HomeMy WebLinkAboutWELL-05-2016-072749.TIF 177.10 4 CATAWBA COUNTY 0 0 0 Case WELL-05-2016-072749
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NAME ON PERMIT: URS CORPORATION, 1600 PERIMETER PARK, MORRISVILLE NC 27560
Site Address: 2950 NORTHWEST BLVD, NEWTON NC 28658
Property Size: Square Feet:87,991.20 Acres:2.02
Directions: Northwest Blvd Newton, corner of Northwest Blvd and Boundary St
WELL ABANDONMENT PERMIT
Wells shall be abandoned in accordance with state regulations:
Article 15A North Carolina Administrative Code Subsection 2C
The Well Abandonment Report must be submitted to the Catawba County Environmental Health within 30 days upor
completion of a well abandonment.
Well contractor must schedule well abandonment inspection with Catawba County Environmental Health.
WELL TYPE
Drilled
Steven Price 05/25/2016
ISSUED BY PERMIT ISSUANCE DACE
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This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends
the Independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and
WELL ABANDONMENT g`E"-ORD For Internal Use ONLY:
This form can be used for single or multiple wells
I.Well Contractor Information: WELL ABANDONMENT DETAILS
MARK IRELAND 7a.Number of wells being abandoned: 1
Well Contractor Name(or well owner personally abandoning well on his/her property) For nnrhtple injection or non-water supply sells ONLY with the same
construction abandonment,you can submit one frrrnr.
A-4163 180.0
NC Well Contractor Certification Number 7b.Approximate volume of water remaining in well(s): (gal.)
GEOLOGIC EXPLORATION, INC FOR WATER SUPPLY WELLS ONLY:
Company Name 7c.Type of disinfectant used:
2.Well Construction Permit#:
Lit all applicable welt construction permits(Le.Crmnt,State,Variance.etc,)if known
7d.Amount of disinfectant used:
3.Well use(check well use):
Water Supply Well: 7e.Sealing materials used(check all that apply):
❑Agricultural ❑Municipal/Public El Neat Cement Grout ❑ Bentonite Chips or Pellets
OGeothermal(Heating/Cooling Supply) Inesidential Water Supply(single) ❑Sand Cement Grout ❑ Dry Clay
❑lndussriallCommercial ❑Residential Water Supply(shared) 0 Concrete Grout ❑ Drill Cuttings
0 Irrigation 0 Specialty Grout ❑ Gravel
Non-Water Supply Well: ❑ Bentonite Slurry ❑ Other(explain under 7g)
O Monitori ng ❑Recove ry
Injection Well: 71.For each material selected above,provide amount of materials used:
❑Aquifer Recharge ❑Groundwater Remediation 240.0 GALLONS
DAquifer Storage and Recovery ❑Salinity Barrier
DAquifer Test ❑Stormwater Drainage
DExperimental Technology ❑Subsidence Control 7g.Provide a brief description of the abandonment procedure:
DGeothermal(Closed Loop) ❑Tracer WELL ABANDONED VIA TREMIE PIPE WITH
❑Geothermal(Heating/Cooling Return) ❑Other(explain under 7g)
PORTLAND BENTONITE SLURRY
4.Date well(s)abandoned: 06/21/16
5a.Well location:
RESIDENCE
Facility/Owner Name Facility IDN(ifapplicablc) g•Certitica ion: z �!.�
2950 NORTHWEST BLVD NEWTON 28658 06/29/16
............
Physical Address,City,and Zip Signature of Certified Well Contractor or Well Owner Date
CATAWBA By signing this form. I hereby certifi,that the well(s) was(were)abandoned in
County Parcel Identification No.(PIN) accordance with 1SA NCAC 02C.0100 or 2C.0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one tat/long is sufficient) 9.Site diagram or additional well details:
35°41'40.59" N 81° 13' 30.59" You may use the back of this page to provide additional well site details or well
W' abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDONED SUBMITTAL INSTRUCTIONS
Attach well construction record(s)if available. For multiple injection or nun-mater supply
wells ONLY with the some construction abandonment.you can submit one farm. 10a. For All Wells: Submit this form within 30 days of completion of well
6a.Well 1D#: WSW-1 abandonment to the following:
Division of Water Quality,Information Processing Unit,
6b.Total well depth: 160.0 (ft.) 1617 Mail Service Center,Raleigh,NC 27699-1617
!Ob. For Injection Wells: In addition to sending the form to the address in 10a
Ge.Borehole diameter: 6.0 (in.) above,also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Gd.Water level below ground surface:- 40.0 (ft.) Division of Water Quality,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
Ge.Outer casing length(if known): (ft.) 10c. For Water Sunnily& Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
completion of well abandonment to the county health department of the county
61.Inner casing/tubing length(if known): (ft.) where abandoned.
6g.Screen length(if known): (ft.)
Form GW-30 North Carolina Department of Environment and Natural Resources—Division of Water Quality Revised March 2013