HomeMy WebLinkAboutWELL-09-2022-180943.TIF =tea CATAWBA COUNTY Case N WELL-09-2022-180943
.t. ,y Public Health Department Subdivision A L KILLIAN
Q "{ Environmental Health Division PINK 374501279598
PO Box 389,25 Government Drive,Newton,NC 28658 LOTH PT 6
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Site Address: 6483 EDDLEMAN ST, CONOVER NC 28613
Name on Permit: CHARLES JOHNSON
Property Size: Acres 0.47
Directions: Springs Rd NE, left onto St Peters Ch Rd, left onto Valwood Rd, left onto Curlee Rd, lefto onto Eddleman St,
property on the left
REPLACEMENT 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.
PERMIT CONDITIONS
Shared well. Required 100'setback to septic systems.
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 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.For questions or for more information,please contact Environmental Health.
r- ,li 11- 142-101nCp ,e.k,Rt 09/22/2022
Authorized State Agent Permit Issuance Date
9/22/2027
Permit Expiration Date
ehpernnt 09/29/2022 14:47
W i--- 09.7.02-2- 1 A olt#3
Catawba County Environmental Health
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Parcel: 374501279598, 6483 EDDLEMAN ST 11n=60ft
CONOVER, 28613
This map/report product was prepared from the Catawba County.NC Goospatial Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location end labelinngg 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,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,Indirect or consequential which arises or may
arise from this map/report product or the use thereof by any persona artily.
Copyright 2021 Catawba County NC
09/28/2022
FROM : MORETZ WELL & PUMP FAX NO. : 7044621322 Nov. 11 2022 09:27AM P1
WELL CONSTRUCTION RECORD (GW-1) For Internal(Jae QnTy; J- u
I.Well Contractor Information:
Ashley T Moretz .:14:wyerrlizolvl"g' r. . - ; . .. . .• . . .
Well Contriclor Mine • 1:PTION
2586-A go ft. / Olt' S p .
NC Well GMtrackv Certification Number - �� a - >�ivk
:•15.OUTER " :7 `farsUltl-eindwelk).OR1 1NER(l(' ,,. '•k):
Moretz Well and Pump Service LLC : M To Dr.snt tilt ESS MAT CRIAL
�.
Company Name' O rt. 6 - ; , 21
C��d / O !�} /p p :Y67 NNN1rR:cAsiNG 0' TOO; . :..; mat chiseda000)..;_.,: :..
2.Well Constructfoa Permit!Y: 1 �, FROns TO Dust .• TmckNec$ MATERIAL
Litt all applicable well cueszruefionpermirs(r-e.UIC.Cols ry,Shaer,Variance,irk.) AllialL ft.
3.Well Use(check well use): M11 _
Water pesky W' - .. . - ..
u end 17c.SCR s: ,..:.,.,. .,
L• .-, u.3t�' SLo T g[.ZE TIIICl es ".....MATFlt1AL ".`
°Agicultinal °Municlpambllc �i _Adak
mGeothcrtnal(Hatting/Cooling Supply) °Residential Water Supply(single) ft. is. �t- -•
RIndustrial/Commercial dnidtmtial Water Supply(shared) r ;.: .,A ,.,;. ,r
LTigation FROM TO MAMMAL ItMP1.ACEMENT MT'rHHOD
Non-Water Supply Well: 0 ft. i le
- 1/ `
°Monitoring °Recovery ft. r` �
Injection Well: -
fi.
BAquiftsReehatge °Grrxmdwatcr Rernediation
Aquifer and •19:- t. r..tt:.P a. lira acne ..
Storage Recovery °Salinity Barrier MEOW MATERIAL EMPLACEMENT wrrwoo
Aquifer Test °Stormwster Drainage Ail, ft.
Experimental Technology °Subsidence Control Aar ��� �.
Ctcothtamal(Clasod I;wp) °Tracdx c 2ar1! ! t t attae4ddtaat
IIIIITIIII
Geothern>al gleaning/Cooling Return) D pater(explain under it21 Remarks) II" 'r4 n ON deobr,trugawr.will.ek t"g' rrir r q de.) ,
4.Date Wells)Completed:/A"?2Z DN 0 Well 1 re.
._ a " C S r l f 3 o %, ,r.w,ti. dG.A
Sa.Well Location: 7 0 n• Ork ae/ AO GA-
CJ.r/sS ZI:)/Lt.S 0it- . ft. ft
Facility/Denier Norm Facility ire(if applicable) ft. ft.
6315: £d / of . .5z 60n4vie r ft. R
Physical Address,City,and Zip ft ft.
.375 /o2'7r 7S7S 21 ..-:.. f• ' . . . ..
County Parcel Identification No.WIN)
Sb.Latitude and longitude in degreea/minutea/aeconds or decimal degrees:
(dwell field,on:hit/long is sufficient) 22-Certification:
35 2.f1.571 N —S/ l•Sr 9s- w
6.Is(ere)the weU(s) r�k Permanent or °Temporary S[anttlut duet ert dwell ConnectorDate
dy Arguing ads form.I hereby cers t5 that Me wwtl(s)was(were)constructed is aetvrdance
7.1s thine repair to an existing well: °Yes or o with ISA NCAC 02C..0100 or 114 NCAC 02C.0200 Weil Cots nmcalon Standards and ilia:a
1/.11i5 u a repair,jdl oat,brown well cwurrw:tion information and ezp/atw the nature aline COPY of Chit record hag been provided to the cell owner.
repair under#21 rrraorkr reaC:,On or on the buck ofthisjonx.
23.Silo diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells hawing the same You IDay use the back of this page to provide additional well site details or well
construction,only 1 GW-klaa needed- Indicate TOTAL NUMBER of wells construction details. Ytni may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
9.Te/al well depth below laud surface: 3 QS (R)
Far e+wft4o a wells tier all depths(fAr(ferertt(s�wtple•303200'and 1(tjl/ao) •For Al! Wellg: Submit this form within 30 days of completion of well
construction to the following:
10.Static water level below top of cosine: ,2� (ft) btvtataa of Water Resources,K./formation Processing Unit,
d'ade.ler&to shove casing,lire"+..
1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter. 6 (in.) 24b.For Infection Weals: In addition to sending the farm ro the address in 24a
t �, eenstructioo method: Rotary above. also submit one copy of this faro within 30 days of completion of well
construction lion to the following:
(es.auger,rotary,*able,direst push etc.)
Division of Water Resources,Uadergronnd lnjection Control Prorate,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Centef,Raleigh,NC 27699-1636
13a.Yield(gum) Method of test: Air Lift Zee.Fur Water aunty&1njes:tieon Wells: In addition to sending the form to
5.0
the addtess(ce) above, also submit one copy of Ibis firm within 30 days of
13b.Disinfection type: C Amount: 9 0 Z_ completion of well oonsttuction to the county health department of the county
wheat constructed.
Pons COW-I North ctroline Dear:ttment ofEavilonreeatat(loath,-fiviainn nt-Wet.r Proven...—,: •.. • ,...a.......•,.