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HomeMy WebLinkAboutWELL-04-2016-070721.TIF �gA CATAw6A COUNT)' Case# t ft , Public Health Department Subdivision 6 „��®, 'q Lnyironmental Health Division PIN# 377117114553 PO Box 389. 100-A Southwest Blvd.Newton. NC 28658 1.0T# 1 NAME ON PERMIT: BRANDON MCKASKLE, 1881 WADES DR, CLAREMONT NC 28610 Site Address: 1845 WADES DR, CLAREMONT NC 28610 Property Size: Square Feet: 30,927.60 Acres:0.71 Directions: Hwy 10 from Newton - left onto Boggs Rd, Right onto Wades DR 1000 ft down & property will be on the left Owner/Authorized Representative Acknowledgement of Permit Receipt Olt certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the proper, described above. As the property owner or authorized representative. I have received the above referenced permit(s) as requested in the application for service RBPR-0 3-201 6-23440 , by the following method(s): .- /Received in Person Facsimile Transmittal (Return form with signature required) Electronic Image Transmittal/ E-mail (Return receipt required) vtir As the property owner or authorized representative I have reviewed and understand the specific conditions of the permit issued, and further understand that all applicable regulatory requirements specified under the North Carolina Laws and Rules for Sewage Treatment and Disposal Systems (15A NCAC 18A .1900), and/or Well Construction Standards (15A NCAC 2C .0100), shall apply to the issuance of this permit and the construction of the wastewater system and/or water supply well permitted. Permit Issue Date: 04/01/2016 Owner/Authorized Representative ;mar Date I Documentation of Permit(s) Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name of person sending permit) Signature Date/Time Method: Fax Email US Mail Other Owner's request to send by the above indicated method of transmittal in lieu of signature We want to hear from you. Please take a few moments to complete our customer service survey at: http://www.surveymonkey.com/s/EHCustomerService ehpennit 04/01/2016 09:34 Page4 of4 1T. f._ iy,A • CATAWBA COUNTY m ; � � � Case� WELL-04-20I6-070721 ,�_i'ra I- < Public Health Department ` �' � Subdivision r 'q Environmental Health Division ti �: PIN# 377117114553 4® PO Box 389. 100-A Southwest 131ad, Newton, NC 28658 i ,{r LOTir 1 SM 3 NAME ON PERMIT: BRANDON MCKASKLE, 1881 WADES DR, CLAREMONT NC 28610 Site Address: 1845 WADES DR, CLAREMONT NC 28610 Property Size: Square Feet:30,927.60 Acres:0.71 Directions: Hwy 10 from Newton - left onto Boggs Rd, Right onto Wades DR 1000 ft down & property will be on the left WELL PERMIT WATER SUPPLY: Individual Well SETBACKS: 1. BUILDNG FOUNDATIONS 25 FT. 2 . EXISTING & PROPOSED SEPTIC SYSTEMS MIN. 50 FT. 3. EXISTING & PROPOSED SEPTIC REPAIR AREA MIN. 50 FT. 4 . SEWAGE PUMP SUPPLY LINE 50 FT. 5. UNDERGROUND STORAGE TANKS 100 FT. 6. STREAMS/BROOKS/CREEKS 50 FT. 7. LAKES/PONDS RESERVOIRS 50 FT. ALL OTHER POSSIBLE SOURCES OF GROUND WATER CONTAMINATION 100 FT. The well driller must verify all setbacks before drilling the well. If the well driller is unable to maintain any of the above setbacks, contact Catawba County Environmental Health at (828) 465-8270 before drilling the well. Grouting Depth: Minimum 20 Feet Casing Height: 12" Above Land Surface All newly constructed private drinking water wells are required to be sampled in accordance with the North Carolina Rules Regarding Private drinking Water Well Testing (15A NCAC I 8A .3800). The fee for this