Catawba_Well Abandonment_20221222

.4113: . CATAWBA COUNTY Case# EHPR 12-2022-42978
Ntia
Q 2 Public Health Department - Subdivision NOAH PROPST ESTATE
Environmental Health Division PIN# 372109054815
- 1 PO Box 389,100-A Southwest Blvd,Newton,NC 28658
, 184L w
NAME ON PERMIT: (DONALD SCRONCE),1850 HOUSTON MILL RD,CONOVER NC 28613
(Donald Scronce)
Site Address: 2010 STARTOWN RD,HICKORY NC 28602
Property YSize: Square Feet23,522.40 Acres 0.54 I +
'
Directions: Radio Station Rd,right onto Old Conover Startown Rd,left onto Settlemyre Bridge Rd,right onto Startown Rd
-t ~ WELL ABANDONMENT RECORD
i y,rY North Carolina Depamnent of Environment and Natural Resources-Division of Water Quality
'w �' WELL CONTRACTOR CERTIFICATION# 22.92 pi .
1.WELL CONTRACTOR: 5. WELL DETAILS:
1 e:A':��\ Ore-, e"--- A.TotalDept6: I l f ft.Diameter: in.
Well Contractor(Individual)Name b.Water Level(Below Measuring Point) It,
le rr SjG>�11 i/Lf6 02 ,I or3 j i\yr Pt~tr f Measuring point is j I CI 2 aboveiandsurface.
Well Con ctorCompanyNamev-
STREEi'ADDRESS .3 L S 2-4 "L hi',4 6. CASING: Length 1 Diameter '
A1�l b"--Z'�g. --` co a.Casing Depth(ifknowv): !R l, .1L ___in.
City or Town i.s Zip Code b.Casing Removed; IL in.
k
Area code-Phone bee 7. DISINFECTION: �t '� 1.Aim)m.-
2.WELLINFORMATION: (Amount of65%-75%calcium hypochloriteused) s• COd't .irtc°
SITE WELL ID#(if applicable) S. SEALING MATERIAL: LE
i V
STATE WELL PERMIT#(if applicable) Neat Cement `` Sand Cement fier 2 2 2022
COUNTY WELL PERMIT# d a lica6le r Gf. / O Cement I 'ft lb. Cc wilt lb. '
C pp ) 1"/� a Water gal. Water, ga. Int`ourt on Prl1c 'F,g Urp Dwoinoo
DWQ or OTHER PERMIT#(ifapplimble) Bentonite
WELL USE(Crcleappliicableuse): Monitoring esidential 1
Municipal/Public lndustrialiCotnmercial Agricu� Bcatonitc Ib. j
Recovery Injection irrigation Type:Stuay_Pellets_ 0 n .
. Water gal.
Other(list use)
Other
3.WELL LOCATION: (^ .L J.
COUNTY v*)2 QUADRANGLE NAME Type material a__ Zr^e.lt�xs i�!rTr»t
NEAREST TOWN: i) Amount___ r I:
(SaectRoadNarn Nuodvn Commanity,Subcraciiimm,Lot No..PaceaL Tip Code) 9: ROPLAIV METHOD OF EMPLACEMENT OF MATERIAL:
TOPOGRAPHIC/LAND SETTING: Ye,%;,,,t 1 Ctt..PC ?:-tTz 'ilk We-4i
•
Slope Valley Flat Ridge Other
• (Circleap atesetting)�), 1
LATITUDE O 3s° �/t..i )IV Alaybeiathyc�+ __ H. '
minaret secoeds.orina Lt-L-.V`
o--j�),/7 `-'V)l ,/ decimal rmat
10. WELL.DIAGRAM:Bran adetailcdske
LONGITUDE' I tchofthewrltotithe back ofthis
Latitudcllongtudesource: GPS Topographic Bon showing total depth.depth and diannierofscreeas(ilany)remaining
(Location of wellmisstheshownoneUSGStopo map c d - in the well.gravel interval,inte sof gperfuxations,and depths sad
winded to this form ifnot using GPS.) types of fill materials used. - .
