HomeMy WebLinkAboutWELL-05-2023-195886.TIF I
46r�� CATAWBA COUNTY Case# WELL OS 2023-I95886
• .i.ii, Public Health Department Subdivision
1"'•j y
Environmental Health Division PIN# 369702750902
PO Box 389,25 Government Drive,Newton,NC 28658 LOT#
1g. n,
Site Address: 6777 LITTLE MOUNTAIN RD, SHERRILLS FORD NC 28673
Name on Permit: KENNETH SIDES
Property Size: Acres 1.28
Directions: Hwy 150 E, left Little Mountain Rd,turn right on private drive just past Jefferson St
Owner/Authorized Representative Acknowledgement of Permit Receipt
_I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
K As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-03-2023-43686,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
YAs the property owner or authorized representative I have reviewed and understand the specific conditions
1� 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: 05/17/2023
Owner/Authorized Representative Signature
Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name ofperson sending permit)
Signature_ Date/Time Mb)
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 yoLPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
hone s-i e5 Q fahop. Coo
,i.,, 08/03/2023 08:31
WPDT Screening Report
Area of Interest (AOI) Information
Area : 3,134,508.78 ft2
Aug 3 2023 12:04:10 Eastern Daylight Time
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•
111en
1:4,514
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Parcels(Polygons)-Parcels I
0 Eli County Boundary 0.05 0.1 0:Km
— Secondary Route
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GroTrdn+oapn.rw YCTYNASA U34S.EPA.NPS US C.ar«n Ova.
USDA*COOT CAS u,,e.&wires Car Aaeua OS LSGS NGA NASA
6777 Little Mountain Rd, Sherrills Ford, NC
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catawba county
public health
August 21, 2023
Jeff Speagle
Lake Norman Well Drilling
6830 Dolphin Ct
Sherrills Ford, NC 28673
Dear Sir:
Following is a list of permits that we have not received a well record(log)for at this time. Please forward at your
earliest convenience.
PERMIT# ADDRESS NAME
WELL-05-2023-195886 6777 Little Mountain Rd, Sherrills Ford Rd Kenneth Sides/Nina Fitzpatrick
Reminder,well records(logs) must be received within 30 days from the well head inspection. Paperwork will be
withheld from Building Inspections and a final will not be scheduled until well record is received.
Your cooperation in this matter will be greatly appreciated.
Sincerely,
Catawba County Environmental Health
catawbacountync.gov
Environmental Health
Catcwbo County Government Center
25 Government Drive PO Box 389 Newton NC 28658 828.465.8270
MAKING. LIVING. BETTER.
.. .1.) '-'+ J i iiiii.........�..it) l DI>SCRIPTION
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1
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c,mr,cs VA/VC l 16t1 FRfANINGOHTLB\(.ItcedIcetwalciwd•ianp)
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2.Well Construction Permit q: rTtrt`t To I DItMiTFM nUt K cry. I 1f.aiERICL !I
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3.Well Use(check well use): (I. ' ft in. I
i
E 17,!CRFF.N _
NlaterSupply Well: IRON TO ~-TIMMI.TrI S).OTal& THH'KNr_as --i TERRI
DAgricuitutal QS imlclpaf`Ikthlie ft, ft 1 la `•
(irnlfiennallNpnin Cooling,Nu y) �esidcn:tat\k'atCTSu Supply i.) —J f
It • ppl. pp. (single) ._._ i f ft in.
Industriat/Commerciat �Residential\\attt Supply lshurecti 1*.GR04 f 1
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Non-Wafer tiupph\%ell: l}"-I(' S I as J Cull --s,:
\tnnnnnnt: Rcaiscry ft. ' ft. ! -
In)retina Well: 1CH ------ fG---— h.
Aquifer Recharge � uwtdwaret Kemcdiat,1r, I.._._
1g.SANIICRAITI.PAC K ill applkahle) ,.....1Aquifer Storage and Rccovct) OSahnilyHarrier PMN'I:M
incise Ito st !i Alt . EMITTMEIHOD
ft. 1 ft.~
Aqui ler Test 0 titnrmwater I Manage {
f'npetimentatTechnology OSubsideiiceConuu' i ft. ft.