sampling is included in the cost of the well permit. It is the applicant or property owner's responsibility to notify Environmental Health when the well is ready for sampling. Water samples will be drawn from an outside faucet unless otherwise specified. Please note that all water samples are taken during one visit. The processing laboratories have different protocols and timeframes for reporting results; therefore,you may receive several different reports concerning your water sample. For questions or more information, please contact Catawba County Environmental Health at(828)465-8270. Mogen McBride 04/01/2016 AUTHORIZED STATE AGENT APPROVAL DATE ehpennit 01/01/2016 09:35 Page 1 of3 Ac,w -w n?c , 03-)DIb-23'1+`10 Ilul5 Modes Dc. GkoAUMDn tIr\S-1a11 I000 9a►loh seP}ic -,-anK and 30441. of a57 redvc4io4 j N-75c1. -ften&liec. Znskall drain-NIA on con+ca)C * Se fFic Sys-f e m mull be, a4 Ieasl 50% -from Wells, 10}x. from ProPerli lines, , from SINCA016 - Includin decks + Porches and oo} of on r5►i-of_viols and edsemerrl5. 4. Do 0 drile, role, co-k, or -GO offer ark- 516-kern area or err Area, D joie, ma r•• sertic Re air gre.4 5°'•ked-Uldis+ 85' * * l must be a1 kAS{: IS 5'7 -50f4.-fromstOic,systems 5. ` 4 ` 3T p,�sed -•)5fl. from 5-4(A res, 3 BeJreon Noon InchAinq deers k 2s,56 J a 6E6 - Jfl,from p10r4,kineS 5o' r 1514. ma \.5.5. * KPer Well ool 4 all „in rt-a we A v doe-of-vials and ll et(semer-15. 1 w n n I17• wades Dr lay 05 16 08:34p Russell Welling Drilling 8286322617 p.1 • iiiiii Print Form WELL CONSTRUCTION RECORD (6W-1) For Internal Use Only: I.Well Contractor Information: I Chris Russell II.WATER ZONES Well Contractor None FROM Ti) I urscmmrIoN 3245A 245 IL 60 ft. R 2 NC Wel!Corulntdm Certification Number IS.OUTER CASING(for multi-cased wells OR LINER Of ap lieable) Russell Well Drilling, Inc. FROM TO DIAMETER THICKNESS MATERIAL Company Name 0 ft 121 ft- 6.25 ia. SDR21 PVC WELL-04-2016-070721 I 6.INNER CASING OR TUBING(geothermal dosed-loop) 2.Well Construction Permit k: FROM TO DIAMETER THICKNESS mATEIUAL List all applicable well consrrurrian permits(.e.INC.County,Stare,Yarumce etc) fL n- in- 3.Well Use(check well use): IL ft. In. Water Supply Well: 17.SCREEN PP. FROM I TO DIAMETER I SLOT SVY. I TDICKNESS MATERIAI. f A(picultural DMunicipaLl'ublic FL I R- in. r GWWL:final(11eatingCooling Supply) []ltesidential Water Supply(single) fL I fL In. IndushialiCornm_ttial �Residenlial Water Supply(shared) Ill GROUT Irrigation ESOM TO MATERIAL CMlucnMRNT MFTHOnA AMOUNT Nun-W'aterSupply N'ell: 0 f'' 20 (1' Grout Poured Monitoring []Karocery R. II. Injection Well: f. R Aquifer Recharge �Grt+mdnatcr Rcmaiiatiwt ' t9.SAND/GRAVEL PACK(if applicable) quifcr Storage and Recovery �$aINIly Barrier PROM TO MATF.RIAl. ' EMFI1(.N.MF_S 1'MKTHOII Aquifer Tote []Stormwmar Drainage fL fL Experimental Technology DSubsidenee Control O- W n• I Geothermal(Closed Loop) ©Tneer 20.DRTLLING LOG(attach additional sbveb Ifncca ry) Geothermal(11catin Crclin Retsina) Other(explain under till Remarks) memo To I DESCRIPTION(raise,biMnvn wiEnettypcginin din en) g p 0 "' 115"' Dirt 4.Date well(.)Completed:5-5-16 Well IDk ' 11511- 24511' Rock ft. ft. 5a.Well Location: Brandon McKaskle-Clayt n. Facility/Owner Name Facility IDS(if applicable) tt n' 1845 Wades Dr. Claremont, NC 28610 R. n• Physical Address,City,and Zip ft. n. Catawba 21.REMARKS County erect Identification Nn.