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HomeMy WebLinkAboutWELL-04-2016-071135.TIF (2AT,ava,t COUNT'S' Case N WELL-04-2016-471135 •jt1A Public Health Depanmem Subdivision MOONLITE BAY I. i Environmental Health h Division PINK 460602858810 '4 PO Box 389. 100-A Southwest Blvd.Newton,NC 28658 LO'I'N 21 is NAME ON PERMIT: ERNEST BARRY SCHRUM, 7927 TRADEWINDS DR, SHERRILLS FORD NC 28673 Site Address: 7927 TRADEWINDS DR, SHERRILLS FORD NC 28673 Property Size: Square Feet:22,215.60 Acres:0.51 Directions: Hwy 150, Slanting Bridge Rd, Tradewinds Dr, 6th house on Right. Owner/Authorized Representative Acknowledgement of Permit Receipt NiC _I certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the properly 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-03-2016-23494 by the following method(s): _ Received in Person Facsimile Transmittal (Return form with signature required) /Facsimile Image Transmittal/ E-mail (Return receipt required) ^(. 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: 04112/2016 r-.--"' c - _--- 7 -Owner/Authorized Representative SignatureC � J '" __. . *Date V/3/0R b l 4) Documentation of Permit(s) Transmittal (permit transmitted by electronic or other means) I Permit transmitted by %% .� I �' I i5 (name ofperson cindi gpermit ��(� Signature {�,(,Y:t lI/)l.t� Date/Time g1J21JlL/ �``� Method: Fax Email US Mail Other Owner's request to send b the above indicated method of transmittal in lieu of signature easao a h We want to hear from you. Please take a few moments to complete our customer service survey at: http://www.surveymonkey.com/s/EHCustomerService chpermit 01/12/2016 15:55 Page 3 o13 rs S4A CATAN'BACOUNTy 0��� p1. � Case# WELL-04-2016-071135 .f' r Public Health Department 7S,y�Y�` ,]t Subdivision MOONLITE BAY t� L ::' fir '3. PIN# 460602858810 d , , Environmental Health Division N#©y/ PO Box 389. 100-A Southwest Blvd, Newton, NC 28658 _ {: LOT# 21 1842/su ', T 1117a- a •O r10 NAME ON PERMIT: ERNEST BARRY SCHRUM, 7927 TRADEWINDS DR, SHERRILLS FORD NC 28673 Site Address: 7927 TRADEWINDS DR, SHERRILLS FORD NC 28673 Property Size: Square Feet:22,215.60 Acres:0.51 Directions: Hwy 150, Slanting Bridge Rd, Tradewinds Dr, 6th house on Right. WELL PERMIT 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 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. Robbie Phelps 04/12/2016 AUTHORIZED STATE AGENT APPROVAL DATE ehpennit 04/12/2016 15.55 Page I of3 , CATAWBA Permit # Well-4-2016-071135 e Name Barry Schrum Public Health COUNTY Department Address 7927 Tradewinds Dr Environmental Health Division Lot# 2] PO O Box x 38 389,, 100A Southwest Blvd, Newton NC 28658 /842 sM (828)465-8270 Fax (828)465-8276 'IUD(828)465-8200 Well SITE PLAN ( ■ 2 R wtil I . - • t III • So /o Jr� � 5O4IV D 1 r44 Ov. I , bo Scale IgA (;' Casef WELL-04-2016-071135 / ` __ CATAWBA COUNTY HEALTH DEPARTMENT d ' °" �P<4 Environmental Health Section /842 sM 07/20/2016 WATER SAMPLE FIELD REPORT Owner ERNEST BARRY SCHRUM, 7927 TRADEWINDS DR, SHERRILLS FORD NC 28673 C:9802418880 Site Address: 7927 TRADEWINDS DR, SHERRILLS FORD NC 28673 Name of Project: Name of Subdivision: MOONLITE BAY Parcel Number: 460602858810 Lot: 21 Block: Specific Directions Hwy 150, Slanting Bridge Rd, Tradewinds Dr, 6th house on Right. Initial Collected by: A P Date/Time Sampled: -7-10—16/i 1 S CA M Type of Sampling Point: .Sei ja f 11 -f'ro,p) f of boort Well New or Existing? New Existing >�,211I ✓ip4 r 1.