HomeMy WebLinkAboutWELL-07-2022-175409.tif CATAWBACOUNTY Case# WELL-07-2022-175409
14 t Lk Public Health Department Subdivision B L KISER
d "'I Environmental Health Division PIN# 461602563893
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# PT 21
!g. SM
Site Address: 4611 KISER ISLAND RD, TERRELL NC 28682
Name on Permit: JESSICA KISER
Property Size: Acres 0.59
Directions: NC-150, right onto Kser Island Rd,go about 2 miles, home is on the 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 Health 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(I5A NCAC I8A.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.For questions or for more information,please contact Environmental Health.
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07/11/2022
Authorized State Agent Permit Issuance Dale
7/11/2027
Permit Expiration Date
chperntit 07/13/2022 10:21
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Parcel: 461602563893, 4611 KISER ISLAND RD 1 in=54ft
TERRELL, 28682
This map/report product was prepared from the Catawba County,NC Geospatial In omiaibn Services. Catawba County has made substantial efforts
to ensure the accuracy of location and Iabeilng 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
personnel,declaim,and shal not be held gable for any and all damages,loss or liability,whether dked.Indirect or consequential which arises or may
arise from this map/report product or the use thereof by any person or entity.
Copyright 2021 Catawba County NC
07/11/2022
gz) WPDT Report
Area of Interest (AOI) Information
Area : 3,134,508.7 ft2
Jul 11 2022 10:34:22 Eastern Daylight Time
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Krawh Releases oI cutm,wtion Omer System Roads 0 ow D 06 0 12 m
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0 Underground Tun In.ndents — Ramps Rest Areas,ttol- I5 1I ne 0 0.06 0.1 0 2 bn
-_ Pieces lPolyyors)-Parceaa Pmlecled Rate
Non-System Roods — Omer Stale Agency Route
Federal Route — Secondary Roue rr_nvr ors Um.E.c..r.rn Me,.lank-but.IN w,*:,ur'.,2.,
vwr.Carer Sao d Nor.faro..DOT a Ow3...N.o..ba....
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ES.A.+U'S US Centro avvu USDA.Sows,0. Mnn OS USGS
Interstate
4611 kiser island rd
Known Releases of Contamination
1 $1b4 Name 6 t' OurrentAst Of • Ceara
1 36992 CHEN RESIDENCE Underground Tank 12/18/2019 1
Inicidents
All North Carolina Department of Environmental Quality(NCDEQ)GIS data is expressly provided"AS IS"and"WITH ALL FAULTS".The
NCDEQ makes no warranty of any kind,express or implied, concerning this information, including but not limited to any warranties of
merchantability or witness for any particular purpose.The NCDEQ assumes no responsibility or legal liability concerning the Data's accuracy,
reliability,completeness,timeliness,or usefulness.The data is not intended to constitute advice nor is it to be used as a substitute for specific
advice from a professional.Users should not act(or refrain from acting)based upon information in the Data without independently verifying
the information and obtaining any necessary professional advice. Users are solely responsible for ensuring the accuracy,currency and other
qualities of any products derived from or in connection with the NCDEQ's Data.The Data is collected from various sources and may be
modified over time without notice to improve spatial andattribute accuracy.The NCDEQ disclaims responsibility for the spatial accuracy and
attribution of GIS features and makes no warranty concerning same.
UST Section
Description of Dataset
The Underground Storage Tank(UST)Section's data presented here is representative of two different
programs within the Section;the UST program and the Aboveground Storage Tank/Non-UST(AST)
program. While the UST data specifically relates to UST systems,the AST data may be related to a
variety of release sources, i.e. AST systems,fuel tanker spills, illegal dumping, etc. Whereas,the UST
data Is specific to releases of regulated substances from USTs.All UST Section features presented in this
tool represent locations where the latest reports document confirmed or assumed exceedance(s)of the
NC Groundwater Quality Standard and/or the Soll-to-Groundwater Maximum Soil Contaminant
Concentrations (MSCCs).
Contaminants Potentially Present I!