(PIN) 5b.La4mde and longitude in degrccsrminutes/seconds or decimal degrees: (if' field,one!along is sufficient) 22.Ccrtifrca// 35' 41.200' {p-�T1 N 081' 06.997' w 5-6-16 6.'shire)the well(s)11 Permanent or []Temporary Signature of Certified ell Conw�a Date ry Bysigning thin f rm, r hereby naafi:that the walks)was(were)conurm=ted in accordrtre 7.1s this a repair to an existing well: []t es or Ell No with ISA NCAC 02C.0104 or/5A NC'IC 02C.17209 Well Commie:ion Standards ace,.bat a If MU a a repair,fill nut Itonn...chi rn n iM n and',plain the aann f the rrpv ofh as record had hero prnv,'dea to t e call owner. repair under ti2 I reinadsamnor.or on the buck ofthvJorm. 23.Site diagram or additional well details: or Closed-Loop Geothermal Wells having due same You may use the back of this page m provide additional well site details or well 8.For GeoprohefDP'f construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional ifnectssary. drilled: SUBMITTAL INSTRUCTIONS 9.Total well depth below fund surface: 245 (ft.) 24n. For All Wells: Submit this Corn within 30 days of'completion of well For multiple welly tic all depths I/dtQnenl(emmple.30.200'and 21a100) construction to the following: 10.Static water level below tap of casing:60 (ft.) Division of Water Resources,Information Processing Unit, If soles level it above easing.use•'+" 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: 6.25 (in.) 241s. For Injection Wells: In addition to sending the form to the address in 24a Air Drilled above, also submit one copy of this forth within 30 days of complction of well 12.Well construction method: construction to the following: (i.e auger,rotary.cable.direct push,etc.) Division of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY WELLS ONI.V: 1616 Mail Service Center,Raleigh.NC 27699-1636 13a.Yield Igpm) 20 Method of test:AIr 24c.For Water Supply& [niection Wells: In addition to sending the form to the addresses) above, also submit one copy of this Ginn within 30 days of 13b.Disinfection type: HTH Amount 213 cut completion of well construction to the county health department of the county where constructed. Font GW-I North Carolina Deo:Matalt of Env imomc atsl Quality-Divisiwt of Water Resources Revised 2-22-2011. (41k Case# WELL-04-2016-070721 : itt\ CATAWBA COUNTY HEALTH DEPARTMENT H t j\ tiaa Environmental Health Section \� 2 PA 05/06/2016 WATER SAMPLE FIELD REPORT Applicant *CI.AYtON HOMES 11 81/CMH INC(UNLICENSED). 1230 CONOVER BLVD,CONOVER NC 28613 13:828-4653450F:528-464-0261 JWIIOLDER@1-IOTMAII_COM Owner BRANDON MCKASKLE, 1881 WADES DR,CLAREMONT NC 28610 C:8282174043 Parcel Owner STANLEY ALLEN. 102 3RD ST SW.CATAWBA NC 28609 Contractor *CLAYTON HOMES g 81 /CMH INC(UNLICENSED). 1230 CONOVER BLVD,CONOVER NC 28613 13:828-465-34500:828-464-0261 JWHOLDER@HOTMAIL.COM Site Address: 1845 WADES DR, CLAREMONT NC 28610 Name of Project: Parcel Number: 377117114553 Lot: 1 Block: Specific Directions Hwy 10 from Newton-left onto Boggs Rd,Right onto Wades DR 1000 ft down&property will be on the left of A^ g;55i.M Initial Collected by: M�I , k"�rl(,t f j Date/Time Sampled: �' b Type of Sampling Point: We tt kf A"c Well New or Existing? New X Existing Type of Well: Drilled x 13ored Dug Spring City ,Ii Does well meet adequate construction standards from what can be observed: I Yes No Reason tirr non-compliance: Defective well cap and/or seal Piping does not exit through top of well by approved cap and sanitary well seal Evidence of improper grouting or no grouting Opening in the well casing or cap Supply too close to source of potential contamination Notification: Existing well owner notified that well does not meet adequate construction? Yes No Date of Notice: E9-rsamfieldreport 5/6/2016 Page 1 of 2 A��O Case# WELL-04-2016-070721 (-711111NL‘ CATAWBA COUNTY HEALTH DEPARTMENT Environmental Health Section �-48 42 su. 05/06/2016 WATER SAMPLE TEST RESULTS Applicant *CLAYTON HOMES.