HomeMy WebLinkAboutWELL-11-2023-208100.TIF 13 +• CATAWBA COUNTY Case# WELL-11-2023-208100
Q(f- Public Health Department Subdivision
.......� ''1 Environmental Health Division PIN# 370110354646
PO Box 389,25 Government Drive,Newton,NC 28658 LOT#
• w
Site Address: 2260 JOHN BOWMAN RD, HICKORY NC 28602
Name on Permit: JEFFREY CHESTER
Property Size: Acres 20.08
Directions: NC 127, Right John Bowman, property on Right
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.
kelii /_Jiee Pe kt 44) 11,'09/2023
Authorized State Agent Permit Issuance Date
11/9/2028
Permit Expiration Date
elIpermil 11/13/2023 10:37
`1 ,—N J J 0
4
II^ O� o C
0 o vt W W
p O o v1
aC a' w
ci . 0 0 oo
a
0 S1 o
I
j[-'‘• ' ‘ - --\ pb
Sh
V v _
OOP - e O
U o 2
a.. 'to oZ y� (1
4 * _ 10 1 ,.
^o S '
O
G o. o o �i T ro ' g4 '>
er \ r
---."-
CO `
S
1.
t {
\'‘\
W1J �£ v ,`
8 t'I W I 1
r l
it
,,I i .
1
f-7 J • ll
r ,Gta
7—
n
\\/
I \_______ _
r I
e... — 9)''''[...-
1 1.
7.________ \1r- i,
H o
o24ft I J: r
,t/
•
_ ,/
f f r-
IJ
°0 1Tr: ::::; .4:iI
� \ I I / I '
1 4,514
Parcels(Polygons) Parcels Other System Roads o G.03 0.06 0.12 mi
1 > > ti ti ti ,, ti '1
�
__ —
County Boundary Ramps. Rest Areas.Non-Mainline o 0.05 0.1 0.2 km
Non-System Roads — Secondary Route
Non-System Primary Roads
NCCOT GS t/v.Soaropt Wt.Aru4 OS.JSOS.NGA.NASA.CGAII.N
--- NC Route IComan.NCEAS tA.S.OS,NNA.Geooafastresen.M;IksvawerMsal.GSA
GE,NN1,FERN.Mta 1 aIS Iv GG;user conn.ntl,Es,Conrwnq
Mas COnebubrs. SW* of Nofn Groins 00T, C Cpir0treelMap
Mrrasaft Est HERE Orrnl SaN4acn Geohcmc+agres.trc METv
S....)
WPDT Screening Report
Area of Interest (AOI) Information
Area : 3,134,508.78 ft2
Nov 9 2023 7:32:27 Eastern Standard Time
2260 John Bowman Rd., Hickory, NC 28602
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.
Ir
WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Ashley T Moretz 14.WATER ZONES• '. ...
Well Contractor Name FROM TO DESCRIPTION
370 3
2586-A ? t. .�g pig
39 39 ft. S"O sP�
NC Well Contractor Certification Number 15.OUTER CASING:(for�multi=cased wells) LINER(if:op lictble)_. ` '
Moretz Well and Pump Service LLC FROM TO DIAMETER THICKNESS MATERIAL
74/ 3/ ft. 6 S '" SAS [/-
CompanyName /y/
�J 7 �^/ J��J �J 16.INNER;CASING ORTUBING�(aeotLermrilclosed=loop)
2.Well Construction Permit#: /®�G�Ol� �/`�"��`' 0 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 t '
Water Supply Well: FROM RED ' •r TO DIAMETER SLOT SIZE THICKNESS
Agricultural OMunicipal/Public f,/t. ,�� ft. is
Geothermal(Heating/Cooling Supply) esidential Water Supply(single) t \7tt
IndustriallCommerctal I�Residcntial Water Supply(shared) 18.GROUT \. .
' Irrigation FROM TO MATERIAL/ 1. EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft' ry'+.�J �-^ `� J7YO ft. el -(��(1e /lrn> //A35
Monitoring fRccovcry - ft. ft.
Injection Well:
ft. ft.
Aquifer Recharge jGroundwater Remediation
_ 19.SAND/GRAVEL-PACK(if appueable).
Aquifer Storage and Recovery ElSalinityBarrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test 0 Stormwater Drainage ft. ft.
Experimental Technology liSubsidence Control ft. ft.
Geothermal(Closed Loop) IDTracer •20.DRILLINGLOG attach addltional''s3eets.if.neces'sary) F= ;'i ,' `
. Geothermal(Heating/Cooling Retum) 0Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness soil/rofib
a grain size,etc.)
l ® ft. 2D ft. CA ,8ir0k /<
4.Date Well(s)Completed://' Well DO ft. ft i
5a. el�Location: t
Oft. Vo . / 6. fl oC jr
3-e / o� C�Ae 74e f/�-
ft. 7 ft. �✓
Facility/OwngrName
' FacilitylDi5(if applicable) ft. ft.
.J 6)0 0AA. /3WM d6111 XS 1/+CA - / ft. ft.
Physical Address,City,and Zip //� / ft. ft.
Ca.AV lt/LCL 3�Jr Ol/O3s�6Y4 21.REMARKS . '
County Parcel IdentificationNo.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(i£well field,one lat/longis sufficient) 22.Certification:
6.Is(are)the well(s)OPermanent or Temporary Signanrre ofCA-4-1:7164,7k--
Well Contractor Date
By signing this form.I hereby certify that the wells)was(were)constructed in accordance
7.Is this a repair to an existing well: Dyes or %:No with I5ANCAC 02C_0IO0 or.ISANCAC 02C.0200,Well Construction Standards and that a
If this is a repair,fill out/mown 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 fonn.
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=' SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface:. O� (ft.) 24a.For All Wells: Submit. this form within 30 days of completion of well
For multiple wells list all depths ifd erent(example-3 0O'and 2@1001 construction to the following:
10.Static water level below top of casing: /0 0 (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,ducctpush,etc.)
Division of Water Resources,Underground Injection Control Program,
FOR WATERSUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
n
13a.Yield(gpm) . / Airl-ift 24c.For Water Supply&Injection Wells: In addition to sendingthe form to
Method of test: '
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: CC Amount: /0 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