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Home My WebLink AboutWELL-05-2022-172385.TIF k I oorr CATAWBA COUNTY --- �. nr, Public Health Department Subdivision Z� ' _ �s`' Environmenl�l Health Division PINS 481901094974 �� PO Box 389,25 Government Drive,Newton,NC 28658 LOIN 2 Bits Adds.'s,: 1318 MOLLYS BACKBONE RD,CATAWBA NC 28809 Name on Permit: ERICA FRAZIER Property Stu: Acres 1.23 Directions: NC 10 Left 2nd Ave SE,Right 2nd ST SE,Right Rhyne RD,Left Husdon Chapel RD,Left Long Island RD, Right Monbo RD,Left Lowe ST,lot on Right Owner/Authorized Representative Acknowledgement of Permit Receipt I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of e property described above.th . - Z...... Aepermit(s)the property owner or authorized representative,I have received the above referenced permit(s)as requested in the application for service RBPR-03-2022-40526,by the following method(s): _ Received in Person Facsimile Transmittal(Return form with signature required) V-- Electronic Image Transmittal/E-mail (Return receipt required) pAs the property owner or authorized representative I have reviewed and understand the specific conditions a.--- of the permit issued, and further understand that all applicable regulatory requirements specified under the North Carolina Laws and Rules for Sewage Treatment and Disposal Systems(15A NCAC 18A.1900), and/or Well Construction Standards(15A NCAC 2C.0100), shall apply to the issuance of this permit and the construction of the wastewater system and/or water supply well permitted. Permit Issue Date:05/26/2022 n, PA - Owner/Authorized Representative Signature l ""r/L, -7 Date (2 i IS i'DP'' Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name of person sending permit) Signature 411 Date/Time l/)f 15/)) Method: Fax J Email US Mail Other Owner's request to send by the above indicated method of transmittal in lieu of signature We want!tto hear from yoiPlease ttake a few momentts tto complette our custtomer service survey att http://wwwsurveymonkey.com/s/EHCusttomerServlce ei • n Zito lc,.8Peg iteuLsi, erty% 05/2712022 15:31 4y= • CATAWBACOUNTY Case# WELL 05 2022 172385 F. .fi.Ili ,� Public Health Department Subdivision y Environmental health Division PIN# 461901094974 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 2 /842 sM Site Address: 1316 MOLLYS BACKBONE RD, CATAWBA NC 28609 Name on Permit: ERICA FRAZIER Property Size: Acres 1.23 Directions: NC 10 Left 2nd Ave SE, Right 2nd ST SE, Right Rhyne RD, Left Husdon Chapel RD, Left Long Island RD, Right Monbo RD, Left Lowe ST, lot on Right NEW WELL PERMIT REQUIRED WELL SETBACKS: Septic Systems and Repair Areas for Single Family Dwellings 50 ft. Septic Systems and Repair Areas for Businesses and Multi-Family Residences 100 ft. Underground Storage Tanks 100 ft. Animal Barns 100 ft. Lakes/Ponds 50 ft. Streams/Brooks/Creeks/Rivers 25 ft. Building Foundations 25 ft. All Other Sources of Groundwater Contamination 100 ft. Saprolite Septic Systems and Repair Areas 100 ft. Septic Systems and Repair Areas to Wells with 2 or more connections 100 ft. Wells shall be constructed in accordance with state regulations: Article 15A North Carolina Administrative Code Subchapter 2C 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 I lealth at 828-465-8270,before drilling the well. Grouting Depth:20 feet minimum Casing Height: 12 inches minimum above finished grade 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(15A 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 fur sampling.Water samples will be drawn from an outside faucet unless otherwise specified.For questions or for more information,please contact Environmental Health. 05/26/2022 Authorized State Agent Permit Issuance Dale 5/26/2027 Pennit Expiration Date ehpennit 06/03/2022 16:14 ,60 R/w BACKB�N MOLLYS ER� , 1.1 .....\ mod; 1 .... ....2 It:„.„, \ .-.,.. s►�� I • r. .i -.. ,3 ,.a r. ED 7., id,^ F.., 0 (7 ,,-- n ,.i ff > IEU Dw 7..1)1 l 61 II n 1 co ul w D G m . -�m�v _ 7. _ 21 - i 9 0 22L A u T 4-1 - 3 - Z 3 - 19 6 8 3 ago' .30.'cot 5 t 1 1,.,ti t,t. - 5 - Z Z.-- !l Z-3 b f 1 SHEET TIRE PROJECT NAME: a v c Soil de Forntry Services � ��,�y �� n� AZIER of t o Corol1 PA 4 s Q I p sEP11C SYS MLAYOUT �ai�s Acrt BON IIIL F�IUFITIT �c°9dllPc 2Ro2 w o a, 791 Et,9 SKE FEBRUMY 2023 IEI■,IEt usablesollegmall.com a �r+s ssaasare ws a eore:39—S00753 soliandforsitryeervicss.com Scanned with CamScanner WELL CONSTRUCTION RECORD(C W-l1, For Internal Use Only: 1.Well Contractor Information: Chris C Russell 14.WATER ZONES Well Contractor Name FROM TO DESCRIPTION 3254 A 60 ft- 325 rt, ft. rt. NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap licahle) Russell Well Drilling, Inc. FROM TO DIAMETER THICKNESS MATERIAL. 