HomeMy WebLinkAboutWELL-12-2022-185629.tif �--; CATAWBACOUINTY Caw a WVELL 12-2022.185('29
/. a Public Health Department Subdivision
,,r Environmental Health Division I'IN# 372214433090
- /w Po Box 389,25 Government Drive,Newton,NC'.2N658- Luria
9
Slto Address: 2869 9TH AVE SE,HICKORY NC 28602
Name on Permit: HISPANIC WOMEN FARMERS INC
Property Size: Acres 1.32
Directions: 21st St Dr SE right 9th eve SE,2nd from end of street on left
Owner/Authorized Representative Acknowledgement of Permit Receipt
4.14Gl certify that I ant the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
y. tiff(..-As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EI1PR-10-2022-42556,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
0;V,.y E:lectronic Image Transmittal/E-mail (Return receipt required)
' "-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 ISA.1900),
and/or Well Construction Standards(1 SA 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: 12/06/2022
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Owner/Authorized Representative Signature ( .............._......1..___.__.- ..._._':..__.._....._._.....
Date 3 ._ ..- ' j
Documentation of Permit(s)'I'ransmittal
(permit transmitted by electronic or other means)
Permit transmitted by..--..........................__.._..._. (name of person sending permit)
ns �.3
Signature q/€: Date/ I ime I Method: Fax J Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wand tto hear from yoaPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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CATAWBA COUNTY Case# WELL:12-2022-185629
.t. Public Health Department Subdivision
Environmental Health Division PIN# 372214433090
•
PO Box 389,25 Government Drive,Newton,NC 28658 LOT#
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Site Address: 2869 9TH AVE SE, HICKORY NC 28602
Name on Permit: HISPANIC WOMEN FARMERS INC
Property Size: Acres 1.32
Directions: 21st St Dr SE right 9th ave SE,2nd from end of street on left
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.
PERMIT CONDITIONS
*DRILL WELL IN DESIGNATED AREA
*DO NOT DRILL IN ROAD RIGHT OF WAY
*WELL MUST BE 100FT FROM SEPTIC NO EXCEPTIONS
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 new 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 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.
03/06/2023
Authorized State Agent Pennit Issuance Date
3/6/2028
Permit Expiration Date
!��' � 03/10/2023 08:21
Catawba County Environmental Health
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Parcel: 372214433090, 2869 9TH AVE SE 1 in=40ft
HICKORY, 28602
This map/report product was prepared from the Catawba County,NC Geospatiel Information Services, Catawba County has made substantial efforts
to ensure the accuracy allocation 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
nn persoel,disclaim,and shall not be held liable for any and all�damages,loss or liability,whether direct.Indirect or consequential which anses or may
arise from this map/report product or the use thereof by any person or entity.
Copyright 2023 Catawba County NC
03/02/2023
1216/22,8:30 AM about:blank
Pc riA...,,, WPDT Report
Area of Interest (AOI) Information
Area : 3,134,508.57 ft2
Dec 6 2022 8:30:28 Eastern Standard Time
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Known Releases of ConteIT nadon Other System Roads 0 0.03 r.:W 0 12 m,
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`/ Underground Tare Incr.ents — Raipe.Rest Areas•1.1cvMOmlme a 005 0.1 0.21vn
Parcels!Polygonal.Parcels ted Route
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Federal Route — Secondary Route POT dSIYe Sum.en.A•".DS USGS NSA NASA Cana N
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TIC"SySlem Primary Roads G.c.a.0 MCA.rn.mnu ma ON sIs•.w.one...) Ca Car,m,.T,
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12/6/22,8:30 AM about:blank
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.
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Print Form
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...7 afr;.> a„`:r,<r. r ..::Lr;.,ed''-Tu.,iiY Gr. Cr:a,,. 's:�'. -, ✓✓r:r. .....__— ........II. .. ....._ IF. .._.. in. ._...,.,.
).MO e(st(check W ell ose): "-4_.._._ft.............. .m..i..,....,....,..- .�......_.