UST and AST Program Sampling Recommendations:
• Volatile Organic Compounds
• Semivolatile Organic Compounds
• Metals (Cr and Pb)
Contact Information
To request additional information from the UST Section please contact the NCDEQ Regional Office
assigned to the area of Interest and ask to speak with a member of the UST Section.A map of the UST
Section's Regional Office coverage areas and phone numbers can be viewed by following this link.The
UST Section's Regional Office contact Information is also presented below.
UST Section- Regional Office Contact Information
Asheville(ARO)—2090 US Highway 70,Swannanoa,NC 28778(828)296-4500 •
Fayetteville(FAY)—225 Green Street,Suite 714,Systel Building,Fayetteville,NC 28301(910)433-3300
Mooresville(MOR)—610 East Center Avenue,Suite 301,Mooresville,NC 28115(704)663-1699
Raleigh(RRO)—1628 Mall Service Center,Raleigh,NC 27699(919)791-4200
Washington(WAS)—943 Washington Square Mall,Washington,NC 27889(252)946-6481
Wilmington(WIL)—127 Cardinal Drive Extension,Wilmington,NC 28405(910)796-7215
Winston-Salem(WS)—450 West Hanes Mill Road,Suite 300,Winston-Salem,NC 27105,(336)776-9800
Guilford County Environmental Health,400 West Market Street,Suite 300,Greensboro,NC 27401,(336)641-3771
WELL CONSTRUCTION RECORD (CW-1) For Int,mal Use Only:
I.Well Contractor Information:
Joseph Bailey 14.WATER ZONES
Well Contractor Name
IN1)s? I to HIM Hilt IO'
3271-A cw( ft, ash ft. 5/10// cal e O,r!
NC Well ContractorCcniicauon Number �d6 ft C 5 i ft'
t ,5
mA�/ ��/4' �p�
I .OUTER A 1NG(fur multi-eased wells)OR LINER Of applicable)
B & K Well Drilling Inc FROM u) UI.isIETER Ito(IaISS 1 MATERIAL
Company Name a ft• 91/ ft. g,(7 In, S6R-71 PVC
Af „ri 16.INNER CASING OR TUBING(geothermal closed-loop)
f_eF MATERIAL.
2.Well Construction Permit#: f� G� �D%� (10??, 1� 7 FROMTU DU 11 ET THU K�FSS
�" JJJ II. II. in.
!au all appfrrohlc KO r,mtrrurhun re Ann(+e l+l(,('nunn',Aire, 1'an,rnr,',rt
, J +
3.Well Use(check well use): ft. ft. In. l
Water Supply Well: 17.SCREEN
00.'tiCLltaral FROM 11I DIAMETER SLOT SIZE TIIICK'FSS MATERI SI.
' b 0Municipalipublic ft. ft. in.
JGeothcrmal(lieating'Cooling Supply) EaResidential Water Supply(single) ft. fl- in. i
Ind ustriaVC'ommcrcial ❑Residential Water Supply(shared) IS.GROUT
Irrigation FROM 10 MATERIAL F.1tPLACEME\T MET 11 D&AMO 1T
Non-Water Supply Well: 6 fl. aO n- &4/1/7//` �i 11 1/�bp'fii•
°monitoring 0Recovery v rt. ft. ,UO
Injection Well: rt. rt. . I
0 Aquifer Recharge DGroundwatcr Remcdiation
Aquifcr Storage and Recovery OSalinityBarrier 19.SAND/GRAVEL PACK(if applicable)
FROM TO MATERIAL EMPLACEMENT slE1ROD i
Aquifer Test �Stomlwater Drainage ft. ft.
Experimental Technology Subsidence Control ft. it.
