HomeMy WebLinkAboutWELL-08-2023-201740.TIF i
CXt..wi3A cOl NT V Case a WF,i.l:0S-2(12.-2017'fa
WI.� Public Health IJ pntlmcnl Subdivision
t,�( i linveo mcdnl Health Division PINK 369720905826
. Po Eton 1119,25 Goccnuncnt!)rive,Newton.NC IR65E Loy
Silo Address: 6972 VINEWOOD RD,SHERRILLS FORD NC 28673
Name on Permit: MORGAN WELL AND PUMP
Property Sizo: Acres 0.62
Directions: NC 150,left onto Vinewood Rd,keep straight to get onto Dons Pt,turn right,proeprty on the right.
Owner/Authorized Representative Acknowledgement of Permit Receipt
t:" I certify hurl I am the owner orauthorized agent(owner's authorization required)representing the owner of
the property described above,
�
lj V(_" As the properly owner or authorized representative,I have received the above referenced
permits)as requested in the application Iirt•service EHPR-06-202d-44802,by the following method(s):
_ Received in Person
_ Facsimile'Frtuisntithtl(Return Corm with signalute required)
JElectronic Image'I'ransmittal/E-mail (Return receipt required)
�As the properly owner or authorized representative I have reviewed and understand the specific conditions
alike 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 IBA.l900),
andlor Well Construction Standards(15A NCAC 2C.0100), shill apply to the issuance alibis permit and
the construction of the wastewater system and/or water supply well permitted.
Permit Issue Date:08/0312023 r
t
Ownet/Atdhat'ircll Representative Signature (I 'J ( }'( , fi �1,(JJ`; );� '(J�(� ' 1
/ isJF
�,
Date .... — f
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by ___ —.___—__._ ._(mime r f perso)r sewn' permit)
Signature—_—_ —_ . __—_-_Dute!'I•hnc ji1/ 3 i
Method: Fax J Email US Mail Other
Owner's request to send by the above Indicated method of transmittal hi lieu of signature
We wantt tto hear from yorPlease hake a few momentts tto complette our custtomer service survey att
http://www,suryeymonkey.com/s/EliCusttomerSerylce
POa iin U e (Pk riP @. gr+-l•P•?1€vi
el
I — -- — _
I
Fes . CATAWBA COUNTY Case# WELL-08-2023-201740
• •t.mi(.... Public Health Department Subdivision
Environmental Health Division PIN# 369720905826
AptPO Box 389,25 Government Drive,Newton,NC 28658 LOT#
Zit tM
Site Address: 6972 VINEWOOD RD, SHERRILLS FORD NC 28673
Name on Permit: MORGAN WELL AND PUMP
Property Size: Acres 0.62
Directions: NC 150, left onto Vinewood Rd, keep straight to get onto Dons Pt,turn right,proeprty on the right.
REPLACEMENT 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.
G
i
n yam Fo^cec 08/03/2023
Authorized State Agent Permit Issuance Date
8/3/2028
Permit Expiration Date
ehpennit 08/11/2023 16:53
Catawba County Environmental Health
"X A,
t
e 6984 0 ,
1 rs
r
-X\\ nor ,
1 � * J
,
r,y.---'1ft
J t
4
M
<(::\/>
�r, v'
4' \ cf...?\\ .(
6 1'7!( .T` 3 +
a y
r 5 i�4. �b .
N� � 5 . .N .:
re
:_,..1
, .
(14 � tic, w6982
�6 `�'s ��11
•
• O
l
Parcel: 369720905826, 6972 VINEWOOD RD F,,., lin=40ft
SHERRILLS FORD, 28673 {7 �''i;;5
NN _ (-) ' -a(�^3- Li Li _1
Well -O$ -ao . -V) Orl (e
This map/report product was prepared from the Catawba Couunty,NCGeospetial Information Services. Catawba County has made substantial efforts
to ensure the aoaixacy of location and information nta on this map or data on this report Catawba County promotes and recommends
the independent verification of any deb on this map/report product by the user.The County of Catawba,its employees,agents,and
personnel,disclaim,and shall not be held NSW for any and al damages,loss or liability,whether direct,indirect or consequential which arises or may
arise from this mapheport product or fhb Ube thereof by any person or entity.
Oepyright•2629.Oetawba Geunty NO-
07131/2023
8/11/23,4:51 PM about:blank
1
cni WPDT Screening Report
Area of Interest (AOI) Information
Area : 3,134,508.7 ft2
Aug 11 2023 16:50:53 Eastern Daylight Time
,//Water pr"� ..„----_. I",
5-. ,N.77--
V____ . ..../
\ .,„.../
\4,414 \--- x -'
/ k
\� —N
' '.17 :
,1///
_.- t • . ii_____L,, „Et— ..„..
4.- ..:„...------- 1 . .,,,,, . Ao.,-,,,,, i
)14r/ .
5ik-001,-\0\.> ,__.\.,\,, ,2
.4 \ '',..:
1 - g It Ta- .6.v\z
-,.... / ,
......._
_......_
.......„-..
