HomeMy WebLinkAboutWELL-07-2021-154845.TIF I
MI-L'CONSTRUCTION RN•cn 1L th3L- Fur internal Use Only:
1.Well Contractor Information:
—14'WATRR ZOPfFt f F.CRtPTI04 --"--
Robert Teague IRU\I rtt
14'tll fomnc,or Name
3 Li S ft. 5 O rl. r)._ r'~
B&K Well Drilling Inc Li L n. Z1i_uf' 1 G %,,.
IS.auTPRCAsIr (for ulti-e cif• kahk—l—_ --
NC Well t'onm(Ia Cemsicatwn NIrmM __stvrF.RIAI.
FRUN T(1
UTANF.I F.R 11UCAh IJ4 _,_---
2857-A o it. rl• a ice In— sna•s, PVC
Conlany Namc 16.INNER CASING OR TUBING i6etrnal clos dN y MATERIAL
Ion
`_/ FROMTU mn,\1ETER —f�-�--_'
2.Well Construction Permit q:I c l "7 rt, rt in,
f Ili all applicable Wei CanitrlrriIon permur(It M. in
Cow •State•Variance,rte.) In.
u.
IWell Use(check well use): ft.
Water Supply Nell: 17,SCREEN
roost TO DIAMETERMATERIALIn. x1A1T61rE Tl11('KM1[85
°Agncultuml Municipal/Public
ft h.
r3Gcolhcnlnal(Heating/Cooling Supply) Residential Watcr Supply(single) ft.
t. In.
0 InJuctnal/Commercial Residential Water Supply(shared) 1&GROUT \t\TFTtLU EMPLACEMENT hIr7710D{1M01`T
tool l TO Qlrngelitm ft. it.
Non-War Supply Well:
QMon t tonng ❑Recovery ft. ft._
Injection Well: ft. n.
❑Aquifer Recharge Groundwater Remedialion e,welACEMP.yi MET HOD❑ 19.SAND/GRAM.PACK f a Ilcable
DlAquifer Storage and Recovery
FµOM TU MATrRURecovery 0Saliniry Barrier ft ft
°Aquifer Test OStormwater Drainage
it, ft.
QErperimenlal Technology ❑Subsidence Control t.
Tracer 20 DRILLING LOG(attach additional
sheets ff oecet *,4n•r«L— �Pc s^"Or,tic)
IClosed Loop) ❑ FKont TO
1Geothermal MHeating/Cooling Return) nOther(explain under tf21 Remarks) ft, L •
ft. C,e.-
Well4,Dale Wells)Completed:1 L2,. Z Weil IUa
So. cll Location: 2-6rt,
Art,�� ft. l��r r t i 4 Q�
ft.
FacilityiOwner Nanve ��
Facility!Da applicable}Id LI
ft. ft.
(—Cie 1 v( ✓ - ft. ft.
Physical Address.City.and Zip L'0") c)V�'/
U.REMARKS
C e---
Parcel identification No.(PIN)
County
56.Latitude and longitude In degrees/minutes/seconds or decimal degrees: 22 Cerllflca
Orwell field.one tat/tong is sufficient) a
N W 1
(1f, ic:iinejiiiiucurr
Date
6.b(are)the well(s) Permanent or ❑TempMat y MIA(were!comtnand in accordance
(Jv ngnrng nhLr loan,I hereby who,that the wrflUl Well Cunsrracriun Standards nail that a
7.Is this a repair to an existing well: Yes or N u uh 1 to NCAC 02C.0100 or 114.HCAC 0.0.0200 n coin of OW reco'd hac been prnvtdcd in du'well owner.
10)1 r is a repair.fill pin known well rnnTvvctmn tnfonnatia+to
the nature of the 23.She diagram or additional well details'
r riwir under 02/remark)archon or on the hark of this fare.
You may use the back of this page to pro\tde additional well site details or well
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same conslnlctiUn devils. You ma)'also attach additional pages if necessary.
construction,only 1 C W-1 is needed. Indicate TOTAL NUMBER of wells 5UR M11 LAI-INSTRUCT IOC
drilled:
(ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
9.Total well depth below land surface: constnlction to the following:
Far multiplenrlk lute!!depths rfd rant O.maple-.)(a.((I) and-@10ll'I
40 10.Static water level below lop of casing: (ft.) Uinislon of Water Resources,Information Processing Unit,
1617 Mail Service Center,Raleigh,NC 27699-1617
If tierce friths WWI'Caring,ace"«"
II.Borehole diameter: _6 / —(in.) 24h. Fnr Injection Wells: In addition to sending the foam to the address in 24a
Air Rotary
above,also submit one copy of this form within 30 days of completion of well
12.Well construction method:
constnlct;on to Itic following:
(r c.auger,roury,cable,direct push.ac.l _ Division of Water Resources,Underground injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh.NC 27699-1636
t: Air Flow lac.For Water Suntlly&t injection 1lells: In addition to sending the form to
]3n.Yield(gpm) _ Method of test: the address(es) above also submit one copy of this form within 30 days of
Chloe Tabs Amount: t 1/2 Oacompletion of well consmhuau to the county health department of the county
Lib.Disinfection type: Amount:
constructed.
Form C V•I North Carolina Department of Environmental duality-Division of Water Resources
Revised=-=:-:010
4.11."
catawba county
public health
Memorandum
April 3, 2023
To: Kenneth Hensley
From: Megen McBride, Environmental Health Administrator
Re: Well Head Inspection Not Complete: WELL-07-2021-154845,
Site Address: 2754 Spencer Rd
Catawba County Environmental Health permitted a private drinking water well at the above
address. Our records indicate that we have not be notified that the well has been put into use
and is ready for water samples to be collected.
If your well is ready for final inspection and collection of water samples, please notify our office at
the contact information below.
There is no need for you to be present for our inspection. The water samples are collected from
an outside spigot. Please note, however, that the well head needs to be accessible. Please
remove any locked well covering or insulation barrier so that we can visually inspect the well for
compliance.
The fees for the well inspection and water samples were included in the cost of your well permit,
so there is no additional charge for this service. The water sample test results will be mailed to
you once they are received by our office. Typical process time is 4-6 weeks.
Please contact our office if we can answer any questions or provide additional assistance. You
may reach our office at (828) 465-8270, or by e-mail at: EHAdmin@CatawbaCountyNC.gov
catawbacountync.gov
Environmental Health
Cotowhc County Government Center
25 Government Drive PO Box 389 Newton NC 28658 1828.465.8270
LIVING. . BEITEL