 18E setbacks
5) Refer to MCHD for any questions.
SITE'EVALUA':ON 10"Large Diameter Pipe —Gravity ---REPAIR '10"'Large Diameter-Pipe-Gravity-
3 Type III F Soil Depth;17'-, :Slope;43%. "'LIAR:0 55 Saprolite;Yes Type III F Area;2000(ft') LTAR;0,55 Saprolite;Yes
SYSTEM 1 ''''TOTAL LENGTH. #OF LINES MIN SPACING n MAX DEPTH WIDTH :, DISTRIBUTION "SEPTIC TANK PUMP TANK
' „ ,DESIGN',r- 270'
3 6'on center 18" 16 Inches Serial Feed 1000 gallon Not Required
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 18E Wastewater Treatment and
Dispersal Systems are incorporated by reference into this document,Including any subsequent amendments to those rules,and shall be adhered to.
June 17; 2024 /, Y`,
Issue Date Chaz Allen,REHS 3258