HomeMy WebLinkAboutWELL-5-11-18222.TIF �B CATAWBA COUNTY Case # WELL-5-ll-18222
Q ., p Public Health Department Subdivision
�' � Environmental Health Division
v v''�' PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Lot #
I SM P�N# 461601297010
Applicant/Owner JOHN R JOYCE ���� � I����
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Site Address: 8362 CHAPIN LN, Sherrills Ford, NC
Property Size: SF 0.56 ACRES
Directions: HIGHWAY 16 S- TURN LEFT ONTO HWY 150 - TURN RIGHT ONTO SLANTING BRIDGE RD - TURN LEFT ONTO
DRENA DR - TURN LEFT ONTO CHAPIN LN - 2ND ON LEFT
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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. STREAMSBROOKS/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: 1Vlinimum 20 F'eet
Casing �Ieight: 12" Above I,and Surface
SEE SITE PLAN FOR PERMITTED WELL LOCATION
A!I newrly constructecB private d�inkirag water wells in North Carolina are
required to be sam�pled in accordance with
'i5A NCAC 'i8A .3800 (Rules Regarding Private Drinking 1�later �Vell Testing).
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.
Jason Boyd OS/23/2011
ISSUED BY PERMIT ISSUANCE
OS/23/11 09:18
.�5�' � Case # EHPR-4-11-10903
�Q" ; G', CATAWBA CO�JNT'Y Subdivision
' � Public Health Depariment Section/BUPh/Lot#
c�,.) , g j� ''G` Environmental Health Division p�#
PO Box 389, 100A Southwest Blvd, Newton NC 28658
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A licantlOwner John Jo ce
Site Address: 8362 Cha in Lane Sherrill's Ford NC
Pro e Size: 0.56
Directions: H 16 S,LT H 150, RT Slantin Brid e Rd,LT Drena Dr, LT Cha in Lane, 2" on LT
Improvement Permit ❑ Authorization to Construct ❑ Well Permit �
S�'�'E PI.11I�T
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System components represent approximate contours only. The contractor must flag the system prior to beginning the installation to ensure that proper grade is maintained. Do not
install system under wet conditions. This permit is subject to revocation ifthe site plan or site conditions are altered.
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AUTHORIZED ST T AGENT DATE
�:�o�ume�ts �,d Sen;� Sett;� Internet Files\Content.0utlook\TENCGZZ 1\EHPR-5-11-10903 WELL PERMIT.docx
Jun 03 11 06:24a 8282412445 p.2
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�� ��,�' North Carnlina Department of Env'uonment and Tfalutsl Rcsourc�- Division of Watcr Qualih�
.�"'"'"�• WELL CONTRACT�R CER'ITFICA.'TION#! � � `�-� �
1. WE�L CONTRACTUR- f. DISINFEGTION: Type, N�� �� Amounta ���o��S
�� t �1"1 C � 1����0.U,'' g. 1VATER Z ES (deP1hY .
We9 Gontractor {Individual} Name From��o �f -- �rom To
� C�1V CU'l�.C'C� �'v P �� ��� i 11 . L�--� From 1 4 0 _To�� From To
WetlContrectorCompanyName Frcrn �1� —Tci �i1 S Frorn �a
:��� �� p�� �p 6. CASING: Tt�icknessl
STREET ADDRESS Depth , �ameter Weight Me e al
1 � r , Q. From � To �� Ft� N � ��
�,,..C��n.u:�C�� i��t �.�� � �
Ciry or Tew� � 5tate Zip Code Fran To Ft
L�� c�� �—� �'SC:� From Ta F�
qrea codr Phone numher 7. GROEfT: Depth Material MGthod
2_VYE�L WFORMATfON_ F� Ft ������ �G�C� 2C�
S[TE WELL ID #Il[appllcat�le) ` Ftom To F1.
STATE W ELL PERt�AIT#(if applic-able)1}�'-ti 1' �I I ga.� Ffom To Ft
DWfl or OTHER PERhAfi #(if aPPGcableJ 8. SCREEPI- I?eplh Oiameter Stol Size MaterYal
From To Fl in. in.
WELL USE (Check Applicable 8ox): Residentwl Water Suppfy p F� To Ft in. in.
DATE DRILEFD `� From To Ft in_ i�.
TIME CORtiPLETED �� O C� AM D PM�
� 9_ SAND/GRAVEL PACK:
p Sizc f�Aalerial
3. WELL LOCATION:
1 � From To Ff.
CITY: �� r f, � S T�� _ COUI�fTY �- From Ta Ft.
D�c�o� I �- �alr1 1-►�. ,�4+fffi,��v.L !J� c3g{�� From To Ft
[SVcec Narne, N�anbera, munlry, Su i�islon, Lot No., Paru� Zip Cade)
,, T // OPOGRAPHIC I LAND SETTING: 14. DRIWNG LOG
�[7Slope pValiey aFfat O�d9e ��� _ Fram. s2r a CQR,, � esCription
,T (duck apprcprlata eo� �
M�y be in deFl�. �_� � + c.�
tATITUDE 3 S �I minutes, setonds ar
—� in a decimal tocmas �—�� `.
LONG(TUDE � � � � � � ' ►.��
Latittideliongitude source: IIGPS ❑Topographic rswP • � �� .1_D�
(lace�on o/►n�edmvsf be shown on a USGS topo map and �$— �'�
aUached to this (orm dnot us+ng GP5) — a QS r Io,.,.��
d. WEi.L OWNER ''''�
OWNER'S NAME �'"�Y� �c� P �
STREETADDRESS �^ ��� � �
.��'vke�`S��tY t�l ����D`�� --
City or Tam —T State Z�p Code
t :}
Ar� code Phone number jl_ REMARKS:
5. W ELL DETAILS: �
a. TOTAt DEPTH: � O �
b. DOES WELL REPLACE EXISTING WELL7 YES ❑ NO�
100 HEREBY CERTi.= !T}U�T h45 YVELL WAS C9NSTAUClED N ACCORDANC£ MffM
c. WATERLEVELBdc�nTopafCasln9: �O �, 15ANCRC�C,WELLCONSTRUGT
( „+, ���. � C ��� g � RECOR WLS BEEM PROY�DED TD THE WELL OWNER
. � �- ���_
d. TOP OF CAStNG 15 �,, 7 . FT• Above Lend Su�face'
.'Top of casing terminated aVOr belaw land surface may requice 51Gh1A�1lRE OF CERTIfIED W ELL COIJTRACTOR DATE
a variance in xoo�dance wdth 15A NGAC ZC .0118 � � C
'�—\} ���,e.�c�el �L .. v�����
o. YIELD (flpm)� METHOD OF TBST `'� r pRINTED NAME OF �ERSOa�1 CONSTRUCTtNG THE WELL
Submit the origtnal to the Dfv[sfon of Water Qualiiy within 30 days. Attn: lnformation Mg� Form GW-1a
7517 Mail Service Cenber— Raleigh, NC 27699-1617 Phone No. (919) 733-70'IS ext 568. Rev. 7f05