HomeMy WebLinkAboutWELL-11-2022-184448.TIF ! k CATAWBA COUNTY
1. Public Health Department Subdivision WYNSWEPT PH 5.2
eNots Environmental Health Division
PINK 367804712877
PO Box 389,25 Government Drive,Newton,NC 28658 I,OT# 74
Site Address: 3207 TIMBER RUN LN,MAIDEN NC 28650
Name on Permit: "NEST HOMES LLC
Property Size: Acres 0.72
Directions: intersection of Buffalo Shoals Rd&NC 16 S to left on Cayton Dr, left on Timber Run Ln
Owner/Authorized Representative Acknowledgement of Permit Receipt
HP I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
ilHP As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-06-2022-41523,by the following method(s):
Received in Person
_ Facsimile"Transmittal (Return form with signature required)
t♦ Electronic Image Transmittal/E-mail (Return receipt required)
HP As the property owner or authorized representative I have reviewed and understand the specific conditions
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: 11/15/2022
Owner/Authorized Representative Signatu O+ti--•
Date 11/1 8/22
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by _ (name of person sending permit)
n
Signature y
1. ______.____ .__ Datc/"Time ilIig1l2-_
Method: Fax J Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from yoLPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/ENCusttomerService
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44,:ie CATAWBA COUNTY
• -t. Public Health Department Subdivision WYNSWEPT PH 5.2
q.(....._
� s Environmental Health Division PINK 367804712877
PO Box 389,25 Government Drive,Newton,NC 28658� y LOTlI 74
Site Address: 3207 TIMBER RUN LN, MAIDEN NC 28650
Name on Permit: "NEST HOMES LLC
Property Size: Acres 0.72
Directions: intersection of Buffalo Shoals Rd&NC 16 S to left on Cayton Dr, left on Timber Run Ln
Owner/Authorized Representative Acknowledgement of Permit Receipt
1( HP I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
HP As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-06-2022-41523,by the following method(s):
Received in Person
_ Facsimile Transmittal (Return form with signature required)
11 Electronic Image Transmittal/E-mail (Return receipt required)
HP As the property owner or authorized representative I have reviewed and understand the specific conditions
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: 11/15/2022
Owner/Authorized Representative Signatu . _ C340✓\—/
Date 11/18/22
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature ..q--i
Date/Time
I(it1?Z_
Method: Fax J Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from yotPlease hake a few momentts tto complette our custtomer service survey aft
http://www.surveymonkey.com/s/EHCusttomerService
hpv3hn Th& (.
cLp,will I1/152022 15 56
�+ CATAWBA COUNTY Case# WELL-11-2022-184448
.i.e Public Health Department Subdivision WYNSWEPT PH 5.2
Environmental Health Division PIN# 367804712877
PO Box 389,25 Government Drive,Newton,NC 28658
LOT# 74
/8 4 2 sw
Site Address: 3207 TIMBER RUN LN, MAIDEN NC 28650
Name on Permit: *NEST HOMES LLC
Property Size: Acres 0.72
Directions: intersection of Buffalo Shoals Rd&NC 16 S to left on Cayton Dr, left on Timber Run Ln
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.
11/15/2022
Authorized State Agent Permit Issuance Date
11/15/2027
Permit Expiration Date
ehpcnnit 11/15/2022 16:00
lei ,tc tell Qt3M city-2022- ` s23
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Parcel: 367804712877, 3207 TIMBER RUN LN 1in=50ft
MAIDEN, 28650
This map/report product was prepared from the Catawba County,NC Geospatielm Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling information contained on thliss ap 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,disdain',and shall not be held liable for any and all damages,loss or liability,whether direct,Indirect or consequential which apses or may
arise from this map/report product or the use thereof by any person or entity.
Copyright 2021 Catawba County NC
. 11/15/2022
KA, WPDT Report
ti
Area of Interest (AOI) Information
Area : 3,134,508.7 ft2
Nov 15 2022 8:59:03 Eastern Standard Time
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!Patted(Po,rgoos)-Parcels Projected Route 0 003 0.06 0 12 m
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Non-Sri Roads — other State Agency Route 0 0 06 0.1 0.2 ien
— Fede a Route — Secondary Route
Non-System Pima Roads
Over System Roads — Interstate Lri Cu.-war Maas cwwasa, .,.Jr Coull, s'.r.c.r rrnn Ca_.'.a
DOT a OpAnSemediro \W.46WA Ern. MERE G.rrnn SAAC.e
— Rarros,Rest A•eas Non.Mar lone — Us Route mt•O..ry«.,e urnNESA USGS IPA MPS u5 Edo~,.free.
USDA µCppT 0'5 Unr Sevres Er A.an Cb uSGS NSA MASA
' NC Route
3207 timber run In
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.
7
arr.' Print Form
WELL CONSTRUCTrON RECORD(GW-f) For Internal Usa Only: -
I.Well Contractor Information: za ra
44
j 6,(�y y1y{J�1. 14,WATER ZONES
'V�- Ct A FROM . TO DESCRIPTION - -
WeU Contractor Name
-1-5 T o 7 ) 'it, rt.
