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HomeMy WebLinkAboutWELL-3-11-16174.TIF �$ • CATAW COUNTY Public Health BA Department Case # WELL -3 -11 -16174 .7 ,.. ?, %'1' Subdivision PLATEAU RIDGE ESTATES . E nvironmental Health Division \ Ti s ® PO Box 389, 100 Southwest Blvd, Newton, NC 28658 Lot # 2 /8 sM PIN# 269702654292 Applicant/Owner CLAYTON HOMES # 81 Site Address: 5324 HOPE RD, Vale, NC Property Size: SF 0.689 ACRES Directions: 10W/ LEFT PLATEAU RD/ LEFT SCHRONCE RD / RT HOPE RD/ ON LEFT WELL PERMIT WATER SUPPLY: Individual Well SETBACKS: 1. BUILDNG FOUNDATIONS 25 FT. 2. EXISTING & PROPOSED SEPTIC SYSTEMS - MIN.50 FT. 3. EXISTING & PROPOSED SEPTIC REPAIR AREA - MIN. 50 FT. 4. SEWAGE PUMP SUPPLY LINE 50 FT. 5. UNDERGROUND STORAGE TANKS 100 FT. 6. STREAMS/BROOKS /CREEKS 50 FT. 7. LAKES/PONDS RESERVOIRS 50 FT. ALL OTHER POSSIBLE SOURCES OF GROUND WATER CONTAMINATION 100 FT. 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: Minimum 20 Feet Casing Height: 12" Above Land Surface SEE SITE PLAN FOR PERMITTED WELL LOCATION Megen McBride 03/21/2011 ISSUED BY PERMIT ISSUANCE 03/21/11 09:04 \ iI S) \ELL U 3-ilMist 1 5n1 il va f ci 1— i 7a1 i 4' f o44o't t uj- be, 0 \ S(\ o \05-\ 5- -f-o►i c \ Q S C I 5i GAL ,c r i S - }� -r''� \ 1 � � \ -4 d MVP. c te, �( L r Wig' Do .3 Gi --CI OV t -,›`• ( 56' 64 ' (:C% co ' i✓ a ;feet Ye r t C i C ; '‘' 7( .,* 1'. 2 . ,,,,i cs N-,,:,. 5' ll�� \ Q 29,76' -Noy 5p, �" + 6■■ Ku54 beA e'o 4 a5 - -crow r 1kc. 1160, 6 \i\4 SA. -fyo\k refit V\os, a Mir e � 61 50 {' `' �iAu. 4 4c4+A- veil 4L 0. h 6� . `' 4 I ''` e 75,00' I —LI6 No A. APR-20-2011 08:14 AM CLYDE RUSSELL 8'?_863?_2617 P_01 �"I t��p �Pc'c', ��a �S -,:'vt�R;;�, (�L'h+Gn`1 ��: ��f'�,'e,�U.�y�e� LU�t'�'�d ,��r.- �. Z�:� . '�� '�° North Cerollno Departrnent ofEnvlronment end Natutxl Raaurco�- U►vi�ian of Water Qua!►ry • � ` � .� "�•,�'���.,�::°�'.'' W�LL CONTRACTOR CER7YFICATION t� _� a.� 1 _ 1. LL CONYRAC R: p. WATP_R ZONES (dupth): ' � � : Top� Boeom YoD E3ottom_ � Well Contredor (Individual) Name • Top Elotfom Top ,_ �om � � Bottom ' � t,i � S� � � �1.� � �� �� � � � n � N ' 7op BaRtom T�_ � WeN Contractor Compeny Name 'fhkkooeel �� 7 f- i b e r 1' � h�� C 11 �\ D a(a : 7. CJ►SM(i: Dopth Dmm�.r w.i0►K i Matorlel Addrexs � : ToP_�_ � Fl. .�� � --L- � �- _� n Y S V� J I� N� �� 7oP Boltorn FL _ _ -�----- C n y or Town �� ��p � : TuP Borium Ft. I �g� �� r,. �.� -� c Y S �8�8� I M� Area code Phone number 8. GROUT: Deplh i � 2. WELL INFORMATION: / Top n�m �D - Ft —���' � I � WELL CON3TRUC'f10N PERM17� -� ` � �� �(� - Tti g � n ' - F �� r � : Top �� � OT}1ER ASSOCIA7ED PERMITIC(It eppl�caok) , � 91TE WEL� ID #(If aPWknbl�) - . 9. BCR�N: Depth DlAmgter Slot 8� Mabe�iei I 3. VYELL U8E (Ghodc Applk,able Bo�: Rexitlendel W�tnr 3upp�y ff� 7oP_.