HomeMy WebLinkAboutWELL-07-2016-074123.TIF CATAWBA COUN'T'Y Case#
.7 '� Public Health Department Subdivision
2 ti x ., Environmental Health Division PIM!
460602990998
\A� ; Pb Box 389, I60-A Southwest Blvd, Newton. NC 28658 LOT# 4
/342 sM
NAME ON PERMIT: *BURNETT HOME BUILDERS, 7887 MOUNTAIN SHORE DR, SHERRILLS FORD
NC 28673
Site Address: 7968 BARKWOOD LN, SHERRILLS FORD NC 28673
Property Size: Square Feet:30,056.40 Acres:0.69
Directions: Hwy 150 E, to slanting Bridge Rd, right on Barkwood, property at end of cul-de-sac
Owner/Authorized Representative Acknowledgement of Permit Receipt
74
" 91) I certify that 1 am the owner or authorized agent(owner's authorization required) representing the owner of the
property described above.
9Q) As the property owner or authorized representative, I have received the above referenced permit(s) as
requested int application for service RBPR-05-2016-23953 by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/ E-mail (Return receipt required)
(PO 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: 07/01/2016
–IN> Owner/Authorized Representative Signature ` - v "'
Date 1 -- Z9 — / £
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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chpenuit 07/01/2016 09:50
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ypA CATAWBA COUNTY 0� � 0 Case WELL-07-2016-074123
.T G�.'1� Public Health Department Subdivision
4 �i `C, Environmental Health Division i ' I. • g3 't PIN# 460602990998
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� PO Box 389. 100-A Southwest Blvd,Newton,NC 28658 LOT# 4
H.2 iu r
.O 15,1ALO
NAME ON PERMIT: *BURNETT HOME BUILDERS, 7887 MOUNTAIN SHORE DR, SHERRILLS FORD
NC 28673
Site Address: 7968 BARKWOOD LN, SHERRILLS FORD NC 28673
Property Size: Square Feet: 30,056.40 Acres:0.69
Directions: Hwy 150 E, to slanting Bridge Rd, right on Barkwood, property at end of cul-de-sac
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 (I5A NCAC I 8A .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 07/01/2016
AUTHORIZED STATE AGENT APPROVAL DATE
cum mit 07/01/2016 09151
� A Permit # RBPR-5-16-23953
Q CATAWBA COUNTY Name Burnett Home Blders(Doug
2 Public Health Department
•< `°""°'r `� Environmental Health Division Burnett
U li PO Boa 389, I OOA Southwest Blvd,Newton NC 28658 Address 4303 Slanting Bridge Rd Sherrills
5,, (828)465-8270 Fax (828)465-8276 TDD(828)465-8200
Ford NC
!g4 PIN# 460602990998
Site Plan Authorization to Construct
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