HomeMy WebLinkAboutWELL-04-2016-070760.TIF gA ' CATAWBA COUNTY Case# WELL-04-2016-070760
G Public Health Department Subdivision
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.1t4 N Environmental Health Division PINY 379103130856
PO Box 389. 100-A Southwest Blvd,Newton,NC 28658 LOT#
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NAME ON PERMIT: STEVE RINER, 6093 HUDSON CHAPEL RD, CATAWBA NC 28609
Site Address: 6093 HUDSON CHAPEL RD, CATAWBA NC 28609
Property Size: Square Feet:38,768.40 Acres:.890
Directions: Hudson Chapel Rd, on right before RR tracks, red tin roof in curve
Owner/Authorized Representative Acknowledgement of Permit Receipt
S,P.I certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the
INproperty described above.
.7( S,PAs the property owner or authorized representative, I have received the above referenced permit(s) as
requested in the application for service EHPR-03-2016-23529 by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/ E-mail (Return receipt required)
see 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: 04/04/2016 s
Owner/Authorized Representative Signature - �_--�- zL
Date y .- C — /‘
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (narne 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 04/04/2016 08145 Page 3 of 3
�gA , CATAWBA COUNTY 0 '+,� ...d 0 Case# WELL-04-2016-070760
^� GA Public Health Department �._,— Th} � Subdivision
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Environmental Health Division •�' ' PINK 379103130856
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'�- PO Box 389. 100-A Southwest Blvd, Newton. NC 28658 _ a " LOT#
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NAME ON PERMIT: STEVE RINER, 6093 HUDSON CHAPEL RD, CATAWBA NC 28609
Site Address: 6093 HUDSON CHAPEL RD, CATAWBA NC 28609
Property Size: Square Feet: 38,768.40 Acres:.890
Directions: Hudson Chapel Rd, on right before RR tracks, red tin roof in curve
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 the/l.
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.
Jason Boyd 04/04/2016
AUTHORIZED STATE AGENT APPROVAL DATE
ehnernut 04/04/2016 08145 Page I of 3
iv,A \ Permit# £HPR-3-16-23529\ CATAWBA COUNTY
G Name Steve Riner
2 Public Health Department
'��. ,,�, Environmental Health Division
Address 6093 Hudson Chapel Rd Catawba
t PO Box 389, IOOA Southwest Blvd, Newton NC 28658 NC
842 sM (828)465-8270 Fax (828)465-8276 Teo(828)465-8200 PIN# 379103130856
Site Plan Well Permit
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