� �n� Ft In. In. �._ , Top Battom Ft. In. �,�_ DATE DRILLED �I -��' I � T � g�� Ft. in. In. � TIME COMPLETED �; U p A� ❑ P�"� m� I 4. WL4l. LOCATION: � 16. AAMDIa �P�: gK Mat��tal i CITY: �I���.� COUN7Y ; 7op Baliom Ft , . I � „ nt_ Top BoQ1om Pt -•--�------ �gfroet NemN. N�nbeis, Commurtity, SuDdlrh+lon, lot No., Paroel. Z1D �e) 70p BOtl�fl'1 F1. � TOPOORAPHIC 1 LAND 3ET71NG: (a»dc �pp�� � � �, pRILLING IACi �lope OValley ❑Flel ❑RldAe 1]Other • Top Botlom Formetton Deeorlptlon LATITUDE 3 .�S °��' � " DMS OR 3X,XXXXXXX DD _ _� l_ q0 , G�C � LONGI7UOE �� "�' �2 " DM3 OR 7X.xX)WVWUC DD :� n " 0 � '�� ' I LadtudeAongltude eource: 4�PS Q►�opogrepNc map � _ (lacatlon of we►1 muat be shown on s USQS topo map srtaottoched to : � I thls lorm Nnot uaing GPS) �- s. weu, awn�v� : �"'� � �`�,�,.�. �=�r►�a�%'�� �� �J ! --- Owner Ne(�ie - • � �53� � -,�a-�n�- � � 9treet Adarose ^� / � 7�� � : _� Ciry or Tov+n 9bro Zp Code / I (���) �F�� .3�1�s�7� ----J � nro a cotle Pnone number . � 2 REMARKS_ I 6. WL'LL �E7AIL.8: / . --r----- o. TOTAL Gf�PTT1: ��S � � b. DO&9 1MrLL REPL,4�CE EXIaT1NG WELL? YE8 ❑ NO �/ : � pp HEREBY CERTIFY T}iAT TNI$ WELI WAS CONSTRUCTED IN c. WATER LEVL°l Belaw Top oi Casing: /� .__.,_.FT• : ����ANCE WITH 16A NCAC 2C, WE�I CON3TRUCTION (Use'�` if Above Top of Ceairtq) STANDARD5, AND THAT A COPY OF THI6 RECORO HAS DEEN PROVIDED TO THE WELL OWNER. d. TOP OF CASINO 19 / �� FT. ADwe Land 8urfrce• I l� �� �7op o1 caxing tertnirwteC aVor bebw Isnd ouRece may require . � � a varlMnca in eccordanoe wllh 1 BA NCAC 2C .0118. g�pNq E pF CE TIFIED WELL CONTRAC70R i DA 7 E r. YIELO (OPm): � MLTHOD OF TE$T U�ti �.__ Q. �C.jS�, • F. DISINF6CTION: Typo AmOUnt _,,��' : PRINTE NAME OF ER�N CO STRUCTING TNE vv�LL I Submit withln 30 doya of completton to: Divis�o� af Water Dualtty - Informadon Proceas�ng Fo�"n CiW'1e �C�'/ Utsll Ca��lr� � un*n� RelcJni� Nf`. 7"1�WU_1R� DhAr1A � fA1AI R117.R:�00 RBV. 210g I � ****�***������* -JOURNAL- **********��*��*****���*� DATE APR-2�-2011 *��W* TIME 09�30 �** P.�2 N0. COMM. PAGES FILE DURATION XiR IDENTIFICATIO� DATE TIME DIAGNOSTIG 19 �K @03 148 �0�01�07 XMT g 93248963 MAR-31 11�21 �107A2000A�70 20 OK �01 149 0��08�27 RCV 828 396 6103 MAR-31 16�01 �S�FCBa�0ADD0 21 OK 0�1 150 �0��0�29 RCV APR-04 12-02 aS07C�00�ADC0 22 OK 003 151 �0�0��27 RCV 828 464 �251 APR-04 14�04 �5@7C0�0�BCB0 23 634 a�0i�85 152 0��0���0 XMT s 970487244�2 APR-�4 14�49 �0�0����0�0�0 24 42� �0� 153 �0�0��42 RCV APR-�4 19�56 BO��C�00000�0 25 OK �01 154 00�00�52 RCV 828 241 3564 APR-�5 10�42 05�FC0000ACB� 26 OK 005i��5 155 �0�00�47 XMT � 917048724408 APR-05 14�40 F107R2�BBACAO 27 OK 002 156 00�01�11 RCU 8283�40191 APR-05 14�49 