NC Veil'Contractor Certification Number 15rOMERgARNO(for pitbcas et]wells OR LINER(trap Ueable)
moat 70 MAI ram THICKNESS MATERIAL
Ift, I 4? ft,f to,1• in. •Pi.
Company Name 16.INNER CASINO OR TUBING Wet normal elostd-hoop)
2.Wc1IConstruction Permit;,l FROM 7'O DIAMETER In, TIIiCttNF.5S MATERIAL
Lrst all app!rcabfewaltronshIrrliohherarltt(Ic.UI bwnp;31ate,Yarlanre,ctn) ft. f6
3.1Vell Use{cbeekwelluse):
` [t. [t. in
17.SCREEN
Wee Supply Well; FROM TO DIAMETER SLOT SIZE THICKNESS L MATZRZAL
QAgncultural DNlunitlpal/Publie o ft, ft. !n. I
Geothermal autinglCoblingSupply) ylRcsidential Water Supply(single) ft. ft, In. I
D,Industrial/Cernm rci l DRcsidenlial Water Supply(shared) IB.GROUT
irrigation FROM TO MATERIAL - LMPLA ODErAMOUNT
1"b 1 ,
Non-WaterSupply Wel: k ft. 9.0 ft
;3Mnnitwitig �Rccovcry fr. G� ft.
dnlettinn Well: ft, R.
qua. Reel,tge GmundwatcrRemtxlifltion 19.SAND/GRAVEL PACK(IfapplIcabIo)
.,gniferStoragezn$Recovc t DSalinhyBarrier FROM TO MATERIAL r.PLACIIIMTIYIETROD
quif r lest DStarmwaterDrainage rt. ft.
tlExpezimonotTTcalmology DSubsidcncc Control ft It. f
iGeothe al(aostriLoop) D-racer 20.DRILLINGLOG(attach-additional sheets If necessary) -
FROM TO DESCRIPTION(color,brdnm,entroektyP4 grata size. )
r"e1,hemu1fEisat an7CooliingRetum) nOthcr(explain under#21Remarks/ a ft. ft.
4.Dattewrll(s)Completed r/7-.g4-2s Well ID# 43 ft.
Sa.S�'tIILoca;iot>+
3 fL5ft. . - _r
)rS cr. S6 ft. IP -'4 G,
FsiTtofDamer3a'acr Feeility106(if applicable) .96 n' t 90> 3.L.�e.4_
R. ft.
Q l r `: brk'- Qi.u-c.. L 1
yil=1:,,tt m Cz7` Z,, ft. ft
, '1 21.REMARKS
dPet
Comity Pamclldentlficatian No.(PIN)
5fa..Latitudeand longitude in degrces/minutes/sceonds or decimal degrees;
writ Ctcld,o:clmilengiscofai 22.Ccrt![IcatI
N W , 7 w a,_ --
6..Is(are)tluivcii(s)+Prrmsrtcnt or rit'I'craporary
Signature mined Contractor Date
By'sip n this far hereby ea*that 11K,uvll(s)nit MYre)crurstructrdln coxpdance
7.jsih1s2Ttpafr In an eXMintweIt: OW; Ar OBNo with 1 ROW 0.lC,a1a0 or 154?CAC'02C.O2OO Well CotrrRlxt=Manetard rand that rr
•
litho fs4r9alr,JWotdknmvo mllccnnrarilon lnfontratfort and wide*the more oph, cal vgflhls record has hegira pruvltfed to tit iudl uw,tar.
rep air.rmdern!rcmmlaorerteinoroxme back ofth(sjann. 23,Site diagram or additional well details;
You may use the back of this page to provide additional well site details.or well
S.FarGeon,onyj37?I'Pr s needed,
ILoop icate'GeothTOnA NUMells BER
the same construction details, You may also attach additional pages lfnecessary,
constructitm.onlyl GW�ieDrxdcd.TadJcaioTfft'AL'MUMBi3It.ofwolla
drilled: rryy j9U(IMITTM.1NSTIUICTIONS
9.Tota1Weli depth below laud surface:. r D 5 (ft) 24a,For Alt WellySubmit this form.within 30 days of completer of Well
Form/We-wells I/st411depI(ts Jdircrent exumple.5(V 1/' d3Wj100�) construction to tlta follawingt
10.Static water level below top of casing: It (fa) Division of Water Resources,Information,I'rocessing Unit,
Ifswlcrlevet Is above cailhi we"+" 1617 Moll Service Center,Raleigh,NC 2,7699-1617
11.Borehole diameter: 6 (tn,) 'fob.For Inleet(pn Wcllst in addition to sanding the form to the address in 244
A�to lr�l above,also submit one copy of this form within 30 days of completion of well
12.Well construction method: construction to the fallowing;
(La auger,Tutary,cablc,directpash,e;c,) -
DlvIsion of Water Resources,Underground Injection Control Frogranl,
FOR WATER SUPPLY WELLS ONLY; b 1636 Mali Service Canter,Raleigh,.NC 27699-1636
13a,Yield(pm) Method of Pest; 0) I x4c.For Water Supply&Injection Wells; In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.DIsinfectiontype: (.L. Amount: ID 0 completion of well construction to the county health department of the county
where constructed.
•
Form GWW-I North Caroline Department of Environmental Quality-Division of Water Resources Revised 2-22 2016