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Home My WebLink AboutWELL-04-2023-193686.TIF 4,/;1 11119.0,4 1i CATAWBA COUNTY +�.t,!Kit Pablic Health DeplMrcnt Subdivision i 5nvtroametnal Health Division PIN/ 369703234816 opPO Box 389,75 Government Drive.Newton,NC 28658 LOTN A Sit Address: 8321 UNEBERGER RD,SHERR1LLS FORD NC 28873 Name on Penult 'SIL1/ERPOINT HOMES Property Size: Acres 1.68 Directions: NC16 lett onto Grassy Creek Rd,Right onto Gates Dr.Rd changes into Chuck's IN,Right onto Sandra's Ct. Right onto Helens Way.Right onto Bumhurst ill,Left onto Buby In,Right onto Lineberger Rd Owner/Authorized Representative Acknowledgement of Permit Receipt KMhi 1 certify that I am the owner or authorized agent(owner's authorization required)representing the owner of the property described above. MYY As the property owner or authorized representative,I have received the above referenced permit(s)as requested in the application for service RSPR-01-2023-43253,by the following meihod(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'll eatment and Disposal Systems(I SA NCAC ISA.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 ittcd. Permit Issue Date:04114/2023 Ovmer/Autho ized epresentative Signature Date 5/5420 ,8 Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name of person sending permit) Signature_ Date/Time 513/)3 Method; Fax f Email US Mail Other Owner's request to send by the above Indicated method of transmittal in lien of signature We wentt tto hear from yed'lease ttaka a few mornentts tto complete our custtomer service survey att http://►www.s urveymonkey.con/s/EKCustto m erSetvko cbpcnnit O4/17/2023 O136 CATAWBACOUNTY Case# WELL-04-2023-193686 Public Health Department Subdivision . r Environmental Health Division PIN# 369703234816 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# A .11111Vgi Site Address: 6321 LINEBERGER RD, SHERRILLS FORD NC 28673 Name on Permit: `SILVERPOINT HOMES Property Size: Acres 1.68 Directions: NC16 left onto Grassy Creek Rd, Right onto Gates Dr. Rd changes into Chuck's LN, Right onto Sandra's Ct. Right onto Helen's Way. Right onto Burnhurst Ln, Left onto Buby Ln, Right onto Lineberger Rd 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. , 04/14/2023 Authorized State Agent Permit Issuance Date 4/14/2028 Permit Expiration Date chpennit 04/17/2023 08:37 AC, / e13Pl( ot- 2.p 23- 4 3 2r3 Catawba County Environmental Health /44-nn a4-ZoU- ??3400 W.1I �- Zoz3- 1?s684f Q yd grey G4, ""\ all- 21 Sr J a- , O 90 o 123.53306. ?s Parcel: 369703234816, 6321 LINEBERGER RD 1 in=60ft SHERRILLS FORD, 28673 This maphepat product was prepared from the Catawba County,NC Geospatlai information Services. Catawba County has made substantial efforts to ensue the aoaracy of location and lab formation contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data on this uct the user.Theemployees,agents,and persorviel,disclaim,and shall not be held Sable for any and P� a of Catawba,its arise from thisproduct or the use thereofire'loss or liability.whether dined indirect or consequential which arises or may map/report by any person or entity. Copyright 2023 Catawba County NC 04/14/2023 FP),_, WPDT Report Area of Interest (AOI) Information Area : 3,134,508.63 ft2 Apr 14 2023 11:21:51 Eastern Daylight Time \\ --_-• ......--------::4\1, ` ......„-- ......._.----------- / 100' ... ..._ ,... ... .. . . .i. . __.• PCP 4 "--` /1f 01 ft • A „sc _. .. _...............__,_ .. ___________ .. .....______ -,,,,,,I 1:4,514 i.—I Parcels!Polygon')•Parcels '-- Prgesled Route (t UO3 006 0.12 m l 1 5 t. ti A 'r Nan-System Roads — Dreier State Agency Route 0 0.06 0.1 0.2 Km — Federal Route — Secondary Route Non-System Pnmary Roads Omer System Roads — Interstate Est cumrr.wr M°°'Curl,PAW"rwN cov ty a,, of o Crn+ DDT A UponSYwNlsp. lwrx Ga4 SAA WAS. Gam, 6446...AA - Ramps,Rest Areas,Non-MairlYne — US Route OeaTateniges.Fe../AETl.NASA VSGS.EPA WS US Ceram rw. USDA NOWT OAS uAr &Armes CAA Arena GB SEDS MC 1.NASA — NC Route 6321 Lineberger rd 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. WELL ONSTRL1CT1ON RE Use On `• 1 ORD CW-1 For internal ly: 1.Well Contractor Information: Robert Teague Weil Contactor yams -I I.WATER ZONES "�'�- • ,, FROM r0 DESCRIPTION '"""'^--,.