#81 /CMH INC(UNLICENSED), 1230 CONOVER BLVD,CONOVER NC 28613 8:828-465-3450F:828-464-0261 JWIIOLDER@IIOTMAIL.COM Owner BRANDON MCKASKLE, 1881 WADES DR,CLAREMONT NC 28610 C:8282174043 Parcel Owner STANLEY ALLEN, 1023RD ST SW,CATAWBA NC 28609 Contractor *CLAYTON HOMES k 81 /CMH INC(UNLICENSED), 1230 CONOVER BLVD.CONOVER NC 28613 B:828-465-3450F:828-464-026 I J WHOLDER(/#IIOTMAIL.COM Site Address: 1845 WADES DR, CLAREMONT NC 28610 Name of Project: Parcel Number: 377117114553 Lot: 1 Block: Lab Coliform Analysis Results: Total ColiCmnls 01 t ^" t . Fecal I E.CoB: 01 111" No Collection Date Over 30 hours old Invalid Results: Excessive turbidity Excessive Chlorine Lab Accident Lab Tech Initials C C/V—+- Date/Time Received 02Mt/u "1" -tG. 144° Date/Time Completed " (/��(//��y�� 'III tu40 eiri • c-FCEIVED 4!).13 0 4 2016 )H COUNTY EN`.. ;L, )'. .9JTAL HF'1LTti E9-rsamfieldreport 5/6/2016 Page 2 of 2 n D v n U r z 31 CL. m o = 2 m 1.1 O. 5 ° 9 .. '1 0. n ; A c °, a 0 ,,,.Ilk s z • _ m n in -e, to Ip • O N p0p-� A SP • O * Co ? 3 w 2° ` ❑ o z rt. ^ a ! w n �- 9 � z N CO _ VI = ¢_ ire F. CO 2 < W _ r Cb ...5 D Nro Q r ❑ D 'Jr n O = 0 �d C-0 C Ui T m U A Z A O [['.L.„, j i 3 _ a o Z F C - V) D A T N •"3 z _ 3 1\-- r, yam a+ 2 CN 2 a /it, ,� A• r :, S T . m Cr iiia ti I ; n ., Q A N ni G .^. o 'J oo oe 0 . N 3 � W ...� ,00 C w . C r U a Cr 9Dit W LLr Y 5_ it•J VI JI E. C n D 7. O - • m ,J-M" y -; m mN -' n !O cr C C z ' r o D r S d m D ❑ 7 S I O• o n r o o 2 2 > -p - = S 5 - _ E. r -4 - A CI' J D D n O c = A I: 5 5 •< q .. - n w 0 e C J� = =cr' z (I o eD= 4- a O U.CO) 00 o 0 0 cZZO o $A I ' Q) n .. Z I I P D m �4 / IQ 10 D X 0 1 Q 9J Ito o 16' r 0 o Itil1(1.) .p '0 3 r. srn7E' . (4,, ._, o ,,. North Carolina State ofPublic Health P.o. Box28047 _ Laboratory 4312 District Drive :in Environmental Sciences Raleigh, NC 27611-8047 http://slph.ncpublichealth.com • • .av �� � �� Inorganic Chemistry Phone: 919-733-7308 , a�. �. / Fax: 919-715-8611 -------- Certificate of Analysis Report To: Name of System: CATAWBA CO ENVIRONMENTAL HEALTH BRANDON MCKASKLE P O BOX 389 1845 WADES DR NEWTON, NC 28658 Courier#09-70-01 CLAREMONT, NC 28610 EIN: 566001814EH StarLiMS ID: ES080416-0032001 Date Collected: 08/02/16 Time Collected: 08:55 AM Date Received: 08/04/16 Collected By: Megen McBride Sample Type: Raw Sampling Point: Well head Well Permit#: WELL-04-2016-070721 Sample Source: New Well Temp. at Receipt: GPS#: Sample Description: Comment: New Well - No Nitrate I (Profile) Analyte Result Allowable Limit Unit Qualifier(s) Arsenic < 0.005 0.010 mg/L Barium < 0.1 2.00 mg/L Cadmium < 0.001 0.005 mg/L Calcium 6 mg/L Chloride < 5.00 250 mg/L Chromium < 0.01 0.10 mg/L Copper < 0.05 1.3 mg/L Fluoride < 0.20 4.00 mg/L Iron < 0.10 0.30 mg/L Lead < 0.005 0.015 mg/L Magnesium 4 mg/L Manganese < 0.03 0.05 mg/L Mercury < 0.0005 0.002 mg/L pH 7.4 N/A Selenium < 0.005 0.05 mg/L Silver < 0.05 0.10 mg/L Sodium 3.70 mg/L Sulfate < 5.00 250 mg/L Total Alkalinity 35 mg/L Total Hardness 32 mg/L Zinc < 0.05 5.00 mg/L Report Date:08/15/2016 Reported By: Deddie.iloncol RECEIVED AUG 19 2016 CATAv'd dH COUNTY ENVIRONMENTAL HEALTH Page 1 of 1