Loading...
HomeMy WebLinkAboutWELL-03-2016-070321.TIF 03 CATAWBA COUNTY Case it WELL-03-2016-07032 1 ,Q' g{ G Public Health Department Subdivision 4 —“z Environmental Health Division PIN# 376301168024 ^ ; � I 0 Box 389, 100-A Southwest Blvd,Norton,NC 28658 LOTH /g.2 sm 4 NAME ON PERMIT: ROBIN LITTLE, 4755 ROCK BARN RD, CLAREMONT NC 28610 Site Address: 4755 ROCK BARN RD, CLAREMONT NC 28610 Property Size: Square Feet:23,958.00 Acres:0.55 Directions: Go past Rock Barn Golf Course about 1 mile, House is on the Left towards Oxford School Rd. Owner/Authorized Representative Acknowledgement of Permit Receipt I certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the property described above. As the property owner or authorized representative, I have received the above referenced permit(s) as requested in the application for service EHPR-03-2016-23350 by the following method(s): /Received in Person Facsimile Transmittal (Return form with signature required) Electronic Image Transmittal/E-mail (Return receipt required) t As the property owner or authorized representative I have reviewed and understand the specific conditions of 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. Permit Issue Date: 03/22/2016 I I Ip (' �wner/Authorized Representative Signature ., lo 1,.,/ V�` 1 Date 3 -3 o 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 We want to hear from you. Please take a few moments to complete our customer service survey at: http://www.surveymonkey.com/s/EHCustomerService ehpennit 03/22/2016 14:45 Page 3 of 3 �r� CATAWBA COUNTY -0- 0 Casc# WELL-03-2016-070321 .T Public Health Department F''3E-I � Subdivision d ® �� H Environmental Health Division S �-di' EINIt 376301168024 PO Box 389. 100-A Southwest Blvd,Newton. NC 28658 � � LOT# tta NAME ON PERMIT: ROBIN LITTLE, 4755 ROCK BARN RD, CLAREMONT NC 28610 Site Address: 4755 ROCK BARN RD, CLAREMONT NC 28610 Property Size: Square Feet: 23,958.00 Acres:0.55 Directions: Go past Rock Barn Golf Course about 1 mile, House is on the Left towards Oxford School Rd. 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 18A .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 Burin, 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. Steven Price 03/22/2016 AUTHORIZED STATE AGENT APPROVAL DATE ehpennit 03/22/2016 14:45 Page 1 of 3 give- (03- 20//6- Z33S9 9153- goic ten 12d Catawba County Environmental Health Wc(i rt he 57) Ft• nvc� S.E J. 414 Zc M _S !V'MC CCJ i 2- t Te.) 5 WCt( - 4 Q rcq m I 2S /a 4�J (100) .5.4' C:7> r • • (100) O /� (t7s q \\*2 210 Parcel: 376301168024, 4755 ROCK BARN RD lin=50ft CLAREMONT, 28610 This map/report product was prepared from the Catawba County,NC Goospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the Independent verification of any data contained on this mapfreport product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 03/22/2016 $A C� Case# WELL-03-2016-070321 F74:' 1 CATAWBA COUNTY HEALTH DEPARTMENT gir Environmental Health Section _Ls sM 08/15/2016 WATER SAMPLE FIELD REPORT Owner ROBIN LITTLE, 4755 ROCK BARN RD, CLAREMONT NC 28610 C:8284558091 Site Address: 4755 ROCK BARN RD, CLAREMONT NC 28610 Name of Project: Parcel Number: 376301168024 Lot: Block: Specific Directions Go past Rock Barn Golf Course about I mile, I-louse is on