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Home My WebLink AboutWELL-1-1-14648.TIF . • CATAWBA COUNTY Case # WELL -1 -11 -14648 aG Public Health Department '",,E �° 2 Subdivision MRS D C YOUNT Environmental Health Division 0 ^C PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Lot # 63 -67 18,2 5w PIN# 370310267003 Applicant/Owner HICKORY WELL DRILLING D 1 Site Address: 1229 7TH ST NW, Hickory, NC - /4 PR. 1 - J _`` �] t)Lf C Property Size: SF 0.419 ACRES Directions: WEST ON 3RD AV NW, RIGHT ON 6TH ST NW, LEFT ON 12TH AV NW, RIGHT ON 7TH ST NW, WHITE HOUSE ON LEFT 1229 WELL ABANDONMENT CERTIFICATE OF COMPLETION Well Type: Bored - INSPECTIONS INSPECTION# COMPLETED, INSPECTION TYPE STATUS INSPECTOR INSP - 115647 • 02/17/201.1 Well Abandonment Observed Approved with notes Megen McBride ksj well wa's approxtmately22 ft. deep; water was at 19 ft. Il INSP- 115648. 01/24/2011, EH Well Abandonment Site Inspection Approved with notes Megen McBride, --- _ Made site yisit'to site well. location (of well to be abandoned) prior to issuing_pennt. INSP- 115649 02/i1/__,_, 201,1 EH VV 11� b dri onment COC ` ° y ' Approved Megen McBride 1 INSP - 115650 ; 02/2 0011 EH Well Abandonment Report Received Approved EH Admin, - -- - -- - - - - -- INSP- 115651 02/17/2011 EH Bored.We Top 3 ft Cas Removed Approved Megen McBride INSP - 115652 02/1,7/2011 EH Well Disinfected Approved Megen McBride] INSP- 115653 02/17/20.11 EH Well', filled with approved material Approved with notes Megen McBride) filled with concrete (from„ concrete-truck) _Ze ----- I INSP - 115654 02/17/201 4 EH Well Capped with Concrete Approved Megen McBride ' k d y '1 ,,I . ' v Contractor - Hickory Well Drilling 02/17/2011 ABANDONED BY DATE OBSERVED Megen McBride 2/21/2011 AUTHORIZED STATE AGENT APPROVAL DATE 02/21/2011 17:39 Feb 11 11 12:36p Dan Huffman . 828.397.6701 p.1 t- 'Atwwnn�uutr� -- , -0_, O .o tio ( r.eli ��w �.auG n wt t-t. -r -, i -taova Pu Health De r' 1111 , En blic vironmental Health Divis partrrten t ion Subdivision MRS D C YOUNG v PO Box 339, 10D Southwest Blvd, Newton, NC 28558 Lot # FINN 370310267003 Appllcantlt7wner ROXANNE WATK NS LINDERMAN Slte Address: 1229 7TH ST NW, Hickory, NC Property Size: SF 0.419 ACRES Directions: WEST ON MD AV NW, RIGHT ON 6114 ST NW, LEFT ON 12TH AV NW, RIGHT ON 7TH ST NW. WHITE HOUSE ON LEFT 1229 / ____ Owner /Authorized Representative Acknowledgement of Permit Receipt I certify that I am the owner or authorized agent (owner's authorization required) representing the owner of the property described above. i/ As the property owner or authorized representative, I have received the above referenced permit(s) as requested in the application for service EHPR -I- 11.9045 , by the following method(s): Received in Person 7 Facsimile Transmittal (Return form with signature required) — Electronic Image Transmittal/ E-mail (Raton n receipt required) As the property owner or authorized representative I have reviewed and understand the specific conditions of the permit issued, and further understand that all applicable regulatory requirements specified under the North Carolina Laws and Rules for Sewage Treatment and Disposal Systems (1SA NCAC 18A .1900), and/or Well Construction Standards (I5A NCAC 2C .0100), shall apply to the issuance of this permit and the construction of the wastewater system and/or water supply well permitted. Permit Issue Date: 0I/25/2011 � •ar~ , �/�,.e. - ,y /k?y, ze ° rte Owner /Authorized Representative Signature -74'lf/ /.(JCS./ /)/ /A/O 62; - : , Date z /i // GG // - - --- PX kO '. -4-VLy w c\ l bl t 111 i n. - 808 - s9 i p - 1- -101 -- ---- -- C Documentation of Permit(s) Transmittal ; (permit transmitt4d y elec is or other means) vita►, /' Permit transmitted by .t.- L. i• • et (name ofperson s - • R p er ry it) Q Signature � 7/ ■ Y =i a A ; •.