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Home My WebLink AboutGW1-2022-10332_Well Construction - GW1_20221114 d'f•ELL CONS TRUCTION RECORD(CW 1) For Intemal.Use Only: - _ 1--liVell Conti-actor Infornuition: Kyle C. Shaw 14."SS'ATER MIES well Contract dame FROM TO DESCI2IP I ION 4521-A 00 n \C Well Contractor Certification'umber fL D Advanced Well Drilling, LLC L.OU-IERCASLYG(formulticasedivells ORLLNER(ifa licible) �, FROM TO DIA:\rEfER THICENESS MTERUL Company\arc z) fL '<, ft. '6 In. Heavy �.1 2.11ell Construction Permit ..11^j- �-�— I/ .� 16.L\'ZTR CASL\G OR TUBL\G(aeotherroal closed-log F• -(J h FROM TO DLL IrrER TFtICh\FSS 1L�TERI.11.List all applicable tell co»sinicton perntrrs(i.e.07C Count,:Stare. lg7riat1cz etc;, ft M in 3.Well Use(check:well use): fL rt in �irater SuppIt 1Fell: 17.SCREEN ❑lgriculhtral FRO\f TO DLI:MECER SLOTSIZE TH ICIG�ESS 1LSTERLIL ❑\Iunicipal/Public ft. ft. in I ❑Geothenual(HeatinJCooline Supply) OResidential ZFater Supply(single) ft ft- in ❑Industrial/Contulercial ❑Residential Water Supply(shared) ❑Irrigation 19.GROUT ❑VFells>1.00.000 GPD FROM TO 3L4TERL�I E\IPL•LCEMEN'TIIETHODS L\IOU1r Non-Water Supply A'ellc ❑\•fonitorhmQ "1 ft. �D iL eentonfte (Poured ❑Recoven ft. ft. Injection Well: fL ft.OA uifzr Recharge ❑Groundwater Remediation [].Aquifer Storage and Recovery ❑Salinity Barrier 19.SANDIGR-VELPACK(if a livable) FROM TO - I AUTERIAL EMPL4C E,\fE\ 'METHOD ❑Aquifer Test ❑Stormater Drainage 0 fL ❑Experimental Technology ❑Subsidence Control ft. fL ❑Geothznlmal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary) ❑Geothermal(Heatinof(noling Rztunt) ❑Outer(explain under`31 Remarks) FROM TO I DESCRIPTION(rnlar,hardness seWrock q• e•gain size,etc) 4.Date Well(S)Completed: 1 �°�well III fL I S fL S �) Sa.lleU Location: - 5 fL l j fL ar-� s-� e fL ��('�SfL ,�/o.r� --I Facility/Owner"aine Facilin•ID=;i£applicable) fL I J / rL fL Physical Address,City,and Zip ft fL ,ems 21.RENUURKS Co., Parcel Identification:,To.(PLC) 9b.LatItude and longitude in degrees/minutes/seconds or decimal degrees: ) r�3r aw• (ifwell field,one]at/long is sufficient) 22.Certification: 6.Is(are)the Ivell(s). LPermmnent or ❑Tempor:ary Sr2n3z&e of Centred well Contractor Date B-Siening lkisfor m,1 hereby cemfi•that the uvllisl Was(ware)constructed in accordance nith 7.Is this a repair to an e3isting well: oyes or 8No 14;-,N'CAC 02C.0100 or I5.;XC.lC.02C.0200 If ell Cotur action Standards crud that n calm 1Tthtis is a repair,till out d•»ox is well cotastntctron information cord a p oi»lire mvure grin- of this record l;:-rs been prcrided to the„ell oavaen repait-nnder=2l unto-krsecdouorottthebackofthis(ornc 23.Site diagram or additional well details: 8.For Geoprobe/DPT or Closed-Loop Geothermal lVells having the same You may use the back of this page to provide additional well construction info construction,only I GJ1--1 is needed. Indicate TOT. \7.1IBER of wells drilled: (add'Sze Over in necessary. Box).You may also attach additional pages if nzcessa .24.SUM-IITTAL L\STR-7CTIO\S 9.Total well depth below land surface: {)0 � (or na+lriple wells list all deprltr ij ditJ rent(example-3ta?00'and 3ra100') Submit this G)V4, ithin 30 days of well completion per the following: 10.Static water level below top of casing: 01,10 24a. For All R'ells: Original form to Division of Water Resources (DWR). IJ„ater level is above casing Ilse '=" (ft-) Information Processing Unit,1617\ISC.Raleigh,\tC27699-1617 11.Borehole diameter: . 