HomeMy WebLinkAboutWELL-06-2016-073501.TIF S 4 A
CATAWBA COUNTY
Case#
`C' 1u ,.4 ublic Health Department Subdivision
ision
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Environmental Health Division PIN# 460703130495
\C.I4. ,PO Box 389. 100-A Southwest Blvd,Newton, NC 28658 LOT# 2
18,2 s.
NAME ON PERMIT: JOURNEYS PROPERTIES LLC, 8217 LANDING CT, DENVER NC 28037
Site Address: 7184 ROLLING HILLS DR, SHERRILLS FORD NC 28673
Property Size: Square Feet: 34,848.00 Acres:0.8
Directions: Hwy 16 S to HWy 150 take left, left on Little Mtn RD, Left on Rolling Hil, Lot on Right, on corner
�'I, Owner/Authorized Representative Acknowledgement of Permit Receipt
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I certify that 1 am the owner or authorized agent(owner's authorization required) representing the owner of the
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property described above.
VV"`�A As the property owner or authorized representative. I have received the above referenced permit(s) as
ic requested in t e application for service RBPR-06-2016-24015 by the following method(s):
ti Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic 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.
›wner/Autha,.Permit Issue Date: 06/15/2016
' •d Representative Signature c--------
6'-/Y �.
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
chpenuit 06/15/2016 08:28 Page 4 of
41, COUNTY 0 i �r r�R.� � Case# WELL-06-2016-073501
,3-gi,n Public Health Department Se . X' Subdivision
4 — p Environmental Health Division i ti
'"e . PIN# 460703130495
� / PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 ' • G X LOT# 2
Di,, ZQI
NAME ON PERMIT: JOURNEYS PROPERTIES LLC, 8217 LANDING CT, DENVER NC 28037
Site Address: 7184 ROLLING HILLS DR, SHERRILLS FORD NC 28673
Property Size: Square Feet: 34,848.00 Acres:0.8
Directions: Hwy 16 S to HWy 150 take left, left on Little Mtn RD, Left on Rolling Hil, Lot on Right, on corner
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 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 06/15/2016
AUTHORIZED STATE AGENT APPROVAL DATE
chpcnuit 06/15/2016 08:29 Page I of 3
rA • CATAWBA COUNTY j Permit tS RBPR 6-16-24015
`_ aG Name Journeys Properties LLC
2 Public Health Department Address 7184 Rolling Hills Dr Sherrills
(......�o�� Environmental Health Division Ford NC
(a6 ,? PO Box 389, IOOA Southtiest Blxd, Newton NC 28658 PINS 460703039476
's. 2 w (828)465-8270 Fax (828)465-8276 TDD(828)465-8200
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Site Plan Authorization to Construct
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