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Home My WebLink AboutWELL-03-2023-191248.tif CATAWBA COUNTY • /� Public Health Department Subdivision • ..0(;) Environmental Health Division PIN# 375019600534 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 2 w Site Address: 2529 CLAREMONT RD, NEWTON NC 28658 Name on Permit: BRADLEY GOOD Property Size: Acres 10.22 Directions: Claremont Rd-Go to Intersection-4th Driveway on right Owner/Authorized Representative Acknowledgement of Permit Receipt /(, er". 7 I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of the propertyro described above. 13" As the property owner or authorized representative, I have received the above referenced permit(s)as requested in the application for service RBPR-02-2023-43431,by the following method(s): Received in Person Facsimile Transmittal(Return form with signature required) , Electronic 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 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:43/14l2023 J 41111 Owner/Authorized Representative Signaturei'12-4/ '-' Date 3 ~z_.� z Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name of person sending permit) Signature Date/Time Method: Fax 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 ycuPlease ttake a few momentts tto complette our custtomer service survey att http://www.surveymonkey.com/s/EHCusttomerService ehpermit 03/14/2023 14.29 — V1 ELL CO111KUL.1its,' icr.t. t1Ktr (srss-t1 rortntcrnaitsc(oily I.Well('ontnctor Information: Robert Teague 114.WATER ZONES -----.__._.-- ------ FROM i0 _ Dt.s sirirON Well Contractor Nam ‘Oft. / rt. 2857-A � �')ft. ft. 1 NC Well('onVactot Certification Number 115.OUTER CASING_(for moltl-cased weRa1,OR LINER(if apQtlhbk) B & K Well Drilling Inc I mom 10 DIAMETER THICKNESS 1 MATERIAL -- — -- . 0 ft. ft t iIg In• SDR-21 1 P'C Company Name !'�,,-{ 16.INNER C iFC OR TUBING(geothermal4k elaaedap) 2.Well Construction Permit k:90)-3 - f"(fI 1 p7� k FRO%t_-_TO - DIAMETER THICKNESS MATERIAL Last all applicable well coastrvctio,motifs(i e UlA. Cnnnn..State Vara-.,- r:t 1 fl. ' ft. in. — —I 3.Well Use(check well use): h. ft. in. - Water Supply.Well: 17.SCREEN ` - FROM I TO DIAMETER SLOT SIZE THICKNESS MATERIAL. � gncultural . ..t._....__. ()Municipal:Public it.1- ft. In. Geothermal(Hwang Gaoling Supply) la Residential Water Supply(single) --fr.:_ -MI. __. -_ __-, In. Olndustnal'Commercial ❑Residential Water Supply(shared) Qlmgation Is.GROLT -FI(0's1 1-TO MATERIAL. _ EMPLACEMENT METHOO at AMOUNT Non-Water Supply Well: ft. ft.� 0Monitoring _ . __ „. ...._- _.. Injection Well: e3Recovery• ft. ft. Aquifer Recharge ---- ft. �----___._ OGroundwatcr Remedial ion Aquifer Storage and Recovery19.SAND/GRAVEL PACK(if applicable)El Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD ❑Aquifer Test ❑Stormwater Drainage ft. ft. • ❑E penmental Technology Q Subsidence Control ft. ft. 13Geatherrnal(Closed Loop) ^20.DRILLING LOG(attach additional sheets if aeensary) Geothermal(Heating/Cooling Retur ) nOther(explain under tr2I Remarks) ...FROM TO DI.S PT r.CRIIO♦(colo ha nett top soil rock e.grain Am tea) 6 n. 9S n. 4� 4 ) 4.Date Well(s)Completed‘-' 1 Well IDq ce ft Sa.Well Location: ft. ft. � Q(\ (rC C`I ft. ft Facility/Owner Name Faedi IDM(if applicable) rt. ft ;-q Cl aY f r,nh-1- Y1 _ ft. it. Ph ddress, sty.and Zip ft, rt. 21.REMARKS County Parcel Identification No !PIN) 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: I (if well field,one!along is sufficient)N Y _�- 22.Cart' o� CC�� 6.Is(are)the wcll(s)EgPermanent or 0Temporary Signature of Certified Well Co actor Date Bs ngntng this form./herehs erltfi Ihat I/u xvll(s)coat(µYee)coneuiccjaJ m ueeordance 7.Is this a repair to an existing well: Yes o No �nh 15 4 AY'AC OW 0100 or Jr SA NCAC O2C 0200 Well Cnnsrrvcnon Standords and Mat a f thu u a repay.Jill