6 (M) 24b.For Iniection hells: Copy to MR. Undquound hijection Control(ItiC) Program,16361ISC,Raleigh.NC27699-1636 12.Nell construction method: C__A —V-oL� {� (Le.auger,rotary,cable,direct push,etc.). 24c.For Water SuRpl\and Open-Loon Geothermal Return Wells:Copy to the county environmental health deparhltznt of tllz county where installed FOR 11-*-1TER SUPPLY"WELLS O\ZI•': 2.1d.For Water«'eUs Droducing over 100 000 GPD•Copy to DWR CCPCU 13a.field(gpm) 7. Method of test: Air Permit Program.lull\4SC,Ralelgil,NC 27699-1611 13b.Disinfection type: HT H P Amount:_ 1 ��10� y. \oath Carolina Department of Envirortmental Quality-Division of water Resources CATAWBA COUNTY Caso# WELL-03 2022-16T350 Public Health Department Subdivision - - Environmental Health Division PINY 36660115784$" ' PO Box 399.25 Government Drive,Newton,NC 28658 LQ7Yl 1 w Site Address: 3166 E MAIDEN RD,MAIDEN NC 28650 /J w®ms on Per OAKWOOD HOMES OF NEWTON �-ad f C// e d1d Property Size: Acres 1.410 0Irections: . ._ _ .TL WC St TR onto Baits Creek TLonto.NOlivers Cross.TR onto Maiden Rd-TR End 3166E Maiden Rd NEWtELLFERMIl REQUIRED WELL SETBACKS: Septic Systems and Repair Areas for Single Family Dwellings 50 ft. Septic Systems and RepairAreas for Businesses and Multi-Family Residences 100 ft. Underground Storage Tanks 100% Animal Bums 100 ft. Lakes/Ponds 60 ft. Stream s/Brooks/Creeks/River's 25 ft. Building Foundations 25 ft. All Other Sources of Groundwater Contamination 100 ft. Saprolite Septic Systems and RepairAreas 100 ft. Septic Systems and Re '100 ft. ep y pair Areas to Wells with 2 or more connections Wells shall be constructed in accordance with state regulations: Article 15A North Carolina Administrative Code Subchapter 2C 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:20 feet minimum Casing Height: 12 inches shinimum above finished grade All newly constructed private drinking water wells we required to be sampled in accordance with the North Carolina Rules Regarding Private Drinking Water Well Testing(15A NCAC 18A.3800).The fee for this sampling is included in the cost of the well permit It the applicant or property owners responsibility to notify Emirontnental Health when the well is ready for sampling.Water samples will be drawn from an outside faucet unless otherwise specified.For questions or for more information,please contact Environmental Health. - 76 03/11/2022 Authmized stets Agent Feangt Issuance Date 3/11/2027 Permit Expiration Deco ehpemut 03/11/2022 14:15 I -141 •• :Lid:: .- ' ;�__F. � +'�� 205:�' N, ga sv. Aw .3150 -Mes. ".JL22 hen: �-wv�c►�iaaio _ - Pot Plfft—3868& 157.846s SIG E•MAIDEN RD 1 �.Bpft. MAIDI�k, 50 ttd nipo+t paiuct au,:vrffipsrse i5am -Cwwf ' ,P1C®__ -. Uat AR�onttttlQn C�tswba. .:mess wb.an�sd arb. f�i eroun.t�i icairi�cynt 10 ►end �+sla �d onm�p or d�anUl�teAa1 Catrabr �w.ii non�i tl�e'kpondint: of idtoe u an ef� rt prodcS by Ifs ins+lM C6urty ol.C�taw�:tt' r�, �d:thW br Ilc61i fo►tfly stet a(QRtntp�s,{ou Ot ikbllgr�whOUxt Qfn�iilndln�t a�.a7rts�quJ wAh srttfty ,�tlr rsu ar fIH by p04uel u�:tt�rraf any p�nian or t9nnt#y., Copytiplst 1'.+Ca4�wb .GQIR►$iNo.