I ...- ...-au ic. it
___--- irr..
__
ax/r r J r--� ry_,_—
i`f1 dohs+ . �_ � -."'E N�1'Sp N r
,.///----------- _i .,
1:4,514
0 003 0 06 0.12 m1
UST Incidents Non-System Roads 1 y ti , ti ,,
i0 0 05 0.1 0.2 km
Low Risk Non-System
Parcels(Polygons) -Parcels — Secondary Route
es,'Comnwnny'Ma65 G,Ord Ih iAcls. get Ceudy Stale ar N.,nlr Can;Jaa
[-_-] County Boundary Primary Roads nor & or ram.*nl,p. m.* Ev1, HME, Garen a;rne.,,h.
' Caitechnunpe:,Ina IXTVNASA,USG%CPA,NPS US Cens.A Bureau
USDA fiC001 GAS U,,,Sources EN, Arms DS.USGS NGA NASA
— NC Route
about:blank
1/2
8/11/23,4:51 PM about:blank
6972 Vinewood Dr
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 and attribute accuracy.
The NCDEQ disclaims responsibility for the spatial accuracy and attribution of
GIS features and makes no warranty concerning same,
about:blank 2/2
(l ntinti Form --
WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
.N Contractor Information:
14.WATER ZONES ___
FROM TO D SCRI'TION
Well Mt tor
►Name n O ft. ft. O
LPL. f ft, ft. 111
NC Wel Contractor Certification Number 15.OUR CASING(for multi-caned wells)OR LINER(If rip Ilcable)'
Morgan Well& Pump, INC FROM TO DIAMETER THICKNESS MATERIAL
1 R. ft. 81/8 In. adr21 eve
Company Name
I Well Construction Permit#: �) �tv " y
�,-\, �n 0� L, (� 16,INNER CASING OR TUBING(geothermal closed-loop)
FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC,County,State, Variance,etc.) ft. ft. In.
3.Well Use(check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
Agricultural DMunicipal/Publie ft. ft. la.
Geothermal(Heating/Cooling Supply) EItesidential Water Supply(single) ft. ft. In.
Industrial/Commercial DResidenlial Water Supply(shared) I8,GROUT
_ Irrigation FROM TO MATERIAL EMPLACEMENT'METHOD&AMOUNT
Non-Water Supply Well: 0 ft. 20 11 bentonite poured
Monitoring ORecovery ft. ft.
Injection Well: R. ft.
Aquifer Recharge fGroundwatcr Remediation
19.SAND/GRAVEL PACK(if applikable)
Aquifer Storage and Recovery DSalinity Bonier FROM To MATERIAL EMPLACEMENT METHOD
Aquifer Test DStormwater Drainage ft. ft.
Experimental Technology InSubsidence Control ft. ft.
Geothermal(Closed Loop) DTracer 28.1)RILLING LOG(attach additional sheets if necessary)
FROM TO DESCRIPTION(color bsrdnu, ma II/rock type, le she,etc.)
Geothermal(Heating/Cooling Return) Other(explain under#21 Remarks) d R. 2� ft• YbWr \1 Y
4.Date Well(s)Completed: { \IIt, 3Well ID# bit. 40 ft, 1^vxlors ,fsscAca
5 Well ocatio r 1O It. 1 ft' \ni\V {
w ft. ` ft. 11,'-,'
PacilltyfOwnerNa,.e Facility Mt?(if applicable) ft. ft.
(rCir1D-V‘rve,voutSC4a SvcxmVs Kira
n. ft. •
(p�lysical Address.City.and Zip 0G^7031►_13 n' ft.
1 i�4/v / v �'r19 21.REMARIGS
County Parcel Identification No.(PIN)
Sb.Latitude and longitude In degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22 C cation:2
3S,5r). (A N l. b‘,1$ W
6,Is are the eil(s) iPermanent or ]Tern orar Signe f wiled Well ContractTor Dote
Is(are) $I tzf P y
Sys ng th rm,I hereby certify that the well(s)was(were)constructed in accordance
7.Is this a repair to an existing well: JYes or rNo with ISA NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a
If tits is a repair,fill out known well construction information and explain the nature of the copy of this record has been provided to the well owner.
repair under#21 remarks section or on the back of this form. .
23.Site diagram or additional well details:
8.For Gcoprohe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well site details or well
construction,only 1 GW-1 is needed, Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary,
drilled:' SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: bej. (ft-) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple srtlls list all depths((d(rferent(example-3 00'and 2Q100') construction to the following:
0
10.Static water level below top of easing: (ft.) Division of Water Resources,Information Processing Unit,
./rioter level is above casing,use"t" 1617 Mail Service Center,Raleigh,NC 27699-1617
I1.Borehole diameter: 6 (in,) 24b.Itor Inlectton Wells: In addition to sending the form to the address iu 24a
rotary above, also submit one copy of this form within 30 days of completion of well
12.Well construction method: construction to the following:
(i.e.auger,rotary,cable,direct push,etc.)
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLSONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) \0 Method of test: air pressure 24c.j:or Water Supply&Inlectlon Wells: In addition to sending the form to
the address(es) above, also submit one copy of this loon within 30 days of
13b.Disinfection type: eranulatadchbrne Amount: OZ completion of well construction to the county health department of the county
where constructed. 0
Porn G W-1 North Caroline Department of Environmental Quality-Division of Water Resources Revised 2-22-2016