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Home My WebLink AboutWELL-04-2016-071354.TIF ;VtA CATAWBA COUNTY Case# AUTH-04-20 1 6-0713 53 T ail 2, Public Health Department Subdivision ¢ ' ®1 17. Environmental Health Division PIN# 470002650130 b PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 L0T# /g.2 .., NAME ON PERMIT: MANDY BARR, 2232 WHITEROCK CT, SHERRILLS FORD NC 28673 Site Address: 7633 MONBO RD, CATAWBA NC 28609 Property Size: Square Feet: 182,080.80 Acres:4.18 Directions: 16S / 150E / left Sherrills Ford Rd / right Molly's Backbone - left on Monbo Rd Owner/Authorized Representative Acknowledgement of Permit Receipt nt'� ' N certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the property described above. AI r K'e s the property owner or authorized representative, I have received the above referenced permit(s) as equested in the application for service RBPR-04-2016-23640 , by the following method(s): . eceived in Person Facsimile Transmittal (Return form with signature required) Electronic Image Transmittal/E-mail (Return receipt required) A - the property owner or authorized representative I have reviewed and understand the specific conditions of tr- 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: 04/19/2016 ]/y� Owner/Autho ' ed Representative Signature / ' `GS�2°/� geb-t ---/ Date ,// r// , 2 rte`" /�lJ 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 ehpennit 04/28/2016 13:43 Page 4 of 4 ,lSa • CATAWBA COUNTY Case 8 r - ttI Public Health Department Subdivision c �1. ; Environmental Health Division PIN. 470002650130 �69 PO Box 389. 109-A Southwest Blvd,Newton. NC 28658 LOTll IH v NAME ON PERMIT: MANDY BARR, 2232 WHITEROCK CT, SHERRILLS FORD NC 28673 Site Address: 7633 MONBO RD, CATAWBA NC 28609 Property Size: Square fccc 182,080.80 Acres:4.18 Directions: 16S/ 150E/ left Sherrills Ford Rd / right Molly's Backbone - left on Monbo Rd Owner/Authorized Representative Acknowledgement of Permit Receipt _ I certify that lam the owner or authorized agent(owner's authorization required) representing the owner of the property described above. As the property owner or authorized representative; I have received the above referenced permit(s) as requested in the application for service RBPR-04-2016-23640 by the following method(s): Received in Person Facsimile Transmittal (Return form with signature required) Electronic Image Transmittal/ E-mail (Return receipt required) N.F j 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: 04/19/2016 I Owner/Authorized Representative Signature Date Documentation of Permit(s) Transmittal (permit transmitted by electronic or other means) Permit transmitted by\& ,d t/ (name of person 'ending pertni0 Signature \ ,Anti / cJL/ Date/Time ' a kp 0 1 1 10 Method: A,. Fax Email US Mail Other Ow is request to send by tl e above indict, 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 chhnuii 04/19,2016 09:46 Page 4 Of 416A CATAWBA COUNTY 0 • o 0 Case# WELL-04-2016-071354 \ • ,. •13* Subdivision .'t'Eta Public Health Department kiii, . - ia� Environmental Health Division rg't PIN# 470002650130 �1K / PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 t • " 'r LOT# 1C NAME ON PERMIT: MANDY BARR, 2232 WHITEROCK CT, SHERRILLS FORD NC 28673 Site Address: 7633 MONBO RD, CATAWBA NC 28609 Property Size: Square Feet: 182,080.80 Acres:4.18 Directions: 16S / 150E / left Sherrills Ford Rd / right Molly's Backbone - left on Monbo Rd 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. 9 . SEWAGE PUMP SUPPLY LINE 50 FT. 5. UNDERGROUND STORAGE TANKS 100 FT. 6. STREAMS/BROOKS/CREEKS 50 FT. T . 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. Jason Boyd 04/19/2016 AUTHORIZED STATE AGENT APPROVAL DATE ehpennit 04/19/2016 09:42 Page 1 of3 �,3A CATAWBA COUNTY Permit# RBPR 4-16-23348 aPublic Health Department Name Mandy Ban. -- °",;,°rr".oi'. Environmental Health Division Address 7633 Monbo Rd Catawba NC V rt ' PO Box 389, IOOA Southwest Blvd, Newton NC 28658 PIN# 470002650130 8 1, sm (828)465-8270 Fax (828)465-8276 TDD(828)465-8200 Site Plan Authorization to Construct -F, "`° AL iCa —> F ku,C, 1 s'r- Si 30 \---( -,-.1,13S to v "-1 5 i �,, ,„ m n. a6' Q r__ ` bon l �i 1 �u°�” �`� as to e�� P T ft L — --.1-ii I i ° '3 � L. - A I) N.15 iA 1. fry"' aS ` 2K9 .v6 3`12-.'37 I -3T55 1 `a io0r �p�f— I � C.<r na,r :,. . 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