----- Type of Well: Drilled V. Bored Dug Spring City -3( h o S ten"7k tei�/ Does well meet adequate construction standards from what can be observed: Yes V No lay // Ltnr FANn Reason for non-compliance: Defective well cap and/or seal /RY Aka- 9ruvn4 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 7/20/2016 Page 1 of 2 s$A. �.'� Case u WELL-04-2016-071135 Fyn �} G, CATAWBA COUNTY HEALTH DEPARTMENT C m,4 Environmental Health Section ��PyGI?Be� /8411 sm 07/20/2016 WATER SAMPLE TEST RESULTS Owner ERNEST BARRY SCHRUM, 7927 TRADEWINDS DR, SHERRILLS FORD NC 28673 C:9802418880 Site Address: 7927 TRADEWINDS DR, SHERRILLS FORD NC 28673 Name of Project: Name of Subdivision: MOONLITE BAY Parcel Number: 460602858810 Lot: 21 Block: Lab Coliform Analysis Results: Total Coliforms: conni-- Fecal /E. Coli: 0103011- No Collection Date Over 30 hours old Invalid Results: Excessive turbidity Excessive Chlorine Lab Accident Lab Tech Initials Date/Time Received Oil In!11( 1 12--(--) Date/Time Completed Of i90 ut0 Co Eki RECEIVED JUL 2 2 2016 CATAWBA COUNT" ENVIRONMENTAL HEALTH E9 - rsamfieldreport 7/20/2016 Page 2 of 2 o > _. , ! , n §. .. •\ /k x { \{ /f ;/ 0 /| ° ~� . { d z NJ co ; :- •-tc ( % 0.1 & } « \ / 0-. \ % _ , § } Z i‘ •": ( -. ( � $ ! \ k f \ ( § $ » _ ; � sin = ,z ) \ 0 1 - akg= _ : - # = • k › � _ c LSI f.A \ / { \ \ - gy f 2 ± / g _ 2 - \ cn - \ 7-- / - \ ! y E 2 & \ } \ r \ / f :f" F > / / \ \ 2 \ \ I \ \ au. " - / / s \ ! ri - } j L. , J \ \ \ \ » p .� 1O r • •b ;_ ! 1 < w I31« ` 3 3 2 { P -1- 'PP.O. Box inNorth Carolina State Laboratory of Public Health 4312 DistrictODrive _41,-.'-- Environmental Sciences Raleigh, NC 27611-8047 �, wi-,_ . . gr httpa/slnh.ncpublichealth.com � m Inorganic Chemistry Phone: 919-733-7308 , 4,r :os'L{ Fax: 919-715-8611 •--` Certificate of Analysis Report To: Name of System: CATAWBA CO ENVIRONMENTAL HEALTH ERNEST BARRY SCHRUM P 0 BOX 389 7927 TRADE WINDS DR NEWTON, NC 28658 Courier#09-70-01 SHERRILLS FORD, NC 28673 EIN: 566001814EH StarLiMS ID: ES072216-0003001 Date Collected: 07/20/16 Time Collected: 11:55 AM Date Received: 07/22/16 Collected By: RP Sample Type: Raw Sampling Point: Outside spigot Well Permit#: WELL-04-2016-07113E Sample Source: Well Temp. at Receipt: GPS#: Sample Description: Comment: Inorganic Chemical + Metals 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 < 1.0 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 mglL Magnesium < 1.0 mg/L Manganese < 0.03 0.05 mg/L Mercury < 0.0005 0.002 mg/L pH 6.4 N/A Selenium < 0.005 0.05 mg/L Silver < 0.05 0.10 mg/L Sodium 10.00 mg/L Sulfate < 5.00 250 mg/L Total Alkalinity 15 mg/L Total Hardness < 7 mg/L Zinc < 0.05 5.00 mg/L Report Date:08/02/2016 Reported By: .i<'e➢ZY/.etl2 Greene RECEIVED AUG 0 9 2016 CATAWBA COUNTY ENVIRONMENTAL HEALTH Page 1 of 1