+. 2857-A j eV d n. /S Ut.i 4,Jr. -- NC Well Contractor Certification Number ft. n' ! - B&K Well Drilling Inc 15. TER CA (form L LINZX M FROM TO DIAMETER Tf11CKNE3s M>a(tA), Compan)'Namt a ft. J C) ft. sirs In. 9DR•21 PVC 2.Well ConsttvcdonPermtt#: 3- 1f.INNER CASINbOR TUBING(SolYxoyllelMN-k.p) •.; '. ,.t, ;-•:' Weil FROM TO DIAMETER THICKNESS 1 MAT L pplknblt well construction permits(i.e.WC,('ounry,State, ar(aare,(rr.) ft. f' in. 3.Well Use(check well use): rt. n. In. Water supply Wll: 17.SCREEN OAgricultural FROM TO DIAMETER SLOT ma Tti1CKN_EEa MA7'ERIAI. ()Municipallpublic ft. R. la ()Geothermal(Hating/Cooling Supply) Residential Water Supply(single) DlndustriaVrn Come cial n A. to []Residential Water Supply(shared) II.GROUT Irri anon FROM TO _MATERIAL EM[LACemtr MLTRODit ANOUNT Non Water Supply Well. rt. rt. Monitoring Recovery lniee on Well: ft• n. Aquifer Rcchargc ❑Graundwatcr Remedietion f t. f t. Aquifer Storage and Recovery ()Salinity Barrier 19.SANDIGRAVEL PACK(if applicable) _ AquifaTest Experimental FROM TO MATERIAL EMI'LtCEMENTMETHOtt OStormwater Drainage ft. Experimental Technology ()Subsidroce Control R n. DGeothermal(Closed Loop) OTracer 20.DRILLING LOG(attach additional Acetyl(axms.ry) ❑GeOhelmal(Heatmg/CooltngRetum) �pther(explain under#21Remarks) FROM TO IrCR�N(rotor.a.rd solv,o,r,ya4ma,,;t#,«el 4.Date Well(s)Completed: 21 Well ID# C— l So.Well Loudon: • � � ^, �"� � �G-�" `�� at'1��-- t SL` flV5 �. 'O$ft.ft. A"(�'" S 1 �<.. 1 Liren I n- 140%6 4,o5T $b5 sa.(`4 Joe-r Facility/Chimer ante Facll' f(DN(t applicable) ft. n. • 3 2.1 G t r. ivi ii /6 S kcy'r t 1 s n. n. Physicittekddress.C'y.and Zip ft. ft.J .9k c.v•rC.t 21.REMARKS - County Parcel identification No.(PIN) Sb.Latitude and longitude In degrees/mioutes/seconds or decimal degrees: (if wall field,one lat/loraQ is sufficient) 22.Certlllcation: o- --• • 6.Is(are)the wells)f}Permanent or ()Temporary not Certified Well ontrae r �� By signing this Jon,,,I hereby Mrvify that M.iwlft)wyv Ewen•)rwrnuctad is uccordaa 7.is this a repair to an existing well: ()Yes or No with 114 NCAC 01C.0100 or ISA NCAC 02C.0200 WeilCotartniation Standards and that a plat is a repair,fill out known well construction information on !plat#,the mare alike capV of this reeved bar(wen provided to the wit toner. repair under Cl!raw*section or on the back of this farm, 23.Site diagram or additional well details: You may use the back of this page to provide additional well site details or well 8.For GeoprobelDPT or Closed-Loop Geothermal Wells having the same construction details, You may also attach additional pages if nocaesary. construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells drilled: �q� SUBMITTAL INSTRUCTIONS9.Total well d pE th below land surface: V (fr•) 241, For All Weill: Submit this form within 30 days of completion of well For multiple wells(ire:II depict If d ftrent(trample-3g200'and 2@!001 construction to the following: 10.Static water level below top of casing:40 (fr.) Division of Water Resou flo Informadon ater level it above crating,use"+" 1617 Mall Service Conte,Raleigh,NC 2 99-166117 Unit, 11.Borehole diameter: 6 1/8 (in.) 24b.For lnlectlon Wells: In addition to sending the form to the address in 24a 12.Well construction method: Air Rota" above,also submit one copy of this form within 30 days of completion of well (i...#,user,rotary,cable,died push,etc) construction to the following: FOR WATER SUPPLY WELLS ONLY: Division of Water Resources,Underground Injection Control Program. 1636 Mail Service Center,Raleigh,NC 27699-1636 13a.Yield(gpm) $ Method of test: Air Flow 24c.For Water Sum:he& Injection Wells: In addition to sending the form to 13b Disinfection type: Tabs t t2 Lba the address(es) above. also submit one copy of this form within 30 days of type: Amount: completion of well construction to the county health department of the,county what constructed. , • Farm GW-1 North Carolina .Department of Environmental Quality-Division of Water Resources Revisal2.72416