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HomeMy WebLinkAboutWELL-05-2016-072511.TIF ,‘,,A CATAAVBA COUNTY Case# ET r.Ald�.9©� Public Health Department Subdivision < 71iiiig T; Environmental Health Division PIN# 366802579273 PO Box 389, 100-A Southwest 13lvd, Newton, NC 28658 LOT# /8.2 5. NAME ON PERMIT: MICHAEL & JULIE CARROLL, 3536 CALDWELL RD, NEWTON NC 28658 Site Address: 3536 CALDWELL RD, NEWTON NC 28658 Property Size: Square Peet: 189,921.60 Acres:4.36 Directions: 16 South, left Caldwell first house on Left Owner/Authorized Representative Acknowledgement of Permit Receipt I/ I certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the / property described above. '.l As the property owner or authorized representative, I have received the above referenced pennit(s) as requested in the application for service RBPR-05-2016-23897 by the following method(s): NJeceived in Person Facsimile Transmittal (Return form with signature required) Electronic Image Transmittal/E-mail (Return receipt required) CAs the property owner or authorized representative I have reviewed and understand the specific conditions the permit issued, and further understand that all applicable regulatory requirements specified under the North arolina 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: 05/18/2016 e Owner/Authorized/,,Representative Signatu e , Date 5i,8-a 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 clip:unit 05/18/2016 09:51 Page 4 of4 X CATAWBA COUNTY D Ail'r •".f0 Case# WELL-05-2016-072511 Public Health Department • • . % r Subdivision u / • . PIN# 366802579273 Environmental Health Division r G �� ^tt- PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 r i LOT# /842 �. t --1 --.r r 8 CIF o . NAME ON PERMIT: MICHAEL & JULIE CARROLL, 3536 CALDWELL RD, NEWTON NC 28658 Site Address: 3536 CALDWELL RD, NEWTON NC 28658 Property Size: Square Peet: 189,921.60 Acres:4.36 Directions: 16 South, left Caldwell first house 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. 9 . SEWAGE PUMP SUPPLY LINE 50 FT. 5. UNDERGROUND STORAGE TANKS 100 FT. 6. STREAMS/BROOKS/CREEKS 50 FT. 7 . LAKES/PONDS RESERVOIRS 50 ET. 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 welt. 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 (I 5A 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 05/18/2016 AUTHORIZED STATE AGENT APPROVAL DATE eh perm it 05/18/2016 09:52 Page 1 of3 Catawba County Environmental Health % x • ,ib` 'Vs) y>� / . I Wy Ii p.k s � Oti o' . ,..6:„.• r A % 2$.p/N/fr/ -4 e _ )Y 7 9i — _ _i C q b CI, 9! N III I T ' l�le'n IC rb h 1 h a ` i