the Left towards Oxford School Rd. Initial Collected by: S{� $t*._I'1-` Date/Time Sampled: W/r//!o 2: Type of Sampling Point: 1n(( tcL Well New or Existing? New JC Existing Type of Well: Drilled X. Bored Dug Spring City Does well meet adequate construction standards from what can be observed: A Yes No Reason for non-compliance: Defective well cap and/or seal Piping does not exit through top of well by approved cap and sanitary well seal Evidence of improper grouting or no grouting Opening in the well casing or cap Supply too close to source of potential contamination Notification: Existing well owner notified that well does not meet adequate construction ? Yes No Date of Notice: E9 - rsamfieldreport 8/15/2016 Page 1 of 2 $A -Ca Case# WELL-03-2016-070321 Hist 'Ci` "a4 CATAWBA COUNTY HEALTH DEPARTMENT d1`waeEnvironmental Health Section �jB;Z sM 08/15/2016 WATER SAMPLE TEST RESULTS Owner ROBIN LITTLE.4755 ROCK BARN RD, CLAREMONT NC 28610 C:8284558091 Site Address: 4755 ROCK BARN RD, CLAREMONT NC 28610 Name of Project: Parcel Number: 376301168024 Lot: Block: Lab Coliform Analysis Results: Total Coliforms: a buil-i- Fecal / E. Coli: a ry\Qyl-} No Collection Date Over 30 hours old Invalid Results: Excessive turbidity Excessive Chlorine Lab Accident y� Lab Tech Initials ec,u.t Date/Time Received el" C4/I /zo ri Date/Time Completed n' I legb Li ('100 gel E9 - rsamfieldreport 8/15/2016 Page 2 of 2 n ± ! r z - .. § / { f = \ \ * e• } ( \ w - 9 \ \ CD InCDI / / f •• ~ Zt CO - ;C) ± CO _ • 111 \ \ t':> \ } - / c \ \ 7 � � \ \ � - § [ -. $ I - 0 - CA_ ( { \ } \ - CA ( f \ ( \rs \ \ G \ 77P/ - ( f _ - \ C \ �\E \ ! t \ e © R 2 0. ' « < j / . ; - 2 j \ itel \ r r } ° Gc . ' § ' & i \ a INI 3 ! ; g /: -\ - • / ( } - Q � � ) / \ 0. - / 2 7 7 ) 00 : / : , . .. _ i / § ` ) { // P - / 1\ � ., / 10 10 i / / � I ( 3 6 — 3 3 \ s, .vin uij' T•. North Carolina State Laboratory of Public Health P.O. Box 28047 ti> -' 4312 District Drive '4 r` c' Raleigh,Environmental Sciences http://slph.n Raleigh, N 27611-8047 cpublichealth.com Inorganic Chemistry Phone: 919-733-7308 •Sit,w::0'4 Fax: 919-715-8611 -- Certificate of Analysis Report To: STEVEN PRICE Name of System: CATAWBA CO ENVIRONMENTAL HEALTH ROBIN LITTLE P O BOX 389 4755 ROCK BARN RD NEWTON, NC 28658 Courier# 09-70-01 CLAREMONT, NC 28610 EIN: 566001814EH StarLiMS ID: ES081716-0028001 Date Collected: 08/15/16 Time Collected: 2:40 PM Date Received: 08/17/16 Collected By: Steven Price Sample Type: Raw Sampling Point: Well head Well Permit#: 03-2016-70321 Sample Source: New Well Temp. at Receipt: GPS #: Sample Description: Comment: New Well -No Nitrate I (Profile) Analyte Result Allowable Limit Unit Qualifier(s) Arsenic < 0.005 0.010 mg/L Barium < 0.1 2.00 mg/L Cadmium < 0.001 0.005 mg/L Calcium 7 mg/L Chloride < 5.00 250 mg/L Chromium < 0.01 0.10 mg/L Copper < 0.05 1.3 mg/L Fluoride < 0.20 4.00 mg/L Iron < 0.10 0.30 mg/L Lead < 0.005 0.015 mg/L Magnesium 4 mg/L Manganese < 0.03 0.05 mg/L Mercury < 0.0005 0.002 mg/L pH 7.3 N/A Selenium < 0.005 0.05 mg/L Silver < 0.05 0.10 mg/L Sodium 3.50 mg/L Sulfate < 5.00 250 mg/L Total Alkalinity 35 mg/L Total Hardness 33 mg/L Zinc 0.06 5.00 mg/L Report Date:08/26/2016 Reported By: Detlie✓woncol RECEIVED SEP 0 8 2016 CATAWBA COUNTY ENVIRONMENTAL HEALTH Page 1 of 1