HomeMy WebLinkAboutWELL-04-2016-070742.TIF ‘p,A CATAWBA COUNTY 0 •r'• 0 Casc# WELL-04-2016-070742
Cri+ Public Health Department �• �} Subdivision
PARA Z, b r
�' ®�� Environmental Health Division f' �+ 3 • PIN# 267704810962
PO Box 389. 100-A Southwest Blvd,Newton. NC 28658 LOT#
1g42 '" •i'
NAME ON PERMIT: RYAN GUTHRIE, 6322 W NC 10 HWY, HICKORY NC 28602
Site Address: 4157 LEFEVERS RD, VALE NC 28168
Property Size: Square Feet:248,292.00 Acres:5.7
Directions: From Hwy 10W, Left at Banoak Elementary School, Bare Right on Lefevers about 1/2 mile on Right going Up
Hill.
WELL PERMIT
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 (I 5A NCAC 18A .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.
Steven Price 04/01/2016
AUTHORIZED STATE AGENT APPROVAL DATE
ehpennit 04/04/2016 08:18 Page I of 3
AL EHPR 03-2016-23356
4157 LEFEVERS RD, VALE
• Do not cut, drive, fill, or grade over septic or repair areas.
• Septic system must be 10 ft from property lines; 50 ft from wells and streams; 5 ft from
building foundations and appurtenances; 10 ft from water lines; and out of right-of-ways
and easements.
• Install a 1,000 gallon septic tank and 400 linear feet of 25%reduction system; (4) 100 ft
lines on contour.
• Final grade of septic area must shed surface water off and away from system.
• If supply line is greater than 50 ft, then at least one cleanout will be necessary.
• Well will need to be at least 25 ft from structures, 50 ft from septic systems, and 5 ft from
property lines.
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7048924705 BKWELLDRILLING PAGE 03
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WELL CONSTRUCTION RECORD Fm Internal Use ONLY'
Ilut form can he aced for sinelc In multiple welts
I.Well Contractor Information:
.. -
Robert E Teague FROM TO p ODCSCRIPTIO.
Wali C innocror Name :41"i- /!1 O. air Lt/
IIIIMIIIIIIIIII
2857-A n. ft.
NC Well Costractur C'crlilicmlun Nurnbe, TmfKVESs_ISM CAa09G lor.td• •wd4.ORD
FROM TQ DIAMETER EZTE
B & K Well Drilling Inc. 0 n' be,- 16 1/8 SDR-21 PVC
[ompauv N'nme .16.INDUS- • N,, in DU:. tsCaa v ... 1:,,J; .
O 7(5 /yr �`^Jti/^ FROM TO D4MF,'r$R THIf.H9ERF -
2.Well Construction Permit k; .._ ft rt. in.
1,,1,,I(u)xlllrupli mei II,vy:tlru(npn per,, (i.e.('Donor.Sealy, Variance.co..)
O. (t. In.
3 Well Use(check well use): .la.SGB:r. ... . . .
EannWater Supply Well: FROM n. �®
l kgricultaral Mtnicipal/Pohl is
O(icolhernisl(Meson /Cooling Supply) 9<c,eidentjal Water Supply sins le ft' ft. In _-
Ohrdustrial/Commercial ClResidential Water Supply(shaft's') ' IL GROUT"
fROFI TO NATrRIN, P,MFLAECMENT METHOD dA,s10UHT
°ligation 0 h- 20 a Hole Plug Pour/Hydrate
Non-Water Supply Well:
R ft.
O jecti oam Ing L]Recovery -_
Injection Well: rt. R.
°Aquifer Recharge ❑Groundwater Remediation WS/AND/GRAVEL PACK ifn 01; . '
•
FROM TQ MATERIAL
/)Aquifer Stnri c and Reeovely °Salinity Barrier fr. n.
LlAquirer Test OStormwatcf Drainage
It. fr.
OFNperimental Technology ❑Suhsidencc Control
_ 2P.DRILLING LOrGlewcirlenters If neat:Rr2) a • '
ID Cionthermal(Closed loop) °Tracer FROM TO DSFRMTIO,NI .,nMgyah roue int,gran Dg Hrl I
OCiumhermal(Ilemma/Cooling Return I UOlher(explain under'121 Remarks) n, /CA TO c_c �� �
(1R�
4.Dare Well(s)Completed: Well lop
ft, rt.
/5/a 7ell hncatlon: / •
ft, n.
f„dl;Iyitwncr Nems Fat lity I De Iii applicable l 4 n
y / S 7 Lefe 0e,rs )4iYa)c. ft. n.
1'hvdeylddreen.chy'and Zip
21,ItCMARAfB.. . . .. ... .
CC CSW LG ol'ol'1045,109In-
County Parcel identification No.iFIN)
Stew Latitude and l l longitude in degrees/minutes/seconds or decimal degrees: 22.Cg1;lOcntlo :
(Assn field.one IaJlonng p o arllieient)
N w / ' (((wry ���
Sig Datura ul'Ccrtilicd Wall Cbn ra.Arr Uatu
6. Is(arc)the'A OW: Permanent or t_ITeinpora is „c A l j n,. l h cent,e /i that the .Ilett fir. ( e) n./nrrmd w
In at tdanee
wit/ /.5.4 Ni //R'.0100 ISA NC A( 1121..0200 Well e l nn M anda.d.:Ind that 0
7, In this repair'to an existing well: [IYe9 is o crpf lel cern ha,A . provided m the ell. ner.
Il pm u n r epa r.lilt,al A,,nn WO/°s'er'e non ngnrnromnr,an,l arplmu the u,nnc til the
re/wrr under 11 remarks\velum ern,the hook or l/u,PvM, 23.Site diagram Or additional well detail,:
You may use the hack of this page to provide additional well site details or well
H.Number of wells constructed: 1 construction details. You may also attach additional pages if necessary.
Por onsistgie n!/till or new.1,0//nrleprie well.ONLY nwh ehe:come construction,vn,curl
•mJ'nurvn'elrmnr' SUBMITT AL INSTUCTIONS
S9.Total well depth below land surface: `O (H.) 24a_For All Wells: Submit this form within 30 days of completion of well
roc's/aro*ii d/,/at al/capon0',1((/even,A...amrle.101200'and 2,2/1/0', construction to the lbl lowing:
ID.Static water level below fop of rasing: 50 (h.) Division of Water Quality.Information Processing Unit,
f/nvrh'r lrrel it WWII'(WOW,tie ' I617 Mail Service Center,Raleigh,NC 27699-1617
II.Borehole diameter: 6 On,) 24b. Fur Injection Wells: In addition to sending the form to the address in 24a
Rota above. also submit a copy of this form within 30 days of completion of well
12.Well construction method: ry construction to the lolluw,ng:
I i,e,anger,rattily,cable,direct pmh etc I
Division of Water Quality,Underground Injection Control Program,
Pole wATEH surnLLY wvl AS ONLY: 1636 Mail Service Center,Raleigh,NC 2 7 6 99-1 63 6
13a.Yte)d term) C/ 0 Method of test: Open Flow 24c. For Water SuDDIY&Inlectton Wells: In addition to sending the form to
the addiess(cs) above, also submit one copy of this form within 30 days of
13n.Disinfection type: Chlor Tabs Amount: 1 1/2 Lbs completion of well construction to the county health department of the county
where constructed.
rya in<INV-I North Ca-olinn Departrncat of llmironmant and Nenual ken-mites-Divisma of warn Quality Reviaedlen,2013
3 4 3