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HomeMy WebLinkAboutWELL-07-2016-075069.TIF rs•j sgA CATAWBA COUNTY B - �-G` O Case# WELL-07-2016-075069 2, Public Health Department •' Subdivision KALE CORNER .�". Imo. Environmental Health Division a� PIN# 470002973672 u i E j PO Box 389. 100-A Southwest Blvd.Newton.NC 28658 S t1:1LOT# 5 1842 _ . 1• — r El o 0 NAME ON PERMIT: BRUCE DANIEL, 7958 TOTTENHAM DR, HARRISBURG NC 28075 Site Address: 1437 KALE RD, CATAWBA NC 28609 Property Size: Square Feet: 70,567.20 Acres:1.62 Directions: Sherrills Ford Rd from Hwy 150/ right Long Island Rd / left Kalke Rd /corner lot 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 (1 5A 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. Robbie Phelps 07/27/2016 AUTHORIZED STATE AGENT APPROVAL DATE ehpcnnit 07/25/2016 10-01 Catawba County Environmental Health tix ' 20(6 07393 Jbl - el3- 7o/ 6-o7o38q ,1256 42.24 ! , '^'tq - 7- 20(6 - o7 so 6R \ S 92.51 N �\ N • \ Y 15 % <F S • • Nq,0- • yI I _ fl i ., \--\\_ \ktill- __ y S 'c` `yr1P J.- G/ �o "fly S, �. I/ \r"F(`' a4 4_ �� \ C;;:may, Ce °"�` L _ I 41.7 � � 138. 5 1\!�0.00 84.37 ----- 21 69 100,53 Parcel: 470002973672, 1437 KALE RD lin=60ft CATAWBA, 28609 I 07/29/2016 13:41 7048924705 BKWELLDRILLING PAGE 01 Li a,■ �w 1 4 WELL CONSTRUCTION RECORD For lntcrnal Use ONLY: This turn,urn be u.,od fot single or malliple walls I.Well Contractor Information; . tx, Robert E Teague DESCRIPTION a. ‘011. ? 6, /3i Well f;onlrPCtor Nan,e /J r 2857-A t. n. .'Fd„MI TO n,..;,- : .. :•OWL1T R ::"L..:.:d ' : 'r MITER G.iiM'i q),'," .�' N('Woll CM,tr.uii:Clnifi.,Vion Number FROM R TRICKNF..58 111111. B & K Well Drilling Inc. 0 n- r It• 6 1/8 in' SDR-21 PVC rumps"Nan,c oR 1M'-` a ,•• � MATERIAL. - 6 0_,_..-- -� ft ft. in. 2.Well Construction Permit tJ: ��--..// ._ 1,1■1 oil(tpptisabla well conoru tton pernol,(t..;.(-uun(v.Slake t'orran.e,toe.) n. Pt- in. 3.Well Use(check well use): 1 FROM TO DIAMETER EMEDIOKETEMITIMIMITZITIMI Water intuit Nell: n, h. In. ❑Agric µ �� ultural [1 nicipal/Public It I. in. CJC.ieotherrnal(Heating/Cooling Supply) esidential Water Supply(Single) g, ROTI'f I llndustrial/Commercial ❑Residentiul Water Supply(shared) 2 - MATERIAL EMPI.ACPMENT METHOD&AMOUNT Q1rtlDauon r• , 0 it. 20 it Hole Plug Pour/Hydrate Non-Water Supply Well: It. n. ❑Mon itoring C2Recovery n. n, injection Well: r- �.,,,�c.��ww t2AtuiferRecharge OC'rroundwaterRemediation .'tN:A.N.OI�3k A-'PAL Of 01) :0100) EMPLACEMENT MLTlIOD M TO L:.lAquifer Storage and Recovery ❑Salinity barrier ft. h- C)AgUil'erTest OStormwater 1)rainage n. n. 01,ixperimtnlal1'cchnOluBy ❑SubsidCnceContr0l , 20...1 ' . '(dttatili.rtdd)i.qusli!''llgteu,lfnerataeryl L.ICkCOthermal(Closed boot)) °Tracer FROM TO Dr.SCRIP1iON co.r h +4 cull/luck . , rgrn tine etc. ❑Geuthcn,7al(Heating/Cooling Return) ❑Other(explain under#21 Remarks) 0 kiall11,511NrallINIMMININ `�ilM 4,Dale Wells)Completed ) -/�1, fell it)ef .•. n. rt. • WellLocation: rt_ n. 1 0G�. PaY1 I P. S rt huriiita%(7wner NNmc F ca l try 11)/1/if pplicable I ft. h. 143 7 Rai ega, caa o& IIIIIII h. rhy.,ical AdClcoSN,ray.a zip t:,61EMA,. c.at e W (manly Parcel Identincnllon No.I PIN) Sh.l,,atitude and Longitude in degrees/minotes/Aeconds or decimal degrees: 22 C iftcation' -------- 1' or well field.Oae IM/long i5,,a llieient) _ N W �� - .igt tune of Ccnilicd Well C'untracto' flair 6.Is(are)the.well(s): ©Permanent or DTemporary by sogtung the,/i,rnr, 1 hereby Ceru 'Mal the “r116.1 'roc (were)con.nlrtrctdd ar a:rnrdonee r•dh 1SA N('A('02('.(11011 or 15A N('A('02('.0200 Well I',instrucnnn Standards and rhar a 7,In(ltit a repair to an existing well: CilYes or 14 copy n)'rhir record ha.c been provided to the m•ll owner. If I/tic is a rclrn,fill ant known wo/I('Onsb'rtauu,nr/i,rntalion and asp/am nci:ncrntre pith,' repair vtkfor.2/rerrtttrks.dcuatn„r on the hack n/rhi.r./(,rm. 23.Site diagram or additional well details: You may use the back of this page to provide additional well site details or well 8.Number of wells constructed: construction Details. You may also attach additional pages if-necessary, For multiple in/ec/inn'of n,nl-uahrr,suprly malls ONLY with rho sow construction,you con A ubnrit elite li(rnl SI IDMIT_TAI,INSTUCTIONS 9.Total well depth below land surface; rT'xJ_5 (Pl.) 24a. wqr All Wells: Submit this form within 30 days of completion of well i•,.uwltyd(:uq.lir hit oil depth,.t/'dr/)front(esernrple-41205'trod 20/110') COnStn)etion to the following', 50 Division of Water Quality,Information Processing Unit, f Static water level below top oPcasing; (n') 1617 Mall Service Center,Raleigh,NC 27699.1617 lhrropr Icrrt t.uhrn�o n1,�41/;.use'.• 11.goreholediameter: 6 (in.) 24h. For Iniic(ion Was: 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 following: t i c Imgcr,rotary,cohlc,direct push.cte.) Division of Water Quality.Underground injection Control Program, FOR WAl'ER Slim. F,L,1.5 ONLY; 1636 Mail Service Center.Raleigh.NC 27699-1636 13a.Yield(gpm) l __ Method or test: Open Flow 24c.For Water Supply&Infection Wells: lo addition to sending the form w the address(es) above, also Submit one copy or this form within 30 days of 13b.Disinfection type!.Chior Tabs Amount: 1 1/2 Lbs completion of well construction to the county health department of the county where t:17n3lruelcd, Yolm OW-I Notlh Caroline Deparancnl of F,'zvironment and Natural Rcsuurcce—Division 01 Water()Wilily kevised Jan.2013