HomeMy WebLinkAboutWELL-03-2016-069671.TIF ,P , CATAWBA COUNTY Case# __ __ _ ..
r rfi t y Public Health Department Subdivision SNOW CREEK COVE
Q , 0 „�, Environmental Health Division PIN# 372515524531
N- PO Box 389, 100-A Southwest Blvd.Newton,NC 28658 LOl'# 6
is.'2, ,.
NAME ON PERMIT: TERESA BOGGS, 2178 ST JOHNS CHURCH RD NE, CONOVER NC 28613
Site Address: 4681 27TH ST LN NE, HICKORY NC 28601
Property Size: Square Feet:27,007.20 Acres:0.62
Directions: Sulpher Springs RDd, turn left onto 43rd AVE NE, go to end Sharp curve onto 29th ST DR NE, then left onto
28th ST Circle NE, Follow until road forks. I will meet at the fork in road and will lead to property.
Owner/Authorized Representative Acknowledgement of Permit Receipt
l certify that 1 am the owner or authorized agent(owner's authorization required) representing the owner of the
operty described above.
!A As the property owner or authorized representative, I have received the above referenced permit(s) as
quested in the application for service RBPR-02-2016-23228 by the following method(s):
/Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/ E-mail (Return receipt required)
��. As the property owner or authorized representative I have reviewed and understand the specific conditions
if the permit issued, and further understand that all applicable regulatory requirements specified under the North
Carolina Laws and Rules for Sewage Treatment and Disposal Systems (15A NCAC 18A .1900), and/or
Well Construction Standards (15A NCAC 2C .0100), shall apply to the issuance of this permit and the
construction of the wastewater system and/or water supply well permitted.
)Owner/Authorized Permit Issue Date: 03/02/2016
Representative Signatu - A r/
■
Date
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Date/Time
Method: Fax Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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ehpermit 03/02/2016 08:03 Page 3 of 3
ti"� 1`. Case
v�e • CATAWBA COUNTY o 0 WELL-03-2016-069671
/� Public Health Department F Subdivision SNOW CREEK COVE
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Environmental Health Division ,� .1 PIN# 372515524531
°�"-� PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 LOT# 6
12
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NAME ON PERMIT: TERESA BOGGS, 2178 ST JOHNS CHURCH RD NE, CONOVER NC 28613
Site Address: 4681 27TH ST LN NE, HICKORY NC 28601
Property Size: Square Feet:27,007.20 Acres:0.62
Directions: Sulpher Springs RDd, turn left onto 43rd AVE NE, go to end Sharp curve onto 29th ST DR NE, then left onto
28th ST Circle NE, Follow until road forks. I will meet at the fork in road and will lead to property.
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
All newly constructed private drinking water wells are required to be sampled in accordance with the North
Carolina Rules Regarding Private drinking Water Well Testing (15A NCAC I 8A .3800). 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.
Water samples will be drawn from an outside faucet unless otherwise specified. Please note that all water samples are
taken during one visit. The processing laboratories have different protocols and timeframes for reporting results;
therefore,you may receive several different reports concerning your water sample. For questions or more information,
please contact Catawba County Environmental Health at(828)465-8270.
Megen McBride 03/02/2016
AUTHORIZED STATE AGENT APPROVAL DATE
ehpermit 03/02/2016 08:03 Page I of 3
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