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HomeMy WebLinkAboutWELL-10-2023-206584.TIF = ; CATAWBACOUNTY CCase# WELL-10-2023-206584 Public Health Department Subdivision WHISTLE PEACE d `1 Environmental Health Division PIN# 373515742014 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# TR B $4 v, Site Address: 1293 MISTY LN, HICKORY NC 28601 Name on Permit: JESS&DENISE EVERETT Property Size: Acres 9.61 Directions: Sulphur Springs Rd, left on Lynchburg Rd, left Reitzel Dr, left Misty Ln, left on ROW 250'to private drive roughly cut in 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 I5A 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. 0/ /"7„(...............„.. I „ E,4Ns 10/16/2023 Authorized State Agent Permit Issuance Date 10/16/2028 Permit Expiration Date chpemtit 10/17/2023 08:26 Catawba County Environmental Health / R B PR.46 - 90)3 - Ys7/452 \ . , \Well - 10- 30D3 .. 9066•8q i P' ( e_ (15 SA-e (rick? !o 9 i,23,, . WO) 22E.40 45 /a/4 1-4 1 A 1 051. ( bi"----- / + 1 F o c F , , E I 1.. q-c°;4 V' 0. i �\ _\ P y' •,< ` I CV , . h VP :6,13 Proposed I - ? 6 �m� 3Ys' > s, I • / ,,,,i G•, P�5s, J 4 .., knell • U 54 116 l r. Pi 1' Parer LN:373515142014.1293 MISTY 1In=100ft "f' HICKORY.28601 ?}.____1441611as 0011____ m lis C+ir.fo o a.MC al ris lin SI Its cdf.tis cairnhu rad._s,sansd NJwv __bums MO __of babaad Iambi Ilbeseb ftli bill w/ball.rebMat t7.ti.br PR+T4444.rde.acwrmr.11 Dabewills1r.lWr.W as .a9, a.wrabow.Thi ss44tc.4a.a .-,.... .r w pwff. WrMMN Walls rwaid al is.`.Nog.orb bud.haw sarsopas.rl when nr..orm.p bib Siva rib~upolbuiblurfeum bawd Iy oorNa�l!rbib. 1i I G grj CamScanner KAN WPDT Screening Report Area of Interest (AOI) Information Area : 3,134,508.61 ft2 Oct 16 2023 15:54:19 Eastern Daylight Time 17 --(21-'1 ,---- ./ .Inns 1} 1 -- I ... .• ......._;;, , .,. ,,i 1 1.- -1-1\ e----- : \ .____7 ,, _ .44/ 15. 9 • .. oc _, ______,. , P7 --'—V--------- , u E \ . —_\_____ ,6------ — '\ C••:,,, r--....1___ \11\''\\\ . \ 1:4,514 0 0.03 0.06 o Parcels(Polygons)- Parcels '2 RP ti ti ti ti ti ti I 0 0.05 0.1 0.2 km County Boundary Non-System Roads NCDOT C45 tmli Boone+EA,Ada.PS.USGS.NOA.NASA.CD/AA.N Non System RoArmon.NCEAS MS 05.WA.Gonclsastyrow FNAANaierauat.GSA Gx4erd FEtAA. htnrnm are Sne GS:r3r community Eat Ceremrrraty Mu. Ce_nbburna SYata d Naar! Ca>dret DOT O OpeASYeclhtap — Secondary Route 1293 MISTY LANE, HICKORY 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. F WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: I.Well Contractor Information: Ashley T Moretz [214:WATER:ZONES` - ~ . ,._•- u . " FROM TODESCRIPTION Well Contractor Name 0232 ft- 3 ft `/0 6P 2586-A J/1 it, ft- NC Well Contractor Certification Number "'15::OUTERCASING(formultl-cased-wells)OItLINER:(iFa licable) . Moretz Well and Pump Service LLC FROM TO DIAMETER THICKNESS MATERIAL Company Name p 1 ft. ?tt. �/� in. � / 2 �/� !�j!/�� �j (/., Q 6.c1NNEI CCASINGG OR TUBING/(ecothermal it/r/oaed4obb)' :x.; = v. 2.Well Construction Pere it#:/a l l�.7,2v 6 5 7 FROM TO DIAMETER THICKNESS MATERIAL. List all applicable well construction permits(lee jjUe IC County.State.Variance,eta) ft. M. 3.Well Use.(check well use): it. ft. Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL Agricultural ©I icipal/Public - ft. a. im Geothermal(Heating/Cooling Supply) sidential Water Supply(single) ft. ft. in. Industrial/Commercial EDResidential Water Supply(shared) Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: O ft. A*q ft. /6e MI6 n /r/*o5 /V /3 e5 Monitoring EDIlecovely ft. ft. Injection Well: ft. ft. Aquifer Recharge DGroundwater Remediation 19.SANlD/GRAVEL PACIC.(if abaci/tie),'"',...' Aquifer Storage and Recovery 0Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD Aquifer Test Ell Stormwater Drainage ft ft. — Experimental Techniilogy CIISubsidence Control ft. Geothermal(Closed Loop) OTracer '202DRILLING LOG(attacti a ddiflonal'sheets'If necessary) .. . ' Geothermal(Heating/Cooling Return) Other(explain under#21 Remarks) FROM TO DESCR ON(color,hardness sotVrnctctype,grain tine etc.1 I� .� Oft. yO ft. 6/11 J A IPif - shitc- 4.Date Well(s)Completed: --/Z.5 Well ID# ft. ft 5a. Vd it. 3�Sr /3/Well Location: I�f= �«� Tey Gr �[�C5Den�e_ ti/e .... //- ft. ft. Facility/Owncr Name Facility ID#(if applicable) ft. ft. I r40y ft, ft. /2g 3 11rrsfr,C M hysical Address,City,and Zip ft. ft. ._.&-4-a4/4?..)a— 37 /srj 20/ County Parcel Idcati cation No.( 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field,one kit/long is sufficient) 22.Certification: 3' goo g9ti N"'3/,G23-57.5gc W 3-7-�5 6.Is(are)the wellxs) Permanent or Temporary Signature of C ed we 7.Il Co tractor Date By,signing this form,I hereby certify that the hell(()was(were)constructed in accordance 7.Is this a repair to an existing well: DYes or jNo with ISA NCAC 02C.0100 or I5A NCAC 02C.02a0 Well Construction Standards and that a If this 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 rf this form. 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 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:t SUBMITTAL INSTRUCTIONS 9.Total well depth below land surface: 3 c2_5-- (ft.) 24a.For All Wells: Submit this form within 30 days of completion of well Formultiple wells list all depths ifdif erent(example-3Q200'and 2( I00) construction to the following: 10.Static water level below top of casing: SD (ft.) Division of Water Resources,Information Processing Unit, If water level is above casing.use"+" 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: 6 (in.) 24b.For Infection Wells: In addition to sending the form to the address in 24a Air 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 WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 13a.Yield(gpm) /0 Method of test:Air Lift 24c.For Water Supply&Injection Wells: In addition to sending the form to p the address(es) above, also submit one copy of this form within 30 days of 13b.Disinfection type: CL Amount: _, O 0 Z. completion of well construction to.the county health department of the county where constructed. Form GW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016