out known well Construction information a lain the naiurr of r1r<• copy oJlhis record has bran provfdcd to Slit µtit owner. repair under M2/rentarka sec.non or on the back of this form 23.Site diagram or additional well details: You may use the back of this page to provide additional well site details or cell 8.For Geoprobc/DPT or Closed-Loop Geothermal Wells having the same construction,only,I GW-I is needed. Indicate TOTAL NUMBER of wells construction derails. You may also attach additional pages if necessary. drilled: '1 SUBMITTAL INSTRUCTIONS 9.Total well ed below land surface: OW 24a. For All Wells: Submit this form within 30 days of Completion of well For multiple wells hit all depths if different(uample-3 a200'and?�'g100') construction to the Following. P 10.Static water level below top of casing:40 (ft.) Division of Water Resources,Information Processing Unit, If water keel is above casing.use 1617 Stall Service Center,Raleigh,NC 27699-1617 I I.Borehole diameter: 6 1/8 (in.) 24b. For Injection Welit: In addition to sending the form to the address in 24a 12.Well construction method: Air Rotary above,also submit one copy of this form within 30 days of completion of well (i.e auger,rotary,cable.direct push.etc.) -- ionsWetion to the following Division of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 13a.Yield(gpm1, Method of test: Air Flow �(3 24c.For Water Supple & Injection W ells: 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: Chloe Tabs Amount: I t 0 Ltts completion of well construction to the county health department of the county where constructed Form GW I North Carolina Department of Ens uonrccntal Quality•Division of Waicr Resources - Rl:vuod 2.22-2016 Analytical Results fay STA'TESy1LLE ANALYTICAL Catawba County Public Health :r PO Box 389 Newton, NC 28658 Receive Date: 10/28/2025 Reported: 10/29/2025 For: Scott Good:2529 Claremont Rd, Newton NC 28658 Comments: Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst 251028-46-01 Nitrate 191248 <1 mg/L 353.2 10/28/2025 MD 251028-46-01 Nitrite 191248 <0.1 mg/L 353.2 10/28/2025 MD Respectfully submitted, Melissa Myers NC Cert#440, NCDW Cert#37755, EPA#NC00909 PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page 1 of 2 r- 122 Court Street Statesville,NC 28677 704-872-4697 www.sa-nc.com • NITRATE/NITRITE ANALYSIS . tiou: lliiec::mtiaa Mi:be'wp,li tor=Oa=mlit. WA S )#r; WELL-03-aD ,3- t 12' 8 County: Catawba • Name of Water System: • SC- Tl ( -bJ . Sample Type: 0 Entry Point tt Special/Non-compliance Location Where Collected: X5- 9 C-t&PGM-0Dl L 1 New-lb 11 c 2..PCr8 Facility ID No. 1 q(�4 S Sample Point: We 1,kg.04 ;�Collection Date 4 Collection Time Collected By: �vr ighk (�I:k 1 Ior a-7 l_.r - 12: 3" F M n(Pie He) (MM.W OIYYI (Spiry AM.=PM) bail Results to(water system representative): . CATAWBA COUNTY PUBLIC HEALTH Phone 4:i (828)465-8270 ENVIRONMENTAL HEALTH Faze: i(828 465-8276 • , PO BOX 389 Responsible Person's email: • • EHAdmin@catawbacountync.gov • NEWTON,NC 28658 • LABORATORY IF)#: 3775E . 0 SAMPLE UNSATISFACTORY 0 RESADIPLE REQUIRED CONTAM METHOD IN f D°TECTED QUANTIFIED ' ALLOWAB1E CODE CONTAMINANT • CODE RE.ORTINGLIMIT (i.e.<R.RL.) RESULTS* LINLT' all.) (X) • I, 1040 ' Nitrate 3532 1.00 mg/L mg/L 10.00 mg/L, 1C41 Nitrite • 3532 0.10 mg/L __ mg/L 1.00 mg/L *Note;If result exceeds allowable limit,the laboratory must fax analytical rest:Its to the State on day test completed. . DATE: TIME: ,((��,, '.`a�L P NI • ( ANALYSES BEGUN: / 7 /Z' _1.��2 l5 1 y (s.m. ANALYSES COMPLETED:,'ED: l0 /2_( y rig __C _.:��a m Laboratory Log I`:f251.0.'4 kp•V t Certified By: L- . Cie -_-_.,- COMMENTS: . • 2008 • • Laboratory should t<4ail Result,to: Public Water Supply Section,A=Da.. Entry,1634 Mail Service Center,Raleigh,NC27699-1634 • PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page 2 of 2