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Home My WebLink AboutWELL-04-2016-070752.TIF v, CATAWBA COUNTY Case H WELL-04-2016-070752 ,�� Public Health Department Subdivision Q ' ®Y Enviromnental Health Division PIN# 267903227456 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOTH 2-CC 18.2 w NAME ON PERMIT: LORA WOODRUFF MILHORNE, 2061 COLLIE TRL, VALE NC 28168 Site Address: 2061 COLLIE TR, VALE NC 28168 Property Size: Square Feet:20,473.20 Acres:0.47 Directions: Hwy 10 from Newton, Right onto Providence Church Rd, about 3 miles Right onto Collie Trail, Double wide at the end of the Road. Owner/Authorized Representative Acknowledgement of Permit Receipt ( c•0"h I certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the property described above. lip As the property owner or authorized representative. I have received the above referenced petmit(s) as requested in the application for service EHPR-03-2016-23394 by the following method(s): _Received in Person Facsimile Transmittal (Return form with signature required) _ Electronic Image Transmittal/ E-mail (Return receipt required) r, ,� As the property owner or authorized representative I have reviewed and understand the specific conditions `Ii_ 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: 04/01/2016 yy J —�� Owner/Authorized Representative Signature : r o�-A1 l 'l 1 / no 61 e 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 We want to hear from you. Please take a few moments to complete our customer service survey at: http://www.surveymonkey.com/s/EHCustomerService cheering 04/04/2016 08:08 Page 3 of 3 I—-• fr a Case k asi ,gA CATAWBA COUNTY D• o WELL-04-2016-070752 T r' Public Health Department Subdivision r � -3 . PIN# 267903227456 Q ,��__ �; Environmental Health Division `^ PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 : LO'f# 2-CC 1842 si a • NAME ON PERMIT: LORA WOODRUFF MILHORNE, 2061 COLLIE TRL, VALE NC 28168 Site Address: 2061 COLLIE TR, VALE NC 28168 Property Size: Square Feet:20,473.20 Acres:0.47 Directions: Hwy 10 from Newton, Right onto Providence Church Rd, about 3 miles Right onto Collie Trail, Double wide at the end of the Road. 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 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. Steven Price 04/01/2016 AUTHORIZED STATE AGENT APPROVAL DATE ehpermit 04/04/2016 08:08 Page I of 3 wui EHPR 03-2016-23394 2061 COLLIE TRAIL, VALE • Well will need to be at least 25 ft from structures and 50 ft from septic systems and potential repair area. loo' ccss.bk( ' TJ Co\l,C 1 L / J wctl arc, I'\-5 v P: st D ,, , I = '10