HomeMy WebLinkAboutWELL-04-2022-169859.TIF •
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1•WeU Contractor Info!mown. ---
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Robert Teague I i W4IFH I ._.
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Well Contractor Nemr I-1 u 1' •l '1(_ -I / (., 1/ r r+'ti__
B&K Well Drilling Inc ,, f f
NCWellfnrrtnero,Cent rteation l:umber -.. 7.,.._ii__J u
— SINI,ouined wel R , atr�ot!µ2857-A r M �r _ Tln-11!!!..--1--
la. 121 P!-.D "' �.rrr1 I SOH
compeer Sam! lb:INNERCAb1Nr;QRTUBIHG sal doe&
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2.Well Ciotti'lotion('chit a: ! r, ...rPotl—" 7 014MLTLN TNI WWI
1 tat nil apphrahle sell,oaunramn pernttn(I e.U ',(Aunty,Srat, Variance.eh'I _.._..
3.Well Cu(check well use):
%Voter Supply Well: • -- . _ , 17 IGII[L 7p Dtslt7ea Orr atzt s_" NajCAM
IIIAgricuhill 0Municlpa1Pub16: It. rt. is
III 0eo1hcmtal Mcaung,Couhng Supply, Residential cosier Supply(single) R et. ha-
■Industrial/Commercial Residential Water Supply(shared) ' IL GRpII7 sr`m� etintncts¢YT stereo wog`►t j
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Nun-Water Supply Well:'`l — -�� -
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aamtonr,g --_-__ 0kccoscn� �_ ft. ft. _ ---------
injection Well: "' f1, n.
a Aquifer Recharge f(rroundwater Re:nedtgtron
19.SAND/011AVEL►ACR R lia.—Dk)
t!Aquifcr Storage and Recover) ❑Salinity Beerier Roll N To , suire3l C•M►LML siETHOP
EAquifcr Test DStomtwstcr Draina`c
It. i ft.
Expenmental Technology OSubsidence Control ft. i fr. l
II Geothermal IClosed Loop) 0 Tracer 19.DRILLING t.0 Wrath additional shop r.qeo�naiwarai�l'1V�.—,9+ ,
coast To oe cor+lr.lw
II Geothermal tfGtin. Doha:Return ■other ea.laio under a21 Remarks � It. ft. i
n. � n.
4.Date Well(s)CompletedS J/ --��--W ell 1D8
ft. h.
Ss.Well Location:
Cry���"' � n. rt.
�1'�h� lSr �� ,t h IL.r,� ' " - ft. ft.
a.dlrypwner Nana Facility Ina Of applicable l i
ft. h.
1446 5- (9C(ylcnj;` t' SIN'fr1o\5 r1 : ft. ft.
Physical Acheo Coy.Ltd Zip
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Sb.Latitude and longitude In degrcesADinutedsecurids or decimal degrees: '
(dwell fold.one latnoni;..,uffe.enp 22.Cern on•
N _ W — S- .31— 9
• Sr nest.,(CcrtifcJ Will Gala+�
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6.ls(are)the wetl(s)E l'erntaneor nr ['fempntary
J 8.r 2tirmir this form.I hereby mob.rhos the afoot‘.at(were):onlrn.rred:n aanrdan.r
7.Is this a repair to an existing nsrll: \es or fvo nits)14.'C.IC 02C 0140 to HA PC.'IC r)2C 0200 Well Como-axon 5tanvr, ,J and flan w
ropy of due woad han been provided to the veil*niter.
lfthu it a repair.li1l oar broor.nl rrnun.ut n: 'motion cn .rp)atn the nature of the
rywir anJrr a21 remark,erenun or on the Sat k„J:hu f.n 23.Site diagram or additional well&tails:
• You may One the back of this page to pros ide additional sell site details or bell
8.For Geoprobe(DPT or Closed-Loop Geothermal W'elb has mg the same wnstmttior.details. You may also attach additional pages if necessary.
cotutnlctioo,only I OWI is Deeded. Indicate TOTAL NUMBER of wells
drilled: SUBMITTAL INSTRUCTIONS
la.) 24a.for All Weir Submit this form within 30 days of complerwu of s.c:l
9.Total well depth be ow land surface:
For multiplenr1Lr(tar all depict i/drJfrrenr t.:rmnpfr- ¢.'Uri'and: I Dot's
corsttucac'nto the tollowing:
40 ((t) Division of Water Resources,lafonrladon Processing Unit.
l'o ter us water ,ca below top of using: 1617 Mail Service Center,Raleigh.r C 27699.1617
f(tawr use(u eMly casino.bee •"
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11.Borebok diameter:6 118 (In.) 24b.Fur lniecrion Well:: In addition to sending the form to the address in 2aa
Air Rotary above.also submit one copy of this form Within 30 days of completion of wait
12.Well copstrtrctlon method: corstruction to the follo".sg
It e saga.!Dory.table.duot push etc.) Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Rskig►.NC 27699-1636
Air Flow 24c.For Water Suooly&Iniectioa%Vela: In addition to sending the form so
13s.Yield(gpm) N1elhod of rest: the address(Ca) above, also submit one copy of this form within 30 days of
Chloe Taos I t/a Lb* completiou of well construction to the county health department of the county
13b.Disinfection type: Amount:
who,:cunstiuLted.
nit ow-1 North Carolina Department or Environmental Qualul-Division of Water Resources
Roved 2.21:0I6
catawba county
public health
Memorandum
August 18, 2023
To: Joseph & Catherine Hefner
3757 Rock Bridge Rd NE
Conover, NC 28613
From: Megen McBride, Environmental Health Administrator
Re: Well Head Inspection Not Complete: Permit: WELL-04-2022-169859,
Site Address: 4405 Derwood Dr, Sherrills Ford NC 28673
Catawba County Environmental Health permitted a private drinking water well at the above
address. Our records indicate the well was drilled on or about 5/31/2022. We have not been
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 the 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: EHAdminPCatawbaCountyNC.gov
catawbacountync.gov
Environmental Health
Catawba County Government Center
25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270
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