HomeMy WebLinkAboutWELL-07-2016-074133.TIF stA CATAWBA COUNTY Caset1
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Public Health Department Subdivision vVYNSWEPT PH 1
sl o�Y Environmental Health Division PINIt 367804516438
..-^tk- PO Box 389. 100-A Southwest Blvd,Newton. NC 28658 LOT# 28
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NAME ON-PERMIT: *MIKE PALMER HOMES, INC., 6211 DENVER INDUSTRIAL PARK RD, DENVER
NC 28037
Site Address: 4548 CAYTON DR, MAIDEN NC 28650
Property Size: Square Feet: 33,541.20 Acres:0.77
Directions: Hwy 16 turn on Cayton Dr(just before Rant Drum) Property on Left
Owner/Authorized Representative Acknowledgement of Permit Receipt
—L— f.,1 certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the
property described above.
As the property owner or authorized representative, I have received the above referenced permit(s) as
requested in the application for service RBPR-06-2016-24121 by the following method(s):J�./Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/ E-mail (Return receipt required)
YAs 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
Owner/Authorized Representative Signature cz) -Th —
Date 5- 1 - Z ie
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:
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clipenn ii 07/01/2016 11:16
.tSA CATAWBA COUNTY 0 c '-o fi 0 Case# WELL-07-2016-074133
,+ �w:` G Public Health Department i Subdivision WYNSWEPT PH 1
4 ,�I 'Hc Environmental Health Division • r R PIN# 367804516438
�wi, PO Box 389. 100-A Southwest Blvd, Newton,NC 28658 � 117 • LOT# 28
r8.1. 6 _ ` -
NAME ON PERMIT: *MIKE PALMER HOMES, INC., 6211 DENVER INDUSTRIAL PARK RD, DENVER
NC 28037
Site Address: 4548 CAYTON DR, MAIDEN NC 28650
Property Size: Square Feet: 33,541.20 Acres:0.77
Directions: Hwy 16 turn on Cayton Dr(just before Rant Drum) Property on Left
WELL PERMIT
WATER SUPPLY: Individual Well
SETBACKS:
IL. 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 07/01/2016
AUTHORIZED STATE AGENT APPROVAL DATE
ehpennit 07/01/2016 11:19
,,,\..N3A • Permit# RBPR 6-16-24121
G CATAWBA COUNTY
,c7 aII 2 Public Health Department Name Mike Palmer Homes INC
Address 4548 Cayton Dr Maiden NC
r
J el; io�s C Environmental Health Division PIN# 367804516438
41 PO Box 389, 100A Southwest Blvd, Newton NC 28658
/842., sM (828)465-8270 Fax (828)465-8276 TDD(828)465-8200
Site Authorization to Construct
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