(i,(,thcn heal'Closed Loup) 0 rraccr ; ze.DRILLING i�(1G(attach additional sheen If tweetsars)
t FROM I to ._.,._...__._n)'art(irrurvrcaor,hhrdsrw,reit.rad,.t .Wze fir.)-.........
Gcutllernial Illeatin t tx,lnt Return) Other ies lain under r21 licn:arksi --It !t.
4.pate Wellls)(.nmpleted7 `N(I ?...:3 Well 111ts ft ft'
Sa.Well I.ocatiou: n. •�`,5 ft. f rtx+.r __—,. _ ...._.
..ft. ___ft—I—.._.—�_ .
F,.cl:h1 r)„n:•Natl.: Fac City 1O-n a. p,Leah:c1 _- _
(0 7 )7 Lir m t k� .51)t•I`y`t 115 .FOB,') t��`-- .11. I jr;) f. 31pyA_—— --- ___ ___�
P11..i:a:t.',dre . ..md 70 .. _ ft. Zoo ft. tZ)€f>t 1‘
' a (, - .t 2ii__REM•kRl{s. . --- — --- —1
County i'attcIloritiet-sewn\.• i71\1
sh.1_atitnde mid hingflade in degrees,minutes/seconds or decimal degrees; • -----. — ——
v., .„ -.; ;::. altitienll 22.Certification: '
3c- -) y?e, Ali
i to .3F.ci r1j(�l/y /I�'�J3
6.Is(arc)the w .cll(si Permanent or Temporary ti,�xu isQ/ Cfi111ef U tnal'htt tale
r
91 •.eni'iR Mk rams I here', 1 ell!lr Char ter irrlth,aa.Ii.erel goon/Win/In n.rnrdoi,e
?.Is this a repair to an existing well: Ol'es or @Co :.rtk t sA ti(Af n7l'olt'O.'154 NC aT.'o)C- lt,'1iti H ili Lbrn/tir,b0,,s vij.a 4.,hid lbw n
I.l ihr.i..:,.pJP-till tad inmen AA, .Mllrul'WIG in/Ocher:an and lipfO(ri the'sano- of the I'yn'(if DWI rardd ha.h"-s T,mhfrd I"11L. ,4/mint,.
I q.t.ilk).r 21 rearotlrs..r lion of•11,the bark or do:r Jiff..
23.She diagram or additional well details:
H.For Geoprobe/DPT nr Closed-Loop Geothermal Wells having the same You may use the back or this page to provide additional well site details or well
construction,only I(iW-I t.ncaded. Indicate TOTAL.NUM1JFR of wells construction details. You fluty also attach additional pages if necessary.
r►rillcd:__-_..._.__-..__. __-------- 5UBNI[TTA1,iNtiTRCCTION5
9.'fotal well depth helon land surface: , co Ift.l 23R, Fur a,li Wells- Submit this form within 30 days of completion of well
I nr n, ,::r,t,a.':,(1,7 nr'den•(..:- , ,,t.r,nnlpte•I(I (y, tnid_'ii fig,t ..
e ::.tru;ttnr+to T:;e ti.11owatg
W.Static eater level below top id casing: J (ft.) Ilisision if Water Resources.Information Processing Unit.
))..alit lc%ri n ni.nsc.acing.I.'. 1617 Nlail Srrsiee CeMee.Rakish.NC:27699-161'7
II.Borehole diameter: C. (In.) 24k For injection Wells: In addition to sending the form to the address in 24a
hct-tr, ahovc.also submit one copy of this form within 3))days of cod)plclion of well
12.Well construction method: construction,to the fallowing.
(rr tu15: ir,.!')...ari•,...,.rr r l+l.,n..1..
*Britian of Water Resources.Underground Injection Control Program,
FOR N AT ER It StPPI Y N'F.I.L.S()NIA': 1636 Mail Service Center.Raleigh.rC 27699-1636
13a.Yield(spin) Method of test; r)lT (le *Britian
yor WAler Sump&T&tn(retfon Welk. in addition to sending the COM%to
-1 the address(es) those, also submit one copy of this fnim within .30 days of
I tab,ltkintcctiun type: (--Ll'..1j — Ammon!:•_,_Li,-`Z. completion of well construction to the county health department of tiw county
where constructed.
Nonh Carolina Dciiartmem,of Ens ituhrnen:af Quality-Division o:tt'nrer R.-n,::e. Resi.ec 2.22-20ib