HomeMy WebLinkAboutWELL-03-2016-070394.TIF 4t3 • CATAWBA COUNTY Case#
.v i.�.W� .1 Public Health Department Subdivision
G H 0 Environmental Health Division PIN# 460801370024
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PO Box 389. 100-A Southwest Blvd, Newton.NC 28658 LO"T# 1
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NAME ON PERMIT: RODGER GARRETT, 9207 CEDAR RIVER RD, HUNTERSVILLE NC 28078
Site Address: 2543 MT PLEASANT RD, SHERRILLS FORD NC 28673
Property Size: Square Feet: 73,616.40 .Acres:1.69
Directions: Hwy 150 Towards Sherrills Ford Rd, Left onto Sherrills Ford Rd go about 3 miles, Left onto Mt. Pleasant Rd,
about 3/4ths mile, Property on Right. Will Pass a new cut in driveway with gate & property is the next dirt
road on the Right.
Owner/Authorized Representative Acknowledgement of Permit Receipt
I
1
U y I certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the
property described above.
lc t As the property owner or authorized representative, I have received the above referenced permit(s) as
requested in the application for service RBPR-03-2016-23336 by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/ E-mail (Return receipt required)
L 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: 03/24/2016 �j p
__t----) Owner/Authorized Representative Signature Det/ fl ,
Date 3 -24-1 0
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by ('na/ne 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 03/24/2016 09:41 Page 4 or4
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4wv • CATAWBA COUNTY �� '• b Case H WELL-03-2016-070394
/T' �� Public Health Department
S.'-���` � � Subdivision
4 ®- �, Environmental Health Division �'� I.. �3 r PIN# 460801370024
PO Box 389. 100-A Southwest Blvd.Newton.NC 28658 `� r LOT/I 1
/843,2 Bi
NAME ON PERMIT: RODGER GARRETT, 9207 CEDAR RIVER RD, HUNTERSVILLE NC 28078
Site Address: 2543 MT PLEASANT RD, SHERRILLS FORD NC 28673
Property Size: Square Feet: 73,616.40 Aeres:1.69
Directions: Hwy 150 Towards Sherrills Ford Rd, Left onto Sherrills Ford Rd go about 3 miles, Left onto Mt. Pleasant Rd,
about 3/4ths mile, Property on Right. Will Pass a new out in driveway with gate & property is the next dirt
road on the Right.
WELL PERMIT
WATER SUPPLY: Individual Well
SETBACKS:
1. 13UILDNG 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 (I5A 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.
Jason Boyd 03/24/2016
AUTHORIZED STATE AGENT APPROVAL DATE
ehpermit 03/24/2016 09:43 Page I of 3
•
c3A Permit x RE3PR 3.16-23336 •
l CAt-AWI3A COUNTY —
,�' �G Nance _ Rodger Garrett
\Z Public Health Department , Address 25:13 MI Pleasant rd Sherrills
< °'�` ;ii3Oa �; &rvironmemal ileal:h Division
Pa a? PO Box 389, 100A Southwest Med,Newton NC 23633 Ford NC
PIN„ 460801370024
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Site Plan Authorization to Construct
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