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Home My WebLink AboutGW1--06756_Well Construction - GW1_20241112 y i W/] 1_, cONS'rRIICTION RECORDFur Internal Use ONLY: s This form can be used for single or multiple wells I ' iI.Well Contractor Information: '/ _: __..I...Y l L-fC'[ae_1 I 1e.(Ln D 0 i_ 14,WATER ZONES , I DES FROM TO_ DESCRIPTION _ Well Contractor Name .+ fL , p} 'fL • NC Well Contractor Certification Number 15,OUTER CASING ffor asalti-cased welts)OR LINER if a ' lie^T� FROM TO DIAMETER T(t1CI(NESS MATERIAL ,DLnjs ��o• and- we L► Di1 I it►Ic. ►e•- -. ft. ;fr. tn. Company Name. . . - Z" 16.INNER CASING OR TUBING(geothermal clowd-loop) FROM TO DIAMETER TftICKNESS MATERIAL 2,Well Construction Permit I/:__/Of/ al lf- '-./ ft. - fL - ' • in. T List all applicable well Permits(i.e.county,Slate, Variance,Injection,etc.) ~ fL ft. in. 3.Well Use(check well use): • ----- __ 17.SCREEN Water- —Supply Well: . FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL • ❑Agricultural ❑Municipal/Public ftft + in,.. °Geothermal(Heating/Cooling Supply) residential Water Supply fL ft, M. ( g/ pP Y) pp y(single) Cllnduslrial/Commercial ❑Residential Water Supply(shared) 18,GROUT FROM TO MATERIAL EMPLACEMENT METHOD&AMouwr Ql ipzatIon ..— fu..... ff. Slon-Water Supply Well: --. . --~--•--- - . J? + :f';.>":4.s! .J6.*9e -�i—../7 • - �::1!`9ortitoring ❑Recovery • Mil .2e, �• ft' it • es'o.• el ".�ay- l�tQ-� Injection Well: "'-"-'__._._.-___,..-...-__.-__-__.__ ...- -- ft. ft. _)Aquifer Recharge ❑GroundwaterRemediation 19,SAND/GRAVEL PACK(ilapplicable) FROM TO MATERIAL EMPLACEMENT METHOD 0Aquifer Storage and Recovery ❑Salinity Barrier ft. ft. ❑Aquifer Test ❑Stormwater Drainage ---ft. ft. Technology ❑Subsidence Control 20,DRILLING I,OG(steirch addfdaval slu eta if uucew+ °Geothermal(Closed Loop) ❑Tracer -"' si-•"•'-'"" FROM TO DESCRIPTION(colors hardness,soil/rock type,Iron sizes elc.� -C7Geothermal(Heating/Cooling Return) ❑Other(ex lain under H21 Remarks) ft. iI. /' ft. iL' - -_ A.Date Well(s)Completed: tL_p,3•-2, Well IDll..,•_,..,._.!//. '/c •-- rt. —_ ft. 'tin.Well Location: _ . ._�-= --��• .,,,w.. Q ft. - , ft. ..44./..4.16.4)-2Z_._--/l' 4r / _ ,.i.-/-4. - ft. ft. N U V I .fir 6[4— Facility/Owner Name Facility/ID/I(if applicable) rt. ft. — _ 44 lsxlas C'e, L5 »_ _. ft, rt. tom_ G., t:;C':?2 Physical Ad�ddre�ss,City,and Zip 21.REMARKS County Parcel Identification No.(PIN) 5b,Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22,Certification: � (if well field,one lat/long is sufficient) i �/ �� ,/� -3,°-e 3_, •; " _N ...3": °./e.e_____.__.-yW ..%i ia�G )f _4..�-. J a - Signature of Certified Well Contractor Date li, Is(are)the ivell(s): l?anent or ❑Temporary By signing this form, I hereby certify that the well(s)was(were)con.ciructed in accordance with 1.1A NCAC 02C.0i00 or iSA NCAC 02C.0200 Well Construction Standard,and that a 7. is this a repair to an existing well: DYes or t -- copy of this record has been provided to the well owner. If this is a repair,fill Out known well construction information and explain the nature of the repair wider 111/remarks section or on the back of this form. 23.Site diagram or additional well details: You may use the back of this page to provide additional well site details or well B.Number of wells constructed:_ _ -,/ __.___ construction details. You may also attach additional pages if necessary Per multiple injection or non-water supply wells ONLY with the same construction,you can subnnl one form. SUBMITTAL INSTUCTIONS : 9.Total well depth below land surface:__ ,2..3-0 „(ft.) 24a. For All Wells: Submit this form within 30 days of completion of well Formultiple wells list all depths if different(example-3@200'and 2@1110') ' construction to the following: , l'U,Static water level below top Of casing: Division of WatertResources;Information Processing Unit, . .-�._ (ft.) l/water level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC•27699-1617 i II.Borehole diameter:__ '' ___(in.) 24b. For Injection Wells ONLY: in addition to sending-the form to.the address in ,,��.,, - 24a above, also submit a copy of this form within 30 days of completion of wet 12.Well construction method: /0!? - --r_,• - ___ construction to the following: f lie.auger,rotary,cable,direct push,etc.) - . Division of Water Resoti'rces,•Undergroumd Injection Control Program, FOR WATER SUPPLY WELLS ONLY: _ 1636 Mail Service Center,Raleigh,NC27699-IG36 laa.Yield(gpm) Method of test:- 24c, For Water Supply Rc InjlecNon Wells: _- 6� _II-- _ - 1y -•-- Also submit one copy of this form within 30 days of completion of I3b.Disinfection type:_I r� AmounV: _•,• D�, well construction to the courityl health department of the county where _..-._-_-_____--..._.._L�._--._.,.__:��:�..__-__--_-.._.. ,_�:_- constructed. I Form OW-t North Carolina Department of Environment and Natural Resources-Division of Water Resources Revised August 2013 3 5" 0.J 0.5 Qootec.r FNG '2 ,74,/rl ', • ••4 •m Macon County 1830 Lakeside Dr o m Public Health Franklin, —2490 Ir a 828 349—2490 °,d a�J envirovm@maconnc.org y7 g_ a 56 �. �r Ib 3 WELL CONSTRUCTION AUTHORIZATION Owner` William Paul ' WEL• 100124-1 082624-1 - Location TBD Coweeta Lab Rd PID '. 6580138070 11.9 : Directions Ga Rd,R onto Coweeta Lab Rd,Gravel Dr on left just past Little Mountain Rd. 0 esi.n Single-Family Well * Permit T .e. New Construction • Ex•!ration Valid for 60 Months ' v N i T! v O /�" S 1V E ' ��n\O C� 10' V % Well ',a2' So1z !ea 1i+, o�Min � S \ . �dOi ?aO '' ``\ q \ \:P``` O-b %' \ 6, 15rMin 5 Mn �0:��p_ ��\ �a. >200'to creek . 1 `` �` 0�, / 2� 15'Min \� `�` \ Proposed 3 ' . . BDRM House "'ao_ 40'x 40' "'k ye, • . A 28' $a p 25'Min C well Area 10' 10' 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. ' Anyperson abandoning a well must submit to MCPH Form GW-30 upon completion. - . October 10, 2024 (/L451L'i Al,___ Issue Date Chaz Allen, REHS 3258 '