HomeMy WebLinkAboutWELL-03-2016-070480.TIF „cc - C.ATAWBA COUNTY Case'} WELL-03-2016-070480
.r” { G Public Health Department Subdivision I
- '' Erhironmental Health Division P(Nii ! 461703305853
4� PO Boa:389, 100-A Southwest Blvd,Newton, NC 28658 LO'r# } I
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NAME ON PERMIT: ERIC GENZLINGER, 3819 MODE ST, FAIRFAX VA22031
Site Address: 4204 MCGEE POINT RD, TERRELL NC 28682 i I
Property Y Size: Square Feet;78,230.00 Acres:1.75 l '
Directions: Hwy 150 South to Sherrills Ford Rd, Right on Hob Lane, Left on McGee Point Rd,i& house will be 11/2 mile on
the Left
Owner/Authorized Representative Acknowledgement of Permit 'Receipt 1
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I certify that I am the owner or authorized agent (owner's authorization required) representino'the owner of the
pro ' rty described above.
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s the property owner or authorized representative, I have received the above referenced permit) as
X r uested in the application for service EHPR-01-2016 23100 by the following methj)d(s): I
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_ Received in Person
/•aesimile Transmittal (Return form with signature required)
�1 Electronic Image Transmittal/ E-mail (Return receipt required)
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As the property owner or authorized representative I have reviewed and understand the lspecilic conditions
of the permit issued, and further understand,that all applicable regulatory requirements,specifted under the North
Carolina Laws and Rules for Sewage Treatment and Disposal Systems (15A NCAC 18A .1900)41nd/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 Nye]] permitted. 'I �
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Permit Issue Date: 03/28/2016 I1 1
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5 Owner/Authorized Representative Signature': �It���`....�-_—�
Date 31 Z1 /21)16 1
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Documentation of Permit(s) Transmittal i 11
(permit transmitted by electronic or other means) i I
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Permit tran mi ed b I_ 4 _ 't 1 1 I s (name of person, ending >e nit) I __
Signature ,YJ1 \ll� vp ®} Date/Time c U1' l 1� ��' J�
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Method: Fax );mail US Mail Other:1
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Owner's request to send by the above indicated method of transmittal in lieu of signature
We want to hea rom you. PI se take a few moments to complete our customer service survey at:
http://www.surveymonkey.cam/s/EHCustomerService I
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ehpenuit 113/282036 08:59 I i Pane 3 of 3
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V,A CATAWBA COUNTY 03 'b0 Case# WELL-03-20 1 6-070480
Public Health Department ` "P-Ct Subdivision
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<71977).�-� � Environmental Health Division _ 51' 3 PIN#
461703305851
PO Box 389. 100-A Southwest Blvd.Newton.NC 28658 _ {' ' { LOT#
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NAME ON PERMIT: ERIC GENZLINGER, 3819 MODE ST, FAIRFAX VA 22031
Site Address: 4204 MCGEE POINT RD, TERRELL NC 28682
Property Size: Square Feet: 76,230.00 Acres:1.75
Directions: Hwy 150 South to Sherrills Ford Rd, Right on Hob Lane, Left on McGee Point Rd, & house will be 1/2 mile on
the Left
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 (I5A NCAC I8A .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 03/28/2016
AUTHORIZED STATE AGENT APPROVAL DATE
ehpermit 03/28/2016 08:59 Page I of 3
��'A _ -\ Permit # EHPR-I-l6-23100
_ \ CATAWBA COUNTY
Q' �� Name Eric Genzlinger
2 Public Health Department
y Address 4204 MsGhee Point Rd Terrell
dtery a Environmental Health Division
PO Box 389, IOOA Southwest Blvd, Newton NC 28658 NC
4 (828)465-8270 Fax (828)465-8276 TDD(828)465-8200 ,R PIN 461703305851
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