�: I� D ate / Time ' - 6 : u g5 11 Method: 1 Fax Email US Mai] Other Owner's request to send by the above indicated method of transmittal in lieu of signature acknowledges the conditions and statements above. . T tie�,Se 3 ‘t:3 , n and rc ur - tco env otnmentc-\ - k - -( 1 -\+ 1.-1 -c.c - N 2A') - 83 0 u25/11 08:10 Feb 21 11 12:57p Dan Huffman 828.397.6701 p.2 err >�rt f WELL ABANDONMENT RECORD ‘'y'0 1 i. Fi North Carolina Department of Environment and Natural Resources- Division of Water Quality ' WELL, CONTRACTOR CERTIFICATION # 4080 -C 1. WELL CONTRACTOR: 5. WELL DETAILS: Isaac Blackburn a. Total Depth: 29 1 / 2 ft. Diameter 20 in. Weil Contractor (Individual) Name b. Water Level (Below Measuring Point): 2 7 R. Hickory Well Drilling Company Inc. Measuring point is 1 _ ft. above land surface. Well Contractor Company Name STREET ADDRESS P. 0. Box 4216 6. CASING: Length Diameter Hickory N. C. 28603 a. Casing Depth (if known): 30 It 20 in City or Town State Zip Code b. Casing Removed. 3 ;t. 20 in. ( 828 )- 324 -0035 Area code - Phone number 7. DISINFECTION: Chlorine Granules 2. WELL INFORMATION: (Amount of 65 -75% calcium hypochlorite used) SITE WELL ID # (if applicable) 8. SEALING MATERIAL: STATE WELL PERMIT # (it-applicable) Neat Cement Sand Cement Cement Ib. Cement b. 14 I1 I - -648 COUNTY WELL PERMIT # (if applicable) WELL — Water gal. Water gal DWQ or OTHER P ERMIT (if applicable) Bentonite WELL USE (Circe applicable use): Monitoring Residential MunicipaVPublic Industrial /Commercial Agricultural Bentonitc Ib. Type: Slurry_ Pellets_ Recovery Injection Irrigation Water gal. Other (list use) Other 3. WELL LOCATION: COUNTY Cat awba Typemateria; 3000 Pea Gravel Straight QUADRANGLE NAME t.ement NEAREST TOWN: Hickory Amount 2 -25 Cu. Yds. 1229 7th. Street N. W. j (StreeL'Road Name, Number, Co nmuiiy, Subdivision, Lot So., Parcel, Zip Code) 9. EXPLAIN METHOD OF EMPLACEMENT OF MATERIAL: TOPOGRAPHIC / LAND SETTING: Poured from Mixer from Top. Slope Valley plat Ridge Other (Circle appThiTilite setting) 1 Mny LATITUDE N 35 44.941' minutes, e is conds minutes, seeouds, Cr in n LONGITUDE W 81 ° 21 - 027 t decimal format 10. WELL DIAGRANI: Draw a detailed sketch of the well or. the back of Luis Latitude/longitude source: GPS Topographic map form showing total depth, depth and diameter of screens (if any) remaining (Location of well must be shown on a USGSiopo map and in the well, gravel interval, intervals of casing perforations, and depths and aitachcd to this form if not using GPS) types of fll materials used. 4a. FACILITY. The name oFthe business where the well is located. Complete 4a and4b. (If a residential well, skip 40; complete 4b, well owner information only.) 1 DATE WELL ABANDONED 02 / 1 7 /2011 FACILITY ID Cif applicable) N/A I DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE NAME OF FACILITY WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD ,S BEEN PR VIDED TO PIE WELL OWNER STREET ADDRESS k ■ 02/21/2011 City or Town State Zip Code SIGMA E OF CERTIFIED 1 LL CONTRACTOR DATE 4b. CONTACT PERSON/WELL OWNER: NAME Ralph Watkins, Executor SIGNATURE OF: PRIVATE WELL OWNER ABANDONING THE WELL DATE Georgia Watkins Estate (The private well owner must be an individual who personally abandons hisTer residential well STREET A DDRESS in accordance with I SA NCAC 2C .0113.) 31 2 Ayers Circle Isaac Blackburn SL ri lw S C 29485 City or Town State tate dip Code ABANDONING NAME OF PERSON THE WELL. ( 843 ) 875 -9530 Area code -Phone number Submit a copy to the owner and the original to the Division of Water Quality within 30 days. Form GW -30 Attn: Information Management, 1617 Mail Service Center — Raleigh, NC 27699-1617, Phone No. (919) 733 -7015 cat 568. Rev. 5/D6 Feb 21 11 12:57p Dan Huffman 828.397.6701 p.3 Catawba County Permit WELL 1 -11 -14648 Georgia Watkins Estate 1229 7th. Street N. W., Hickory, N. C. 02/17/2011 . DIP G",cGUX/) ,SG SAC 111123 SLAB p01/ -0 c A/cneff- 2 ��1v �• C�,v��f� c9srv��