HomeMy WebLinkAboutWELL-06-2016-073581.TIF rq• \ CATA\VBA COUNTY Case# __ ___
�7' G Public Health Department Subdivision AVIAN WOODS PH 3
Q �< '- Environmental Health Division PIN# 372012853846
j PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT# 47
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NAME ON PERMIT: CHONG SMITH, 702 6TH AV NE, CONOVER NC 28613
Site Address: 2150 MILTON ST, NEWTON NC 28658
Property Size: Square Feet:41,382.00 Acres:0.95
Directions: Settlemyer Bridge Rd, left on Startown, left on Milton, Property on Left. Corner lot.
Owner/Authorized Representative Acknowledgement of Permit Receipt
/ (4 I certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the
7`. property described above.
C 5 As the property owner or authorized representative, I have received the above referenced permit(s) as
requested in he application for service RBPR-04-2016-23759 by the following method(s):
Received in Person
_ Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/ E-mail (Return receipt required)
CS 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: 06/16/2016 /
Owner/Authorized Representative Signatu - °� �, 6/
Date Rif (RC3/(
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
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ehpermit 06/16/2016 09:55 Page 3 of3
`AO• � CATAWBA COUNTY Q 'rJ' - 0 Case it WELL-06-2016-073581
:t1 4 Public Health Department 1F, aPARCiest. Subdivision AVIAN WOODS PH 3
C Environmental Health Division
PIN# 372012853846
PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 _ LOT# 47
H.2 s+
NAME ON PERMIT: CHONG SMITH, 702 6TH AV NE, CONOVER NC 28613
Site Address: 2150 MILTON ST, NEWTON NC 28658
Property Size: Square Feet:41,382.00 Acres:0.95
Directions: Settlemyer Bridge Rd, left on Startown, left on Milton, Property on Left. Corner lot.
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,
Steven Price 06/16/2016
AUTHORIZED STATE AGENT APPROVAL DATE
chpennit 06/16/2016 09:57 Page I of3
RBPR 04-2016-23759
2150 Milton St,Newton
AC
• Do not cut, drive, fill,or grade over septic or repair areas.
• Septic system must be 10 ft from property lines; 50 ft from wells and streams; 5 ft from
building foundations and appurtenances; and out of right-of-ways and easements.
• Install a new 1,000 gallon septic tank and 300 linear feet of 25%reduction system with
maximum trench depth of 30 inches; proposed (4) lines 75 ft each on contour.
• Final grade of septic area must shed surface water off and away from system.
WELL
• Well should be 5 ft from property lines; 25 ft from structures; 50 ft from septic systems;
and out of right-of-ways and easements.
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