HomeMy WebLinkAboutWELL-03-2023-191658.TIF B. CATAWBACOUNTY Case# WELL-03-2023-191658
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-r Public Health Department Subdivision
�� -1 Environmental Health Division PIN# 364711651167
PO Box 389,25 Government Drive,Newton,NC 28658 LOT#
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Site Address: 1613 MAYS CHAPEL CHURCH RD, NEWTON NC 28658
Name on Permit: ADAM &STEPHANIE MCCANN
Property Size: Acres 56.39
Directions: Hwy 321 exit 33 Left Startown0.3 mi Right on W Maiden, 1.7 Left Zeb Haynes, 1.1 mi Right 321bus 0.5 mi
Left Mays Chapel Church , 1.0 Right Deer Hyn dr
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.
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03/17/2023
Authorized State Agent Permit Issuance Date
3/17/2028
Permit Expiration Date
ehpennit 03/20/2023 II.34
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Catawba County Environmental Health 5
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Parcel: 364711557740, 1613 MAYS CHAPEL 1 in=100ft
CHURCH RD NEWTON, 28658
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 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 person or entity.
Copyright 2023 Catawba County NC
03/17/2023
3/17/23,3:34 PM about:blank
nal WP DT Report
Area of Interest(A01) Information
Area : 3,134,508.74 ft2
Mar 17 2023 15:33:36 Eastern Daylight Time
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3/17/23,3:34 PM about:blank
1613 MAYS CHAPEL CHURCH RD NEWTON 28658
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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WELL CONSTRUCTION RECORD(GW-1) Forsnteral Use Only:
1.Well Contractor Information:
Kyle C. Shaw -
1a.WATER ZONES
Well Contractor Name FROM TO I DESCRIPTION
4521 A 3aa n3os I
36 f. ft.
• NC Well Contractor Ceraivatiea Number IS.OtT ER CASL•1G(Tar multi-cased wells)ORI.SNER(if applicable)
Advanced Well Drilling, LLC FROM I TO I DIANIt.itR I THICKNESS I MATERIAL
Company Name 0 ft. s. 6 in. I Heavy ( PVG
r'! J 16.1M'ER CASING ORTGBING(aeothertnslclosed-loop)
2.Well Construction Permit#:jX 1t-03-a.o?..3- p g./6isg FROM I TO I DIAMr., TIIICENEss I MATRR/AL _
List all applicable wreIIconstrucionpermits(_e NC Corny.State.Forienca eta) I I in.
I
3.Well Use(check well use): it. I U. 1R
Water Supply Welt 17.SCREEN
FROM I TO I DIAMETERSIZE
I SLOT I THICIGNESS I MATERIAL
o cultt�l °Municipal/Public U. I ft. in. I I I -
°Greothermal(Heating/Cooling Supply) t3Residenfial Water Supply(single) f. I ft. in. I I I
Dlndusirial/Commercial °Residential Water Supply(shared) IS.GROUT
CiliTiaation DWells>100.000GPD FROM I TO I MATERIAL I EMPLACEMENT'METHOD S AMOUNT
Non-Water Supply Well: a U. I a,o f- I Bentonite !Poured
°Monitoring °Recovery n. I It. I
Injection Well: U. ft. I
❑!Aquifer Recharge ❑Groundwater Remediation
°aquifer Storage and Racolety °Suilinity Bonier19.S L\D/GRAVELPACM(Ifapplicablc)
FROM I TO I MATERIAL I EMPLACEMET'METHOD
°Aquifer Test °Stormwater Drainage ft. I U.
°Experimental Technology °Subsidence Control ft. I rt.
°Geothemutl(Closed Loop) °Tracer 20.DRELLINC LOG(attach additional sheets lrnecessnrv)
DGeothetmal(HeatingiCoolingReturn) °Other(explainunder=21Remarks) FROM t TO DESCRIPTION(cold hardness soroma:tcpt gain sue etc)
0 IL I SS U. D.r 1A/
4.Date Well(s)Completed: 3-I I--VS' Well Mg I SS ft- 16 5 ft I S,F4'ie„tC
al.Well Locution: SS ft- 11? a R' I .1-(o rd cif�.( coat_
c) �� r�ii� I{o 7Z 11. I * 5U. I)Ir-�/3rei rack
Factiitr/OnaerName Foals-D=fifapplcable) ft. I ft.
/613 Mai< cl.pei a rt,l-, jz 1 Ah t.IU( ft. it.
�
PbsleetAddress, ity.and Zip ft. ft
l t-ii 3l.REMARKS
County Parcel Idemincationi+o.(P(PIN)
Sb.Latitude and longitude in de ees/minutcs/seconds or decimal degrees: _
(dcrell field,one lat/langissufficient) v 22.Certification:
35-SSG-1-7-7S i\ 4 7- 2-0076/G(j w 'AirAW---‘ 7
6.Is(are)the v:ell(s): t'_�Pennanent or CTemporatti S'�rtasocofCeifiedWellCoruaaxr Date
By signing ihisforntIhereby it6,zimr the uelll's)war gtere)consrnzctedin accordance inch
7.Is this a repair to an existing well: CYes or 8No 15.3 NC,C 02C.0100 or 15.i1CC 02C.0200 Wall Construction Standards and that a cops
If this is a repair.till out horn well cotzrructioninjotmaaon code pl in the mitre grit? of lids record l asbeenpraridedto the welt ornren
repair under 01 eerOvla•sectionoron the back oftJ orm
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 construction info
construction.only 1 Gll;-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over in Remarks Box).You mayalso attach additional pages ifneces an:
drilled:
,'- 24.SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 'R t S {t,
For multiple wells list ell depths indifferent(trample-5;g:200•and_1Z110 l ( ) Submit this GW-1 within 30 days of well completion per the following,'
•
ft 24a. For All Wells: Original form to Division of Water Resources (DWR)„
10.Static water Ievel below top of casing: �'ff
If enter Icsrl is above casing use••�• ( ) Information Processing Unit,1617 MSC Raleigh NC 27699-1617
11.Borehole diameter. 6 (m) 24b.For infection Wells:Copy to DWR.Underground Injection Control(IUC)
�( Proaratn,1636 MSC,Raleigh,NC 27699-1636
12.Well.constructionmethod: 4`-1,C` PoiekrN7 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copt/to the
(i.e.auger,rotary,cable,direct push etc.) county environmental health department ofihe county where installed
FOR WATER SUPPLY WELLS ONLY:
24d.For Water Wells producing over 100,000 GPD:Copy to DWR.CCPCCJ A
13a.Yield(gpm) 30 Method of test: Air PermitPr°itram.1611 MSC,Raleigh,NC?7699-1611
13b.Disinfection type: H t H amount: 1/43
Fonm c-1 Nor( CaalinaDepartmentefrnsiratmmente!Quality-DivisionofWaterResac¢ccs Revised'&= `