HomeMy WebLinkAboutWELL-11-09-2549.TIF
CATAWBA COUNTY Case 9 EHPR-11-09-2604
7. Public Health Department Subdivision
qp 4 Environmental Health Division
v
PO Box .389, I00A Southwest Blvd, Newton NC Section/I31/Ph/LoO
184 2 (828) 465-s270 Fax (828) 465-8276 TDD (828) 465-8200 PINS 461820905357 _
Applicant/Owner Duke Energy Carolinas LLC
Site Address: 3275 1-Iarvel Road, Terrell, NC
Property Size: 2.829
Directions: 1-Iw 150 1 , LT Harvel RD, Property on LT
WELL ABANDONMENT PERMIT Poo
WELL TYPE: DRILLED, BORED, DUG, ETC Zr~ u L V4etj se,
° I
3NER Y: PERMIT ISSUANCE DATE
62::C~Npq Mr~s5rtir1~1~
'
OR LEGAL REPRESENTATIVE DATE,
WELL A13ANDONMENT INSPECTION
TOP Y OF CASING MATERIAL REMOVED (BORED WELLS) YES NO ❑
WELL DISINFECTED: DATE INITIALS
WELL FILLED WITH APPROVED MATERIAL I
(BORED OR DUG WELL, ONLY) DATE _ INITIALS
WELL GROUTED TO SURFACE (DRILLED WELLS ONLY DATE b G~ INITIALS A4&
WELL CAPPED WITH CONCRETE; DATE INITIALS ~1/1{VI
WELL ABANDONMENT RI PORT RECEIVED DATE d INI'T'IALS
PERSON ABANDONING WELL
OWNER r DATE
CONTRACTOR l` DATE ( b
Wells shall be abandoned in accordance with all state and local regulations and rules. The Well Abandonment Report must be
submitted to the 11 filth De artmc within 30 days upon completion of a wgcl .
A TI-10 -D STATE AGENT COMPL TI N DATE
C:\Documents and Seuings\jenglish\Local Settings\Tempornry Internet Files\Content.Outlook\PP83 W9G6\EI-IPRI 1-09-2604 WELL,
A13ANDONMENT PERMIT.docx
EHPR 2604
TRACKING INFORMATION
Date Calls
11/9/09 1" Contact - Discussion Only
11/10/09 Site Ready to be Flagged
11/10/09 Site Flagged
11/10/09 Site Ready to be Evaluated
11/10/09 Site Evaluated
11/10/09 Approved for Issuance
Other
Date Comments/Field Notes
,.,.I-...__..._.. _._._._._.1... , .
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I
NOV-18-2009 WED 12;45 PM McCall Brothers FAX N0, 7043982605 P. 02
WELL ABANDONMENT RECORA~,
..Cris
Notch Carolina Departracrtt of Environment and Natural RCSOUrces- Division of Watcr Quality
WELL CONTRACTOR CERTIFICATION 0
1. WELL CONTRACTOR; 5. W1~1.I. DETAILS;
S P- Total Depth: (L DiametW- L'-1-~
Well Contractor (t dividual) Name b. Water Level (13clow Measuring Point): ft.
n s ,e 11 /~k Measuring point is , 1.0 • tl, above land Surface.
all Contractor Company Name 1 ; 71^
STREET ADDRESS L 7 DO f, 5 ~ r~ 1 ti. CASING: Length Diarncta
~o a, cuing Depth (ifknown): _ __a~ ~ A• in.
City or Town State Zip Code b. Casing Removed: It. in.
0
Area code- hen numbcr 7. DIS[NFTGiIONr C and ~t
(Amount of -75% calcium lrypachlOdle used)
2. WELL INFORMATION.
SITE WELL ID #(if applicable) S. SEALINCMATERIAL*
. etll
STATE WELL PERMIT # Gfapplicablel tel Cement Sand Canl
'
Ccmcot Ib. (-meat lb,
.
tAUNTY WEi.L PERMIT q (lfappl'tcablc) ~f ^ g ~..ZS Water gltl Witter PL
DWQ or OTHER PERMIT N (if applicab(e) nontolft
L-D
WELL USE (Circle applicable usc): Monitoring ealde to
Hcnlanitc
Mualelpa"ubllc Industrial/ComMOCIA! Agricultural TYPE Siuay_ Pallets-
Recovery IDjeceon Irrlptlab Warcr -gal•
Other (lid use)
her
3. WELLLOCATION:
i Type matcrief
{ COUNTY C }A1A QUADRANGLE NAME
NEAREST TOWN;-q 4-cal I Amount
(StreatlRoad Name, Number, Coaanunity, Subdivision. Lot No., Parcel. zip Cad4 9, EXPLAIN METHOD OF EMPLACEMtNT OF_MATERIAL:
latL 65G) T.-,. G' t~
TOPOGRAPHIC t E4 BD SEWING;
E _ Slope Valley x;jU t Ridge
(Circle appropriate setrirW
Mon be its degrees,
LATITUDE. ~ ~ minuW3r steoads, or bl a
o ' '-1-l ronnRt to, WELL DIACIRAM: DOW a detailed skoteh of the well an the back of this
LONGITUDE I► S(O ~ 1_~ L+9 7
I:atitudeTlongitude source: CrPS Toprsgreuc.Illap farm showing total dcpt, depth and diasncter of scrocas (if eon) remaining
(Locorlon of wet/ wets/ beshown on 4 U3G8 repo map and ~ in the well, gravel interval, intervals of casing perlornllons, and depths and
atraehed to thh foot Knot using GPS.) types of fill materials used t l
4a. FACILITY-11m name orimbusindt where rho well is located. Complete 9aand4b 11. DATE ►~VIF.I-L ABANDONED I 1 ` 7 1
Rra mldenrial well. sUp 4a; compkie 4b, Wen awm inf nation only.
FACILITY 10 0(if opplloable) I loo tmpxoY C m'y THAT nits wEP.L; WAS ABANDONED N ACCORDANCE
NAME OF FAC[L1TY S~ WITH 15ANCAC 2C, waL GONSTRu.mw STANDARDS, ANDTHATA COPY OF
THIS RECORD HAS Dr~N pROv'IDEDToTSE WK.l.OWNEL
STREET ADDRESS IL /tea /
2.~GS~Z I dl /7-`I
City or Town State 7.iP Cnde SIGNATU CERTMUP WMAXON rRACUM DATE
4b. CONTACT PERSONIW$LI.OWNEIL-
NAME SIGNATURE OF PRiVATR WELL OWNER ABANAOWNG THE WELL DATE
('LbeprivatewdtownerAnticbeanladWdoalwhopytgn abendanshistharm%I&Atislwag
STREL7T ADDRESS oZD ir //.,/u tP15C 2C .ll l {3.
v.-'K iONAUNDOMNG. IWE AYht.L -