0 ft' 114 R• 6.25 I°' SDR21 PVC Company Name WELL-05-2022-172385 16.INNER CASING OR TUBING(geothermal dosed-loop) 2.Well Construction Permit#: FROM TO DIAMETER , THICKNESS MATERIAL. Lie:all applicable well construction permits(i.e.U/C.County,State,Variance,etc.) ft. ft. In. 3.Well Use(check well use): ft, ft. In. Water Supply Well: 17,SCREEN FROM TO DIAMETER SLOT SITE THICKNESS MATERIAL. ❑Agricultural ❑Municipal/Public ft. n. in. ❑Geothermal(Heating/Cooling Supply) II]Residential Water Supply(single) ft. ft. in. ❑IndustriaVCommercial ❑Residential Water Supply(shared) lg,GROUT ❑Irrigation ❑Wells>100,000 GP FROM TO MATERIAL. EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: 0 ft' 20 rt. Grout Poured ❑Monitoring ❑Recovery ft. ft. Injection Well: ft. ft. ❑Aquifer Recharge ❑Groundwater Rcmtdiation 19.SAND/GRAVEL PACK(if applicable) ❑Aquifer Storage and Recovery OSalinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD ❑Aquifer Test ❑Stormwater Drainage ft. ft. ❑Experimenta]Technology ❑Subsidence Control ft. ft. OGeothermal(Closed Loop) OTracer 20.DRILLING LOG(attach additional sheets If necessary) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,'Wreck type,grain sire,etc.) ❑Geothermal(Heating/Cooling Return) • 0 ft, 109 ft• Dirt 4.Date Well(s)Completed: 8-5-22 Well HA 109 ft, 325 rt. Rock 5a.Well Location: ft. ft. Erica Fraizer Jonathan Scronce ft. ft. Facility/Owner Name Facility IDt#(if applicable) rt' rt. 1316 Molly's Backbone Rd, Catawba NC 28609 ft. ft. Physical Address,City,and Zip ft. ft. Catawba 21.REMARKS County Parcel Identification No.(PIN) ' 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field,one lat/long is sufficient) 22.Certification: 35.657.020' N 80.984.650' W 10/21/2022 6.Is(are)the well(s): fI)Perrnanent or ❑TemPory ra Si ttun�Certified Well onaractor Date By signing this form,I hereby certi('that the well(s)was(were)constructed in accordance with 7.Is this a repair to an existing well: ❑Yes or QNo 15A NCAC 02C.(1100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy If this is a repair,fill out known well construction injurrnation and explain the nature of the of this record has been provided to the well owner. repair under rill remarks section or on the back of ask form. 23.Site diagram or additional well details: 8.For GcoprobelUPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary. drilled: 24.SUBMITTAL INSTRUCTIONS 9.Total well depth below land surface: 325 (B•) Submit this GW-1 within 30 days of well completionper the following:For multiple wells list all depths If dierent(example-3(ig200'and 2La1100') y P 10.Static water level below top of casing: 60 (ft) 24a. For Al) Wells: Original form to Division of Water Resources (DWR), ljwater level is above casing.use"+" Information Processing Unit,1617 MSC,Raleigh,NC 2 7699-1 6 1 7 24b.For Injection Wells:Copy to DWR,Underground Injection Control(LUC)11.Borehole diameter: 6.25 (In.) Program, 1636 MSC,Raleigh,NC 27699-1636 12.Well construction method: Air Drilled 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the (i.e.auger,rotary,eahle,direct push,etc.) county environmental health department of the county where installed I FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPI):Copy to DWR,CCPCUA 13a.Yield(gpm) 20 Method of test:Air Permit Program, 1611 MSC,Raleigh,NC 27699-1611 13b.Disinfection type: HTH Amount: 3/4 cup Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6.6.2018 1 --- -------------T 60' R/W MOLLYS BACKBONE Rp .t 1 1. `.r.\i . 4\ g \ i'.\ Al .0" - , . -.LT... 1 \ . „:, .. • . ., ., ic\ ,...:.;\ It_• %.4 r 1 z i a:;. 3 .,L+i• f 0 O )v o � L J - S Jo-f 1n�� A\S i To4A; w\L.5, -. c) D a ' •WrI.1 lk 2 -0_ • - II n Co 0 i 03 -> : . •S M•P�( - 'L _ 21 — 190 22� i 1 A c°�,, �e.J iT-L L., — S — 2 2.— I i-3 8 s` 1 ytEET 'ME PROJECT NAME:FRAZIER Sao do Forestry Servlcee . 8 gn 7) Niel g of�6,"e grpolhNas, PA s p i 9 ci SEPTIS- 1 SS0H IAA YOUT OA AWBA A WNTNYE 11�� Ftn,�E,1�� Concord NC 2B023w oii�� t�H ��1 tr FEHRUARY 2023 1E�*'�1 ueablesoflOgmotl.com 7° o Ewa suuasr�we lIcies 39-3007 soflond orestryseMces.com Scanned with CamScanner