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Home My WebLink AboutWELL-07-2016-075115.TIF i .CATAWBA COUNTY Case ti Public Health Department ,it p Subdivision Environmental Health Division P1N4 368703436934 ',c,.,,s,•,.,-:t 4•'!"' PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOTS 3 ...!.. .2Lt—') . NAME ON PERMIT: MARC DEAN, 2621 EIGHT IRON DR, DENVER NC 28037 Site Address: 4256 RUGGED HILL RD, MAIDEN NC 28650. Property Size: Square Feet-447,361,20 Acres:10.27 Directions: HWY 16 N TO RIGHT ON RUGGED HILL DR, GO TO TOP OF MOUNTAIN, WHERE THERE IS A GATE (YOU CAN PUSH GATE OPEN)PROPERTY ON RIGHT AFTER GATE Owner/Authorized Representative Acknowledgement of Permit Receipt A/(_ 01..oertify thati am the owner or authorized agent(owner's authorization required)representing the owner of the pq'perty described above. . ' s the property owner or authorized representative, I have received the above referenced permit(s) as 'requested in the application for service RBPR-06-2016-24123 , by the following method(s): Received in Person _ . . / Facsmule Transinittal (Return form with signature required) i Electronic Image Transmittal/E-mail (Return,receipt required) lc, .(777s 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 tinder 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 oi this permit.and the construction of the wastewater system and/or water supply well permitted. Permit Issue Date: 07/29/2016 ,... wner/Authorized Representative Signature --, ----,_., 1p /Date 9A a 0/ Documentation of Permit(s) Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name of peon 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 ilat:01AVe(arta di etatJi ttek We want to hear from you. Please take:a few moments to complete our customer service survey at: f Vittpti/www.surveymorikey.comisiEHCustornerService Lhfv.imit 07/2912016 10:03 ire , CATAWBA COUNTY EV.. _6❑e Case# WELL-07-2016-075115 .TAfj- Public Health Department " am u} Subdivision 4 �a N) Environmental Health Division i . �1- • • PIN# 368703436934 -o� PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 - LO"f# 3 g.2 , • NAME ON PERMIT: MARC DEAN, 2621 EIGHT IRON DR, DENVER NC 28037 Site Address: 4256 RUGGED HILL RD, MAIDEN NC 28650 Property Size: Square Feet:447,361.20 Acres:10.27 Directions: HWY 16 N TO RIGHT ON RUGGED HILL DR, GO TO TOP OF MOUNTAIN, WHERE THERE ISA GATE (YOU CAN PUSH GATE OPEN) PROPERTY ON RIGHT AFTER GATE 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. 9 . 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 07/29/2016 AUTHORIZED STATE AGENT APPROVAL DATE ehpennit 07129/2016 10:04 -4; ..4-oi STATF:: �d ',r n un lt ',. North Carolina State Laboratory of Public Health P.O. Box 28047 4312 District Drive li4 Raleigh, NC 27671-8047 o;; Environmental Sciences http:/Islph.ncpublichealth.com Inorganic Chemistry Phone: 919-733-7308 `•4ik ... ,. Fax: 919-715-8611 - - Certificate of Analysis Report To: Name of System: CATAWBA CO ENVIRONMENTAL HEALTH MARC DEAN P 0 BOX 389 4256 RUGGED HILL RD NEWTON, NC 28658 Courier#09-70-01 MAIDEN, NC 28650 EIN: 566001814EH StarLiMS ID: ES032618-0004001 Date Collected: 03/22/18 Time Collected: 09:27 AM Date Received: 03/26/18 Collected By: Eric Price Sample Type: Raw Sampling Point: Spigot on front of house Well Permit#: WELL-07-2016-07511E Sample Source: New Well Temp. at Receipt: GPS#: Sample Description: Comment: New Well - No Nitrate I (Profile) Analyte Result Allowable Limit Unit Qualifier(s) Arsenic < 0.005 0.010 mg/L Barium < 0.1 2.00 mg/L Cadmium < 0.001 0.005 mg/L Calcium < 1.0 mg/L Chloride 18.00 250 mg/L Chromium < 0.01 0.10 mg/L Copper < 0.05 1.3 mg/L Fluoride 0.21 4.00 mg/L Iron < 0.10 0.30 mg/L Lead < 0.005 0.015 mg/L Magnesium < 1.0 mg/L Manganese < 0.03 0.05 mg/L Mercury < 0.0005 0.002 mg/L pH 8.0 N/A Selenium < 0.005 0.05 mg/L Silver < 0.05 0.10 mg/L Sodium 87.00 mg/L Sulfate 23.00 250 mg/L Total Alkalinity 150 mg/L Total Hardness < 7 mg/L Zinc < 0.05 5.00 mg/L Report Date:04/05/2018 Reported By: Xennetlt 9reene RECEIVED APR 192018 cAT;`W5A COUNTY •ENVIRONMENTAL HEALTH Page 1 of 1