Fillable SITE EVALUATION SHEET WATER WELL for LIVESTOCK (Information Technology Services)

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SITE EVALUATION SHEET WATER WELL for LIVESTOCK (Information Technology Services)

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First Name Last name
County Tract - Field
Contract Number Program
Type of livestock:
Beef Poultry
Dairy Equine
Swine Goat/Sheep
Other, specify:
Well Site Coordinates (decimal degrees): LAT LONG
Surface runoff from any area used by livestock shall be diverted away from the well head.
SITE EVALUATION SHEET
WATER WELL for
LIVESTOCK
COOPERATOR INFORMATION
WELL SITE INFORMATION
Please check each box to acknowledge that the proposed well location meets the following conditions:
Type of operation:
The well will be located at a higher elevation than any source of contamination
The proposed well location is NOT in an area generally flooded or where surface flow of any volume
should be expected. (Areas to be avoided include – concave slope, alluvial or colluvial soils, gullies,
depressions and drainage ways.)
There are no overhead or underground utilities in close proximity to the proposed well location
The proposed well location is readily accessible for maintenance and repair
500 Feet
300 Feet
150 Feet
100 Feet
100 Feet
100 Feet
100 Feet
100 Feet
100 Feet
100 Feet
100 Feet
100 Feet
100 Feet
50 Feet
50 Feet
50 Feet
50 Feet
50 Feet
50 Feet
25 Feet
25 Feet
Please check each box to confirm that the proposed well location meets required setback distances from sources of
contamination [the greater of NRCS Standard 642 or N.C. State Law]. Note: Some county regulations are more restrictive; you
must use the most restrictive rule which applies to your well.
WELL SITE INFORMATION
Regulated fuel or chemical storage tanks (without secondary containment)
Sanitary landfill
Waste disposal lagoon or holding pond
Pit silo
Septic tank and disposal field
Permanent Livestock feeding area (concrete pads or heavy use areas, etc.)
Livestock barn
Manure pile
Waste irrigation sites
Fertilizer, pesticide or other chemical storage areas
Non-hazardous / Inert debris landfills (stump dumps)
Gravity sewer line or transfer station (non-water tight)
Agrichemical handling and mixing facility
Regulated fuel or chemical storage tanks (with secondary containment)
Gravity sewer line or transfer station (water tight)
Heating fuel storage tanks – above and below ground
Ponds, lakes, reservoirs
Gravesites
Other possible sources of contamination
(livestock watering tank, equipment wash areas, etc.)
Streams, creeks, rivers, etc.
Building foundations
YES NO
Wells located in the CCPCUA are subject to the CCPCUA Rules:
• Permits are required for ground water users of more than 100,000 gallons per day.
•
•
The Well Flow Estimates should be provided to the well driller as an ESTIMATE of the required well flow that will be needed
to meet the cooperator's livestock watering needs. If wells in the area do not typically yield the estimated flow, multiple
wells or an alternate water source will be required OR the number of animals watered will need to be reduced.
In the example below a livestock watering system capable of providing an adequate water supply for 50 beef cow/calf pairs,
running for 24 hours per day, requires a minimum well flow rate of 1 GPM, and will use 1,500 gallons per day.
CCPCUA counties include: BEAUFORT, CARTERET, CRAVEN, DUPLIN, EDGECOMBE, GREENE, JONES, LENOIR, MARTIN, ONSLOW,
PAMLICO, PITT, WASHINGTON, WAYNE and WILSON
COASTAL PLAIN CAPACITY USE AREA PERMIT
Is the well site located in the Central Coastal Plain Capacity Use Area (CCPCUA)?
Beef Cow/Calf pair
50
Annual registration and reporting of withdrawals is required for surface and ground
water users of more than 10,000 gallons per day.
WELL FLOW ESTIMATE
The Well Flow Rate and Total Water Use are an estimation of the potential water demand that will be required from the
proposed well to meet the water needs of the specified livestock.
Animal Type
Number
Water Use
1
(gal/day/head)
30
Well Flow Rate
2,3
(GPM)
1
TOTAL Water Use
4
(gal/day)
3. The Well Flow Rate calculation is based on the livestock watering system operating 24 hours/day. If the system
run time will be different adjust the calculation accordingly.
4. Total Water Use = Number X Water Use
1. Value from attached Livestock Watering Parameters table.
1,500
2. Well Flow Rate =
(60 min X 24 hrs/day)
(Number X Water Use)
YES NO
NC DEQ Permits are required to construct any Large Capacity Water supply well
• For more information visit:
NC NRCS Practice Job Sheet - 642 - Water Well
Local and/or State well permits, if applicable N/A*
Name Agency
Signature Date
LARGE CAPACITY WATER SUPPLY WELL PERMIT
* Contact the appropriate local agency and NC DEQ
to verify that permits are not required for this well.
TECHNICAL REPRESENTATIVE
REQUIRED DOCUMENTATION
The following documents must be completed and included in the contract folder and/or conservation plan folder. Please
check the box to acknowledge that each document has been completed.
Operation and Maintenance Plan - Water Well
Operation and Maintenance Plan - Pumping Plant
Will the proposed well qualify as a Large Capacity Water Supply Well?
A Large Capacity Water Supply Well is any water supply well or water well system with a design capacity equal to or greater than
100,000 gallons per day
GIS Map showing the location of the proposed Water Well. Include the 100 yr. floodplain and any potential sources
of contamination
Well System Details Diagram
NRCS Cultural Resources Review
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signature
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15
20
30
2
8
35
45
15
2
0.7
2 - 3
3 - 5
3
3 - 6
2.5 - 7
5
(gal/1,000 birds/day)
70 - 85
1. https://content.ces.ncsu.edu/water-needs-assessment-tool-a-guide-for-technical-specialists
2. https://projects.ncsu.edu/project/swine_extension/healthyhogs/book1995/almond.htm
3. 2013 J. Appl. Poult. Res. 22 :934–941 http://dx.doi.org/ 10.3382/japr.2013-00767
WELL SITE EVALUATION
LIVESTOCK WATERING PARAMETERS TABLE
The values in this table should only be used to ESTIMATE Well Flow Rate and TOTAL Water Use for a NC
CSP water supply well and pump. The Water Use values should not be used to create detailed livestock
watering designs. The actual livestock water use may vary based on other parameters.
ANIMAL TYPE
Water Use
1,2,3
(gal/head/day)
Broilers
Dry cow
Sheep and lambs
Nursery pigs (up to 60 lbs BW)
Grower Pigs (60-100 lbs BW)
Finishing Pigs (100-250 lbs BW)
Nonpregnant gilts
Beef cattle
Pregnant sows
Lactating sows
Boars
Beef cow
Beef cow/calf pair
Goats
Horses
Milking cow
Milking cow/calf pair
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SITE EVALUATION SHEET WATER WELL for LIVESTOCK (Information Technology Services)

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Completed 14 August 2020

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