05�7C�000A070 28 OK 002 157 00�01�31 RCV 828 632 9234 APR-06 09�18 aS�FC00�eADDO 29 OK 002i002 1S8 00�0��28 XMT $ 94289128 APR-06 11��3 F0�?A2��0BCA0 3� OK �83 159 00��0�36 XMT $ 9464�261 APR-06 12�15 F107A2000BCA0 31 �K 0�3 160 0��00�36 RCV 828 464 �261 APR-06 14�31 0507C00�@BCB� 32 OK ��6 161 0��01�41 RCV 8283226814 APR-�7 �8�16 05�7CB���BDCB 33 aK �04 162 00��1�24 XMT $ 93222974 APR-07 11�18 01�7A2000AC9� 34 OK a01 163 �0-�0�45 RCV 7�4 434 61�7 APR-10 19��5 05@7C��@01070 35 OK 0�3 164 �0�00�37 XMT $ 917049921285 APR-11 08�45 0107A2�a0BC90 36 OK 003 165 00�00�3� RCV 828 4b4 02b1 APR-11 1� 05�7C��0�BCB� 37 OK 001 166 00�00�26 RCV APR-11 12��1 05aFC00�0BCA0 38 OK 0�3 167 00�00�30 RCV 828 464 0261 APR-11 15�16 05�7C���BBCBO 39 OK ��6 168 00�0��59 RCU 8283226814 APR-12 09�57 0507CB���BDC� 40 OK 007 169 0��01�10 RCU 8283226814 APR-12 1��05 �507C000�BDC0 41 OK 0�2 17� �0�01�05 RCV 8282564989 APR-12 11�37 �5�7C�00080?� 42 420 ��0 171 �0�0��42 RCU APR-12 14��4 0000000�8000� 43 QK ��4 172 �0�0��58 XMT $ 94593533 APR-12 15�28 �007A20�0ACA� 44 OK �01 173 �0�00�36 RCU APR-12 15�33 04aFC���0ADC0 45 STOP 0�1 174 00�00�56 XMT $ 93975279 APR-12 16�20 09�7A200�8�7� 46 DK 007 175 00�02�36 XMT $ 93975279 APR-12 16�21 �1�7A20008�7� 47 OK 001i�01 176 @0�00�31 XMT s 92416059 APR-13 12�25 01�2A20�01�70 48 OK 0�7 177 0��0��53 XMT CITY OF HICKORY APR-13 12�33 01�7A200aBCB0 49 OK ��8 178 ����1��2 XMT CITY OF HICKORY APR-13 12�34 0107A2�0�BCB0 50 OK 8�6 179 00�0@�55 RCV 8283226814 APR-13 13�39 0507C0800BDC� 51 42� 000 180 00�00�42 RCU APR-13 19�10 �O��C��008000 52 OK 0�3 181 00�00�40 RCU APR-15 08�20 0407C8008ACB0 53 OK ��2 182 0��0��33 XMT $ 97043982605 APR-15 09�45 80�7R20�0AC8� 54 OK �01 183 �8�0��27 RCV APR-15 1��29 0407Ca�0�A07� 55 OK �01 184 0��00�37 RCU APR-15 1a�35 0507C0000A07� 56 OK 003 185 0��0��50 XMT $ 93040�82 APR-15 17�00 F107A20�aBC90 57 OK 0�1 186 00�00�46 RCV 828 294 7766 APR-18 10�17 050FC�a0�A�70 58 OK 001 187 ���00�51 RCV 303 3�7 �703 APR-18 11�35 0507Ca�00A07� 59 OK @04 188 00�02�22 RCV APR-19 08�46 05�FC0�B�A�7� 60 420 00� 189 �0�00�42 RCU APR-19 �8�5� 000�C���a��afl 61 OK �01 190 �0�00�2? RCU APR-19 �9�1� 0507Ca�00A07� 62 OK 001 191 0��0��27 RCV APR-19 �9�1? �5�7C0�00A�?0 63 OK �04 192 00��1��7 RCV 8282412445 APR-19 09�37 �S�FC�0�0ACC0 64 OK 003 193 0��00�35 RCU 828 3�4 0882 APR-19 11�17 0507C��00BGB� 65 OK 003 194 00�00-32 XMT � 97045287355 APR-19 15�52 61�7A2000BCA0 66 OK 003 195 00��0�31 XMT $ 97045287355 APR-19 16��7 61�7A2000BC9� 67 436 0�1 196 0��00�49 RCU 8 22617 APR-2� m9�11 �50�C00��183� 68 OK 001 197 0��0��58 RCV 8c86322617 APR-2� �9�13 050�C0�001030 ---.._ i� -CATAWBA COUNTY GOVT - ******�***�:*******��***��*****�***�* -ENVIRNMTL HEALTH- �:**�� - 1 828 4b5 8276- ****�****