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HomeMy WebLinkAboutWELL-04-2016-071790.TIF sg• CATAWBA COUNTY Case# ,.. _ _. . .. . 4 rt.IA Public Health Department Subdivision GEORGIA PARK < ®, ,,ac, Environmental Health Division PIN# 366703234039 PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 LOT# 7 /g._ sm NAME dN PERMIT: CLAYTON HOMES, PO BOX 132, TAYLORSVILLE NC 28681 Site Address: 3463 MELDONNA DR, MAIDEN NC 28650 Property Size: Square Feet:20,037.60 Acres:0.46 Directions: Hwy 16 / left Buffalo Shoals Rd / right Meldonna Dr/ lot 7 on left Owner/Authorized Representative Acknowledgement of Permit Receipt I certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the l)c roperty described above. OttiAs the property owner or authorized representative. I have received the above referenced permit(s) as in the pplication for service RBPR-02-2016 23283 by the following method(s): eceived in Person Facsimile Transmittal (Return form with signature required) Electronic Image Transmittal/ E-mail (Return receipt required) ildpi NS:, 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 ISA .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: 04/29/2016 �t 'iOwner/Authorized Representative Signature7" Date 51 lid I(1 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 chp:relit 04/29/2016 1 1:14 Page 4 of 4 ^,,`z CATAWBA COUNTY 1:14 o' f 0 Case# WELL-04-2016-071790 •.C' .„ Public Health Department ` JY Subdivision GEORGIA PARK © - ' ' • I'IN'# 366703234039 \.��t ,c Environmental Health Division r 1 11. PO Box 389, 100-A Southwest Blvd.Newton. NC 28658 -a.i� " LOT# 7 1842 NAME ON PERMIT: CLAYTON HOMES, PO BOX 132, TAYLORSVILLE NC 28681 Site Address: 3463 MELDONNA DR, MAIDEN NC 28650 Property Size: Square Feet:20,037.60 Acres:0.46 Directions: Hwy 16/ left Buffalo Shoals Rd / right Meldonna Dr/ lot 7 on 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 verily 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 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 tinteframes 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 04/29/2016 AUTHORIZED STATE AGENT APPROVAL DATE ehpcnnil 04/29/2016 11:17 Page 1 of3 Ault - 4-2aq- 07(7q( Catawba County Environmental Health k_iii_ u_2016 - 0717 qo • 1 <ooti H4 0 • R so_ ^'1n • /.ect �j2 �' 9 e- �2 b yoh \Z 2 A6 \�� - . r 2k` F. C. V SO% 4-� . . ` 7 .p \ Ji 42 ()noel cLr Vr4 q 0471 dry, • Parcel: 366703234039, 3463 MELDONNA DR tin=40ft MAIDEN, 28650 • • This map/report product was prepared from the Catawba County.NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC • 04/27/2016