4a.FACILITY-31aaureorcheh cwhsedewrLislorteetm,Ptrrr4aacd4b. /1) . /� 2-2... (Ifaresidconlllieu,stip4xcomplete4b,adl owner infommionotily.) II. DATE WELL ABANDONED
FACILITY iD#(if applicable) '
{{kk IDDIIFitEHYCQtTIFYTHATTHLS\)'ELLWASASAPmONFDRNAC6TRDANCE
NAME OF FACILITY '�GI7U.!('i �C.y►C� WI H15ANCAC2C,wELLCONSTRUCTIONSTANDARDS.ANDTHATACOPYOF
STREET ADDRESS 2 ,-;1 Li +S' 6 j,.��l]i t /� s y TUT RECORDHAS BEEN ROVIDEDTOTHE tVELI.OWNER:
-etf�- t �-,C3 �'1 Rd
P'rCi y or Town t w S �c�Coda • OF CER"T1F ED\YELL CONTRACTOR /1 vl DATE
4b.CONTACTPERSONIWELL��OaaWNER: t i `�.,)C „�Z
NAME t f6c`s ICI t7Cr ,�t�P Gt Q- Gwt.�-_�-- /
�.r �g.. p SIGNATURE FPRIVATE VELLOWNERARANDONINO ME WELL DATE
STREET ADDRESS +� 'll bt (The ptivuevrclivlvasmust bean ixdividasl who p:nvnattvgb tailor residential well
t�^,.ST EET S 4$L4."It'h, t V In accontance with l5itNCAAC'2C.0I 34 I' �i ,.
5r 44 71 rrr . tic., 2 t 13 PRINTED E�F PERSON. NING TAfi WELL`�-_
City or Town Sale Zi Code
Areacede-Phone number f
' ..Submit a copy to tbe owner and the original to tbnDivision of Water Quality within 30 days. I FormG\V-30
Ann:information-hfanagement,.i617 Mail Service Center'-Raleigh,NC 27699-1617, PhoneNo.[phone] eM 568. Rev.5/06
i
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• 1 I

CATAWBA COUNTY Case# EHPR 11-2022-4.2808
ce
Public Health Department
� gill.�, Subdivision
.d :.' '-'3 Environmental Health Division
PO Box 389,100 A Southwest Blvd,Newton,NC 28658 PIN# 372109061111
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NAME ON PERMIT: (ROBIFOSTER), 1990 STARTOWN RD,HICKORY NC 23602
(Rob Foster)
Site Address: 1990 STARTOWN RD,HICKORY NC 28602
Property Size: Square Feet 20,908.80 Acres 0.48
Directions: Startown Rd,lot on the right before short rd
,.s*^:2 WELL ABANDONMENT RECORD
y4r++v F.,y North Carotin(Dcpanment of En,"rutunent and Natural Resources-Division of Water Quality,
~ "' WELL CONTRACTOR CERTIFICATION# 2-2-53
I.WELL CONTRACTOR: 6. WELL DETAiLS: i � 1)
r9 - i,. is ScXt Ob�IC .1 a.Total Depth , 1 ft.Damcler 2-0 in.
W 11Conttacto ndivi al)Name b.Water Level(Below Measuring Point)_ 9, ft.
C Se i-G a Lo 1,10r tl i bfid-Yu`� P Measuring point is ft.above land surface.
Well or Company Name J
STREET ADDRESS 3 i.4'c L„),.. ^)av 6. CASING: -Length Diameter
IVY {��(L i� �. 7�6.5"S a.Casing Depth(if known): S�' I it. 6 in.
