HomeMy WebLinkAboutWELL-08-2023-202736.tif �r . CATAWBA COUNTY Case# WELL-08-2023-202736
• t. Public Health Department Subdivision GABRIEL PARK-PH 1
,�� Environmental Health Division PIN# 460904507318
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 2-7
Site Address: 7552 SHERRILLS FORD RD, SHERRILLS FORD NC 28673
Name on Permit: *VR FARMS LLC
Property Size: Acres 20.92
Directions: NC 16,left onto Balls Creek Rd,bear right onto W Bandys Cross Rd, bearl left onto Buffalo Shoals Rd,then
right onto E Bandys Crossroad, bear right onto Sherrills Ford Rd, property on the left
WELL ABANDONMENT PERMIT
Well Type: Bored
Wells shall be abandoned in accordance with state regulations:
Article 15A North Carolina Administrative Code Subchapter 2C
The Well Abandonment Report must be submitted to the Catawba County Environmental Health within
30 days upon completion of a well abandonment.
Well contractor must schedule well abandonment inspection with Catawba County Environmental Health.
T3cyG.n Fo,cee 08/16/2023
Authorized State Agent Permit Issuance Date
08/16/28
Permit Expiration Date
chpennii 08/16/2023 16:II
Catawba County Environmental Health
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Parcel: 460904507318, 7552 SHERRILLS FORD 1 in=300ft
RD SHERRILLS FORD, 28673
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Ibis rrapheport product was prepared from the Catawba Cot ,NC Oteospetial Information 9ervfoes. Catawba County has made substantial efforts
b enure the acaaacy of;oration and labeling inkonratlon ined on this map or data on this report Catawba County promotes and recommends
the independent verification of any data oontelned on thie map/report
product by the user.The County of Catawba,its employees,agents,and
personnel,disclaim,and shal not be held liable for any and al damages,toss or le.bilty,whether direct,Indirect or oonsectusntiaf which arises or may
arise torn this map/report product or the use thereof by any person or entity.
Copyright 2023 Catawba County NC
O8/16/2023
1
P tr L'LL YDc11�!LPI.J ' .VJ.L1' 1 KL� l URD
���Internal Use ONLY:
I.Well Contractor Information: t
L�--Q'`z1 � 5 WELT,ABANDONMENT DETAILSTh
'a.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
Wel]Contractor Name(or well owner personally abandoning well on hivher property) well construction/depth,only 1 GW-30 is needed. Indicate TOTAL NUMBER of
3. 3 2- wells abandoned:
NC W el]IC'o�ntrtractor Cctif icaionJ Number 7 b.approximate volume of water remainingNetC'
VV'�'e� U[/`{.i i remaining In well(s): "" ��•)
FOR WATER SUPPLY WELLS ONLY:
Company Narita
0 ,? 0^7 73 r 7c.Type of disinfectant used: �,� :'. ll Z
2.Well Construction Permit : C. c0 _
Lust all applicable well construction permits(i e.UIC,Coun
ty,State,Variance,ete T tJ'lrtawn
3.Well use(check well use): ,
7d.Amount of disinfectant used: 9a II 01" -
-Water Supply Well:
7e.Sealing materials used(check all that apply):
`''Agricultural ❑Municipal Public ❑Neat Cdnant Grout
•OGeotherrta:(Reating'Coolingr:Sit ti ❑ tCnite Chips or Pallets
PP.) I�sidential Water Supply(single) ❑ Sand Cement Grout ❑.Dry Clay
❑iudustriaL•Conuaercial ❑Residential Water Supply(shared)[ ) 19/Concrafe Grout Drill Cuttings❑Tn'ieatiolt
Non-Water Supply Well: 0Spy cialn Grout ❑Gravel
❑Monitoring G BentoniteSlumry ❑ Other(explain under 7g)
❑Recovery
Injection Well:
7f.For each material selected above,provide amount of materials used:
C]Aquifer Recharge ❑Ground water Retnediation l (( ��
Aquifer Storage and Recovery ❑Salinity Barrier / 0 Vt�`�S�
❑
❑Aquifer Test ❑Stortnwvter Drainage
❑E:perintental Technology OSubsidence Control
7g.Provide a brief of the abandonment procedure:
L7Geothermal(Clos�Loop) pTrncer
❑Geothermal(HeatingiCooling Return) ❑Other(explain under 7g) lO '3eri- ‘rm
1 Date well(s)abandoned: f�- / /xUr� ♦^.hA0v:+'t ,i--J',Oa-II1 vn,J r 1_A5-0e1
3 9
5a.Well location:
V GZ. o-r L L c
Fealig/C.vner Nrrne Facility IDc{if applicable) S.Ce Cation:
Physical Address.City,and Zip :6 1J 1 o-(^20,2';
Signatw died well Contractor or Well Osyna; Date
Comb By signing this form.1 hereby certify.that the well(s) was (v.iere) abandoned in
Parcel Identification No.(PN) accordance with 1...V1:YC4C NC.0100 or 2C.0200 Well Construction Standards
Sb.Latitude and longitude in degreesfminutes/seconds or decimal degrees:
and that a copy of this record has been provided la the well owner.
(ifucll field,ons lat/long is a.>ificient)
6 - r 9.Site diagram or additional well details:
5 0 3 N F) , 0 Q c7 S 3, ". You may use the back of this page to provide additional +ell site details or well
abandonment details. You may also attach additional pages if necessary.
CONSTRUCTION DETAILS OF WELL(S)BEING ABANDO ED
.litaelr well cons[rtrcrionrecvrd(J)fc ifable For narltiplsirf action or non-water supyi,wens SUBMITTAL INSTRUCTIONS
(JAL r airt the sane cvnslrnctiotuabondontnent,row can submit one form
10a. For Ail Weill: Submit this form within 30 days of completim of well
6a.Well DX: abandonment to the following:
Division of Water Resources,Information Processing Unit,
6b.Total well depth: Cef 0 (ft-) 1617 Mail Service Center,Raleigh,NC 27699-1617
(i. 14b.For Infection Well: In addition to sending the form to the address in We6c,Borehdediameter: `i (111) above, also submit one copyof this form within 30 days of completion of well
abandonment to the following:
6d.Water level below ground surface: (:,0 (It) Division of Water Resources,Underground Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
6e.Outer casing length(if Blown): 0/4 (ft.) 10c.For Water Supply&Inieetion Wells: In addition to sending the fore to the
address(es)above,also submit one copy of this form within 30 days of completion
} of well abandonment to the county: health department of the county where
6f.Inner casing/tithing length(If known): )U/ } (ft.) abandoned.
6g.Screen length(if known): /4 (ft.)
Four t Glt'_30 North Carolina Department ofEnvim.,r,>,.ro n...,t:«. ni..:-,._ -.•.... -