HomeMy WebLinkAboutWELL-11-09-2511.TIF
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CATAWBA COUNTY Case # EHPR-10-09-2422
Public Health Department Subdivision
Environmental Health Division
PO Box 389, 100A Southwest Blvd, Newton NC SectionBl/Ph/Lot#
i 1 42 (828) 465-8270 Far (828) 465-8276 TDD (828) 465-8200 PIN# 46170899597
Applicant/Owner Duke Energy Carolinas LLC
Site Address: 3275 Harvel Road, Terrell, NC
Proper!y Size: 2.829
Directions: H 150 E, LT Harvel RD, Prope!jj on LT
possi;o
WELL ABANDONMENT PERMIT
WELL TYPE: DRILLED, BORED, DUG, ETC ~.1 'PUY\C~^ >~el~
i
I S BY: PERMIT I SUANCE DATE
viW55IMtiNl~ r' ~
R OR LEGAL REPRESENTATIVE DATE
WELL ABANDONMENT INSPECTION
TOP Y OF CASING MATERIAL REMOVED (BORED WELLS) YES NO
WELL DISINFECTED: DATE INITIALS
WELL FILLED WITH APPROVED MATERIAL Nik
(BORED OR DUG WELL ONLY) DATE INITIALS
WELL GROUTED TO SURFACE (DRILLED WELLS ONLY DATE [ L INITIALS
WELL CAPPED WITH CONCRETE DATE____ 11 16 Ol INITIALS
E WELL ABANDONMENT REPORT RECEIVED DATE INITIALS
PERSON ABANDONING WELL
OWNER DATE
I '
I CONTRACTOR I DATE Cv
Wells shall be abandoned in accordance with all state and local regulations and rules. The Well Abandonment Report must be
sub 'ited to the H lth De utmen within 30 days upon completion of a ell.
AUTHO Z D STATE AGENT COMPLE IO DATE
CADocuments and SettingsljanglishkLoeal settings\Temporary tntemet FileslContent.Outlook\P6CRMTUFIEHPR10-09-2422 WELL
ABANDONMENT PERMIT.doex
TRACKING INFORMATION
Date Calls
11/02/09 1" Contact - Discussion Only EHPR-10-09-2420 and 2422 Left message
11/02/09 Site Ready to be Flagged
11/02/09 Site Flagged
11/02/09 Site Ready to be Evaluated
11/04/09 Site Evaluated
11/05/09 Approved for Issuance
Other
Date Comments/Field Notes
11/5/09 Spoke with Elena Massimini. Told her well abandonment permits would be issued and ready
for pickup today.
i
NOV-18-2009 WED I2:45 PM McCall Brothers FAX NO, 7043982605 P, 04
WELL AgANB(]NMEIVT RECORD
North Carolitta Department of Environment tend Natural Res ounces-Division of Water Quality
WELL CONTRACTOR CERTIhICATION # 3
1. WELL CONTRACTOR: S. WELL DETAILS:
i Oiameter:i~
. ~ ~ p W11/ ~ (3 d ~ s. Total l7ePth.,--~
Wd1pontraetor (I dividucl) Name b. Water Level (DeloW Measuring Point)' ft.
l r 1 Measuring point Is ~ fl. above lead surface.
WcU Contractor Company Name
y 6,
S7RGETADDRESS CASING: Length Diameter
` .
O e it. Casing Depth (if known): _ n• uL
City or Town State Zip Code b, Casing Removcd: L
7, DISINFECTION: ly d
Area code - hone number
(Amount o 6S~/o•751/b Cold= bypocttloritc utxd)
2, WELL INFORMATION:
i J
1 SITE WELL lb#(ifapplicablc 8 SEALINGMATSR1AI.t
S il
STATE V YELL PE1tMIT ti (if apptieablel matt errant .s l
Q Ccrncat -15f- Ib. Cemcnt_ lb,
COUNTY WELL PKRr4IT If (if applicable) Water SA Water gaL
DWO or OTHER MRMIT H (ifapPlicabte D nnlto
WELL USE (Circle applicable use): Manltorft idantla Eenloalte_ 1b•
Munlcipal/Publlc IRdustrtaUCammerclal xv a1 Type: slurry- Pellets_
Rccm+ery Injection Irrigation Watu~. -g~
Other (list uses)
char
3. WELL LOCATION: Type material
COUNTY, QVADRANGL.HNAM$
k NEAREST TOWN: _ l o r.^a - Amount
(StmeVRoad Nium Number, Cmnmanky, Sab& i%ian. Lot Iota., Marcel. Zip C040 9. >EXPLAl1V Mls`I I UD OF PLACLMENT O MATEl2l~ll s
TQPQaMPHICIL SE[TiNG: Q/B=,? ~
slope Vallcy ~ Ridge Otter
(Circle approprtato setting)
~ r May bo in degrees,
LATMJD& 3 r 3 . c mlm+u~,+~on1~, or in ■
LONGITUDE Jam. BD-' 0 . I 5at 1 `~~"t°I format 10. WELL DIAGRAM: 17ravv a detailed tUetd of the weal on the back of this
Latitudellongitude source: GPS TOP6917[Phic map forte showing total depth. depth and diameter of screens (if any) retnaittiag
i ([.canon of wet wwl be shown on a USGS lopo amp and in ft wo1i..9mvei interval, intervals of casing pufatations. and depths am
attached to this form 9f nol using GP5) types of fill materials used.
4a. PACILITY-T1x Same arthobtuinua whore the well b tocmcd. Complete 4aand4b. I I. AATZ WELL AHANDON=_ 6
(Ira reshimaal well, slip 4a; tcrnploic 4b, well owner mr, don GAY.)
FACILITY 11) 90f applicable) ' I Do t•ISRtia` CERTIFY THAT 7141S VIU4, WAS ABANDONED IN ACCORDANCE
NAME OF FACIXY ~ Wrm 15A NCAC 2C, WELL CONSTRUCTION STANDAItDS,ANDTHATA COPY OF
1 %,,RECo10 HAS BL•FN oVrDED TO'rft$ WELLOWKM
Sl"lt>rET ADDRESS !n, Z'1 611- e! ( 11-127-
A-/ C 11
C4 or Town Stab Zip Coda A OF FW0 WE A. COS fRACCO1t DA7 E
4b, CONTACT PERSONIWFLL OWNER:
/Q KJ~ Yq ~q 8IG1VATl1itEOFPRIVATF,UMLL,OWNERAAANDOt~iINGTHEWYAJ, DATE
NAB / /4 (rhoprivatoWaliawncrmustbeaniadividadwh4MgM23dl%abandonswos err=ddandatwati
STACEY ADDRESS Dot c/ O to accoudaoco with ISA NCAC 2C-0113)
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bur•re.eh NAME OFPEt/ 1~ THEWY.sI-
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