HomeMy WebLinkAboutWELL-11-2022-184549.TIF *IT,- CATAWBA COUNTY , -..
•/.1.Ile, Public health Department Subdivision WYNSWEPT PH 5.2
V a b vinmincntal Health Division PINH 367804712948
PO Box 3t9,25 Government Drive.Newton.NC 25658 1.0TP 73
alt 1-
Site Address: 3201 TIMBER RUN IN,MAIDEN NC 28650
Name on Permit: 'NEST HOMES LLC
Property Size: Acres 0.66
Directions: Intersection Buffalo Shoals Rd&NC 16S; NC16S to left on Cayton Dr then left on timber run In
Owner/Authorized Representative Acknowledgement of Permit Receipt
\1/2Y I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
(` the property described above.
As the property owner or authorized representative, I have received the above referenced
Af
permit(s)as requested in the application for service RBPR-07-2022-4I618.by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
f Electronic Image Transmittal/E-mail (Return receipt required)
on
k' As the property owner or authorized representative I have reviewed and understand the specific
p conditions
3/4°?
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(I5A 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: 11/16/2022
Owner/Authorized Representative Signature 5 z .-37
Date __-1IIrf?)IL2
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by__ nn (name cif person sending permit)
Signature __ _Date.Time L 1(J
I DI2L
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/EHCusttomerService
h j)Othv &h est/vvt S,eovl
11 16:202 12 37
CATAWBACOUNTY Case# WELL-1I-2022-184549
Public Health Department Subdivision WYNSWEPT PH 5.2
-I Environmental Health Division PIN# 367804712948
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 73
/84
Site Address: 3201 TIMBER RUN LN, MAIDEN NC 28650
Name on Permit: *NEST HOMES LLC
Property Size: Acres 0.66
Directions: Intersection Buffalo Shoals Rd&NC 16S; NC16S to left on Cayton Dr then left on timber run In
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(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 for sampling.Water samples will be drawn from an
outside faucet unless otherwise specified.For questions or for more information,please contact Environmental Health.
11/1 612 022
Authorized State Agent Permit Issuance Date
11/16/2027
Permit Expiration Date
ehpcmtit 11/16/2022 12:39
f P1 Ac, wkil l iYb (�iNR 0-7- Ze - `l(L 18
Catawba County Environmental Health /k..t+t IL- Zozz- 1 f`f s51
wc_<< it_ Zoaz- iriS91
87.78
a
r
•3195 72 cr
-5
�.i"
°° 242-90
10
.l; r
4 \
‘,..ir.);.,- '''1 \
T. mot," i
,.,3:11:-;.-77.t
n-' 3
s,.
la* \
201
I 313 r "'`:
r 22, .
z s '
��
piste 274.77
T47.92 " 1:\�1.?1 'k'tilctit ''''''''''''..------..-----71'.-.4-"--(..-.- ica3-7 �.a
trlf
`h���l
•3207 �,,��'^,�,
. r i
O e1%°-,;11„,
• 'i.G. t.}
Parcel: 367804712948, 3201 TIMBER RUN LN 1 in=50ft
MAIDEN, 28650
1
I
i
i
This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts
': to ensure the accuracy of location and labeling 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 shag not be heid liable for any and all damages,loss or Ifabgity,whether direct,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
11/15/2022
i
l
1711)(2),_ WPDT Report
Area of Interest (AOI) Information
Area : 3,134,508.72 ft2
Nov 16 2022 7:54:56 Eastern Standard Time
,l Ii
-_,,,---, , .
‘ \
Ir .1
1.04
lir \ -. \ 11 l'
\ 0110
1,1
1 011 \ ____ ----
WI i. 001
---".-- OW 00110' \
L.�_ - -� .
#--..-
yiiV\
`
.._
________ .• ; • , ,
i ...„, 1
j
,)
71 1 i ........
_..,-- ...........A.,,
1:4,514
Percets 1Potygonst•Parcels -• Protected Route 0 003 006 U 12 m
I 1 1 1 ti ti 1 . t
Not-System Roads — Other State Agency Route 0 0.05 CO 0.2 km
— Federal Route — Secondary Route
- Non-System Primary Roads
Other System Roads Interstate Cat,Cu.rtinN%Yoe Co otmen.keJel Carty sd.eft"Co. ..
grit 4 CwmiraeWap lApn.oA km Will Gann AerC+4h
— Ramps.Rest Areas.Non.Ma11Ire — us Route �°rd•mya k ut:TUNASA,urns.EPArros us Caton*Pow
USDA NCAGT GIS Und Semmes Can Ars.+GS uSGS NGA%ASA
— NC Route
3201 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.
a Print Form
WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Michael A Brook 14.WATER ZONES ,
Well Contractor Name FROM TO DESCRIPTION
ft• 145 ft. 5 gpm
4210A ft• 185 ft. 5 qpm
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap licable)
Rockwater Well and Pump FROM TO DIAMETER THICKNESS MATERIAL
0 ft• 75 ft• 6.25 in• SDR21 PVC
Company Name
16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: WELL-11-2022-184549 FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,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 SIZE THICKNESS MATERIAL
Agricultural OMunicipal/Public 0 ft' ft. in.
Geothermal(Heating/Cooling Supply) OResidential Water Supply(single) ft. ft. in.
Industrial/Commercial OResidential Water Supply(shared) 18.GROUT
Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft. 20 ft. Betonite 21 bags
Monitoring 0Recovery ft. ft.
Injection Well: ft. ft.
Aquifer Recharge 0 Groundwater Remediation
19.SAND/GRAVEL PACK(if applicable)
Aquifer Storage and Recovery 0Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test 0 Stormwater Drainage ft. ft.
Experimental Technology 0 Subsidence Control ft. ft.
Geothermal(Closed Loop) 0 Tracer 20:DRILLING LOG(attach additional sheets ifnecessary)
Geothermal(Heating/Cooling Return) FROM , TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc.)
( g/ g ) Other(explain under#21 Remarks)
0 ft* 60 ft• red dirt
4.Date Well(s)Completed: 10/27/25 Well ID# 60 ft• 220 ft, blue rock
5a.Well Location: ft ft.
Nest Homes LLC ft. ft.
Facility/Owner Name Facility ID#(if applicable) ft ft.
3201 Timber Run Ln Maiden 28650 ft. ft.
ft, ft.
Physical Address,City,and Zip
Catawba 367804712948 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:
N W 11/15/2025
6.Is(are)the well(s)DPermanent or OTemporary Signature of Certified Well Contractor Date
By signing this form,1 hereby cert fy that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: jYes or Oi No with ISA NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a
If this is a repair,fill out known well construction information and explain the nature of the copy of this record has been provided to the well owner.
repair under#21 remarks section or on the back of this form.
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well site details or well
construction,only I GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled: SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 220 (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths if different(example-3@200'and 2@100) construction to the following:
10.Static water level below top of casing: 35 (ft.) Division of Water Resources,Information Processing Unit,
If water level is above casing,use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6 1/8 (in.) 24b.For Infection Wells: In addition to sending the form to the address in 24a
air rotary above,also submit one copy of this form within 30 days of completion of well
12.Well construction method: construction to the following:
(i.e.auger,rotary,cable,direct push,etc.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) 10 Method of test: air 24c.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.Disinfection type: HTH Amount: _ 1.5 lb completion of well construction to the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016