City or Town Stale Zip.Code b.Casing Removed: it.. in.
fb14 -211 mrJ 4S 5 6c..k. ,ve.7.:%
Atea code-Phone tmtubeber 7. DISINFECTION:
2 WELL INFORMATION: (Amount of659'r75°lo calcium hypochlori'eused) R , ` ��
SITE WELL ID#(ifapplicablel 8. SEALING MATERIAL:
9 2022
STATE WELL PERMiT#(if applicable) r,� Neat Cement y Sand Cement n-.. d
COUNTY WELLPER1v1IT#(ifa livable)GH )�'�� �� �U- Cement CLI Cement lb. Infou(at'.,c7 Przn.wWcl,• uri
PP Water gaL 1Voter gal, v'i cw:1OG
DWQ or OTHER PERMIT#(if applicable) Bentonire
WELL USE(Crete applicable use): Monitoring Residential 1
Municipai/Public Industrial/Commercial Agricultural Bentonite lb. 1.
Recovery injection irrigation Type:Stung Pellets tIt
Other(list use) 'Water gal. TI
Other '
3.WELL LOCATION: lr,
rs t_ C QUADRANGLE
materiatCa_VtAw G V2 UL
•. COUNTYC 4'Tk\LtI�•,QUADRANGLE NAME r
NEAREST TOWN: 4;Z:..#-D Amount Cs yitiv5 I
1
1',.
(SirccURoadName,NianbecCommuity,Subdivisiem,LotNa,Pared.ZtpCodc) 9. XPLAiIN�^M OD 4 OFEMPLA NTOFMATERIAL:
j I
• TOPOGRAPHIC/ SETTING:' v 0 4 f U t+►\--ll F)M i C 2-.
Slope ValleyRidge Other \nil Y CE, d ► , ��\
(Circleappro tesetting) e,
Ij� L
EATITUDE'Ll3�-1/`/�. iv minute.setoaeez,
t minutes;seeaxlt.orioa
LONGITUDE OSEll 1�-1 Is deeunal fatniar 10. WELL DIAGRAM:Draw a detailed sketch of thewell on the back of this
Latitude/longitudesource: GPS Topographic map form showing total depth,depth and diameter of screens(if any)remaining
(location alai!!must bes iown en a USGStape map and - in the well,gravel interval,intervals of casinging perforations,and depths and
• attached to ihirfarnrifaot using GPS.) types of fill materials useii. I,
4a.FACILITY-Tbe name°Me business where the wellis lowed.Coar$ete4aaaik4b. 1��'��
• Ilia residentalwell,st:ip4a:complete 46,well owner infonnatiaaorly.) ' IL DATE WELL ABANDONED_ r G.
FACILITY iD Rif applicoiisstlt7Ie)\
NAMEOFFACILiTY A i is elr �4'V�-C- NU
LC
WITH ISA Nc2C,WELL CONSTRUCTION STANDARDS,AND THAT COPY OF
', h itSRECORDitASB •N PROVIDED TOTIIEWELLO\YNER.
STREEI'ADDRESS /C�i0 `ghty-l�I.ara FA
-7,r11 ) KL_ Z5it,ZyZ Qom' dnc.� 1: /Z-1
City or Town State Zip Code SiGNA E OF CERTIFr Lt7Ys
I�EDWELLCONTRACTOR emu
4h.CONTACT ONAVELL O VNER: • s1t . I 2.--)/ 2 .
NAME �12arrYO Y SIONATU OF PRIVATE WELL OWNER/tDhtNDONING11lE WELL DATE
STREET ADDRESS ! OJ� S�"1CI LL.. D' rnmptivate IIoanermmobemtindividualv.itapetsonsltvabandomlis'her residential w•ri
in scvonlancewith ISA NCAC 2C.0113.)
fij�k&V�1�f i IN):L- 2_ 6O'-2-_ 7 ii11. , SLYZ�r'c t—
City orTown 1 J State Zip Code P INTED N. IE OF PERSON ABANDONING THE WELL
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.[phone] ext 568. Rev:5/06