HomeMy WebLinkAboutWELL-06-2016-073686.TIF `�v,A • CATAWBA COUNTY Case# ___ . __ _, __ ,,,
_f' LW 4 L Public Health Department Subdivision ALTAMONT SPRINGS SEC
',.:, skil 2,'1 H Environmental Health Division PIN# 365917016808
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vb PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 LOP! 56
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NAME ON PERMIT: PAINT MASTERS AND COMPANY INC, 3570 DIVOT DR, MAIDEN NC 28650
Site Address: 2124 LAYTON LN, NEWTON NC 28658
' Property Size: Square Feet: 23,086.80 Acres:0.53
Directions: 3215 -LEFT AT HWY PATROL -STRAIGHT ACROSS AT STOP-RIGHT ON HERMIT TRAIL-RIGHT ON
FRIENDLY LANE-LEFT ON LAYTON
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
7 property described above.
x As the property owner or authorized representative, I have received the above referenced permit(s) as
/ v requested in the application for service RBPR-05-2016-23975 by the following method(s):
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.
Permit Issue Date: 06/20/2016
Owner/Aut orized Representative Signature I~ A1(
i
Date
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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elipeonit 06120/2016 09:24 Page 3 of 3
/Y,A CATAWBA COUNTY Q ; ; - 0 Case# WELL-06-2016-073686 13 7�dt ti Public Health Department s - `. air Subdivision ALTAMONT SPRINGS SEC
3 } PIN#
4 �� H Environmental Health Division ;i '' .' 1 �' 365917016808
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fib PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 Y M LO"f# 56
Alt s.. #40:1..L.'-M!
NAME ON PERMIT: PAINT MASTERS AND COMPANY INC, 3570 DIVOT DR, MAIDEN NC 28650
Site Address: 2124 LAYTON LN, NEWTON NC 28658
Property Size: Square Feet: 23,086.80 Acres:0.53
Directions: 3215 -LEFT AT HWY PATROL -STRAIGHT ACROSS AT STOP-RIGHT ON HERMIT TRAIL-RIGHT ON
FRIENDLY LANE-LEFT ON LAYTON
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 (ISA NCAC I8A .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 06/20/2016
AUTHORIZED SfATE AGENT APPROVAL DATE
ehpennit 06/20/2016 09.27 Page I of3
It 1 Permit # I RBPR 546-23975
CATA1Y 13A COUNTY Name I Paint Plasters and Company INC
Public Health Department Address 1 2124 Layton Lane Newton NC
Environmental Health Division
PIN# 1 365917016808
PO Box 389, 10A Southwest Blvd, Newton NC 28658
(828)965-8270 Fax (829)465-8276 Ti)t)028)465-820
Site Authorization to Construct
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