Geothermal(Closed Loop) Tracer 20.DRILLING LOG(attach additional sheets If necessary)
FROM 10 DE, RI PC N(color,hardness-sal Viva hpe,;rain size.etc.)Geothermal Bleating/Cooling Return) �7E)Othcr(explain under#21 Remarks) D ft. .46) ft. sQ2r/11J I
4.Date Well(s)Completed: ,ofre,, Well ID# 1. r pr i ! Q it. . n' �Q /� Ci/lrl ..O ,�
30 ft. /'►ft. //d//jr/ 54'/,(}%
5a.Well location: V
it
Facility/Owner Name Facility IDa(if applicable) eft. ft. •SDf/ G� 12 c
-� � � >V y
lik1/ASr� 14'"id/c iii( /�/ed el4,245—rt. 465 TL fs,s./7t' ¢�k..
Physical Address,City,and Zip ft. ft.
0.7:14/A9
- ` 9(// o) 3,(Q7 21,REMARKS
ty (� Parcele Identification JNo.(PIN))
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat%lung Is sufficient) 22.Cert misfit n'
N W \me / Q7G/q7
e 1 Ce it 'ell Omit for Date /
6.la(are)the well(s)OPermanent or OTemporary
) iigni rx dm furor. l her he r+rift thus the m'N(U out(we're)c+M t'scrid in wvor,(anci
7.Is this a repair to an existing well: )Yes orlia±‹.--- Pt lib/51 MAC'(L'C.ltl(hl 11.1.1C'.IC 02(' U:W lie!!Coasts-swoon Standards and(hal a
If this is a repair,fill out knows,well construcliva information and rtplara Ow nature of the rap{)uJ th)+record hut been provided hi the well uw titer
repair under#21 remarks section or on the hail of rho form 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Construction details. You may also attach additional pages if necessary.
construction,only I GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled: SIIBMITTAI.INS'rRl'("1'{ONS
9.Total well depth below land surface: [Y40 M.) 24a. For All \Fells: Submit this 1'unn within 30 days of completion of well
Foe multiple wells list all depths Ifdiferent lcraxp/r•.l(C?00'and.?..a,too') construction to the following:
10.Static water level below top of casing: 40 (ft.) Division of Water Resources,Information Processing Unit,
If water kid 1.r aline ia,(ng.nee' 1617 Mall Serb ice Center,Raleigh,NC 27699-1617
II.Borehole diameter: 6 1/8 (in.) 24h. For Infection Wells: In addition to sending the form to the address in 24a
Air Rotary above, also suhmit one copy of this form within 30 days of completion of well
12.Well construction method: construction to the l'ollow•ing:
ti a auger,rotary,cabk,direct push,etc.)
Disislon of Water Resources,Underground Injection Control Program.
FOR WATER SUPPLY WELLS ONLY: 1636 Mall Service Center.Raleigh,NC 27699-1636
13a.Yield(gpm) 8 / 1) Method of test: 24c. For Water Supply & Infection Wells: in addition to sending the form to
the addressfes) above. also submit one copy of this form within 30 days of
Chlor Tabs 1 L2 Lbs completion of well construction to the countyhealth department of the county
13b.Disinfection type: Amount: P ' P
where constructed.
Form G W-I Nonh Carolina Depanment of Ent vomnemal Quality-h is)sron of Water Resources Retread=-22.2016
catawba county
public health
Memorandum
August 18, 2023
To: Jessica Kiser
From: Megen McBride, Environmental Health Administrator
Re: Well Samples Required. Permit: WELL-07-2022-175409
Site Address:4611 Kiser Island Rd,Terrell NC 28682
Catawba County Environmental Health permitted a private drinking water well at the above address.
Our records indicate the well was drilled on or about 10/20/2022.Shortly thereafter,we inspected the
completed work and noted that the well vent was broken. For this reason, we cannot final your well
case and issue a Well Certificate of Completion. Despite this, the fee you paid for the well permit
included water samples.
If you would like our office to sample and test your well water, please contact us at the number below.
The samples would be taken from an outside source, so it is not necessary that you are present. There
is no additional charge for these samples.The sample test results would be sent to you when they are
received by our office.Typical process time is 6-8 weeks.
If you have additional questions, please call us at (828)465-8270,or by e-mail at:
EHAdmin@CatawbaCountyNC.gov
catawbacountync.gov
Environmental Health
Catawba County Government Center
25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270
MAKING. LIVING. BETTER.