1`ater Supple Well: 1"5C NF,k:
(j,Jt ; twos' TO _ DRANLT si i SLOT slrr. I THICK'.t5 4 %IATCRIAL
i�1 AF1Tetil urat Q4lunic!pa Ptthiic rt. ft. i ..—tin. I
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ii: Irrigation 'iao t ;. to _ ii RW itA'. r'IP1.WE%I ENT METHOD a4 WI,T f
jon•"'attr Supply Well: ft. ! rt. 1 1
Monitoring ()Recovery ILi rt. s '
Injection Well: :..._._..__.....:_____ i .______—:__----
--.4 Aquifer Rechargeft. . n. i
4 K DGroundwater Rcmcdia:ion
Aquifer Storage and Recovery °Salinity Barrier 04•SSNI GRAVEL 1ACi( siapOrible}
: FROM : TO : �tiTER1AL 1 EMPLACEMEST METHOD
Aquifer Test �5torrnwaicr[hatrage i w ft. ft.
Experimental Technology 0 Subsidence Control •
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Geothermal(Closed Loop) °Tracer
e£ 20.DRILLING LOC�eu�h add11(asa(sAeth if neeeswYl a
`tiio:r i nr.K:Rttri10%bolo.,.aranr,r.**it rock tomvol.sift.M.)
Geothermal(HeaungCooline Return) Other(esilain under l Remarks
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4.Date Well(s)COmpletrd.It-3- ) `)Wei.(�
Ss.Well Location: +� ttf ,
11 t S Y�'s n s C V n rl e n lrN'F�ierS _ _ t f .,_...._..._..
facihyKJ+sttrNan. Fa::t:;s1i)fl:l atgl:rab'et w rt '• rt f f
• ��4� 4'f t Nit S f, 14 a rJ i _ ft ft. i
Pnys:u:Address.City.and Zip —ft. ft.
Ci0 4L ;6ti r:REMARKS 1
County PatcelIdcntit:C2tion No.1PIV} ' -_-- _�_ j
5b.Latitude and longitude 1a degrecstmjnutes'secnnds or decimal degrees: —_ ___. r
r_.
of well field.one lat long it sufTesenit 22.Certir • •_ ---.
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N
" ___ • 4 — 3 -(
6.IS(are)the well(s)0 Permanent or QTemporan 5:snatcr,olCenificd Wei Cont )1. Date
et arxnn:k Art fa.M.1 h...6.1(emit.(has the srrillq N(1..Noe)CfM.gSNN6d in uetardanee
7.Is this a repair to an existing well: °Yes or m\o :r:rim, is.:\('.4C-n;C.Ir/oo or 134 s^CAC 02C 0200 Well C'mtsrrucnon Standards and Mat a
OW this o a repair,fill out boron Nell tante/vettun tnfrrrfna1N,n onn4 Non the na4ful al the ':"P.''Ilk,*•Poufi lmr hre', ffffkJell tr,rite Nt/I In,sir,
repot.under e,/trrtarka'section or on the!nacho(this/ornr
23.Site diagram or additional well details:
S.For Geoprobe!DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to proside additional well site details or wrl;
construction,only 1 CW)is needed Indicate TOTAL NUMBER of welts construction details You may also attach additional pages if necessary.
dulled:,. SI BMlTTAL lN,
tijRtCT10NS
9.Total well ultok edells i,ah bet all low lanhA if ddlsurface:
anr�%.',i�sa�,ar„i ion.,
(ft.) 24a.for All Wells: Submit this form within 30 days of completion of well
For rr construction to the following;
10.Static water level below top dosing:40 (ft.) Division of Water Resources,Information Processing Unit,
If water level ti ohorecasla.MSC.- 1617%laid Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6 1/8 (in.) 24b.For Injection Tells: In addition to sending the form to the address,n 24a
Air Rotary above.also submit one copy of this form within 30 dais of completion of well
12.Well construction method: construction to the following
(i.e.auger,rotary,cable,caret push.tic.)
Disisiut of Water Resources,Lnderground Injection Control Program.
FOR WATER SUPPLY WELLS ONLY; 1636 Mail Service Center.Raleigh,NC 27699-1636
13a.Yield(gpm) $ Method of test: Air Flow 24c.For WaterSstppis& inicction Wells: in addition to sending the form to
the address(esI above. 31s0 subs;it one copy of this term within 30 days of
1311 Disinfection type: Chlor Tabs Amount: 1 t 2 un' completion of well construction to the county health department of the county
where constructed
Forty.GW-i North Carolina Department of tins irnnrncr.4;i rti;.f;y-Jisisit n of Waicr Rcsrurccs Rct:sod 2,22•it116