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Home My WebLink AboutWELL-08-2016-075324.TIF ,ACATAWBA COUNTY C1Se# WELL-08-2016-07524 fin Public Public Health Department Subdivision VERNON B SETZER ESTA < Environmental Health Division PINS 375019513159 � " PO Box 389, 100-A Southwest Blvd,Newton. NC 28658 LOT/: 12 /842 t. NAME ON PERMIT: JOSHUA RITCHIE, 1372 LITTLE RD, NEWTON NC 28658-9668 Site Address: 1372 LITTLE RD, NEWTON NC 28658 Property Size: Square Feet:61,855.20 Acres:1.42 Directions: Hwy 10 from Newton, Right onto Mt Olive Church Rd about 1.5 miles, Left onto Little Rd & 6th driveway on the Right. Owner/Authorized Representative Acknowledgement of Permit Receipt certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the � 1 property described above. ` s the property owner or authorized representative, I have received the above referenced permit(s) as /hrequested in the application for service EHPR-08-2016-24417 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: 08/04/2016 / .._ 1/44.----2T- Owner/Authorized Owner/Authorized Representative Signature '` Date 0�oy-/6 g / 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: http://www.surveymonkey.com/s/EHCustomerService ehpcmtit 08/04/2016 08:09 v,A CATAWBA COUNTY : R . ❑e Case# WELL-08-2016-075324 r- �� Public Health Department . Subdivision VERNON B SETZER ESTA d I" Environmental Health Division ;ti,, r PIN# 375019513159 ® � PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 •L - � LO'I'�t 12 7842 s. - • 4 - ? •:i 8 O • O+ NAME ON PERMIT: JOSHUA RITCHIE, 1372 LITTLE RD, NEWTON NC 28658-9668 Site Address: 1372 LITTLE RD, NEWTON NC 28658 Property Size: Square Feet:61,855.20 Acres:1.42 Directions: Hwy 10 from Newton, Right onto Mt Olive Church Rd about 1.5 miles, Left onto Little Rd & 6th driveway on the Right. 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 verily 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 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 08/04/2016 AUTHORIZED STATE AGENT APPROVAL DATE °luminit 08/0412016 08:09 �qA Permit# EHPR-8-16-24417 CATAWBA COUNTY Q Name Joshua Ritchie 5. L Public Health Department — CJ , "°"�p d R Environmental Health Division Address 1372 Little Rd Newton NC NC , �� PO Box 389, I OOA Southwest Blvd,Newton NC 28658 PIN# 375019513159 \842 sM (828)465-8270 Fax (828)465-8276 TDD(828)465-8200 Site Plan Well Permit r 6 L.vg-r L , "Th t3 0 gnatOct 1,„,_11 4. te_a 1,,c:L e, Arc. ,r,._..n 1 Lcg-. 13 12.SI M.• -‘ k mt. 32G-2S I Gc rp.-I 1 Icn � 3 �p i IIi - A I (cox. c ..a I too a I (1/. O p Scale / 1 I " S O Aug 15 16 11:30p Justice Well Drilling 8287244548 p.2 Print Form WELL CONSTRUCTION RECORD (GW-1) For Infernal Use Only: L Well Contractor Information: Gary Dean Justice 14.WATER ZONES Well Contranor Name FROM TO DFSCRWI IO5 2150-A 180 n' 190 1GPM NC Wed Cortncie,Coterientionnumbe. 210 n 225 "• SGpm 115.OUT ER CASING Dar nulG sed welle)OR LINER(if a ['cable) Justice Well Drilling l FROM TO DIAMETER I THICKNESS MATERIAL 0 a 140 it 6 118 in• i soh 80 pvc Colman)Name 08-2016-075324 16.INNER CASING OR TUBING(gwlhermal elated-loop) 2.Well Construe don Permit M: FROM Ti) DIAMETER ' THICKNESS .'LATERIAu. In:an app!treble well cormresion Fermin(i.e.UP?.Count),Stare,Valance,at.) fl It in. 1 3.Well Use(check well use): R. ftin. i Water Supply Well: 117.SCREEN I FROM TO DIAMETER I SLOT RILE THICKNESS MATERIAL Agricultural OMunicipal:Public H. R to Geothermal(Heating.'Cooling Supply) Residential Water Supply(single) n. rh to Industrial(Comme¢ial Residential Water Supply(shared) IR GROUT Irrigation FROM TO I MATERIAL EMPLACEMENT mesrIon&AMOUNT I Non-Water Supply Weu: 0 R' 1 n' bentonite 2 Bags illtdon Owing MILecovcry 2 1/ R. 22 n bentonite 2Bags AgUifn Waw 137 it' 14C m. Bentonite 1 Bag Aquifer Recharge Groundwater Remedialim I9.SANDICRAYEL PACK if applicable) Aquifer Storage and Recmery OSallutty Ranier FROM TO (,MATERIAL EMPLACEMENT METHOD Aquifer Test OStormwatet Drainage rt. It Experimental Technology OSubsidence Control R. R. Geothermal(Closed Loop) OTrcer 20.DRILLING LOG(attach additional sheen R aecettory) Geothermal(Heating/Cooling Return) OOther(explain under 421 Remarks) FROM TD DESCRIPTIO."(Wok.,turdneq sail/nal rpx,arils she.my (t R 4.(Ate Well(s)Completed: 8-8-16 Well 110n. R Sa Wel Location: O R 13e R- clay rock Joshua Ritchie D. n. FacilitiOwner lame Facility lot(if applicable) 13E R 245 R- Granite 1372 Little Rd,Newton N.0 28658 n R. Physical Address,Cin,and Zip R. a Catawba 375019513159 21.REMARKS Co.m6' Parcel Id_sihca.on Na(PIN) Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: a (if well field,ant la✓lore is sufficient) Certification: 35"3927.44" ` 81* 10'13.92" W • R 8-8-2016 6.Is(am)the"el(s)e Permanent or O'1'emporary _ ure oFeertitl 'ell Contra° Dae Uy rice this form, hereby cerci hat she ueli(a)oar(were)construe-be(in accordance 7.Is this a repair to an existing well: ]Yes or ONo Rirh ISA NCAC 07C MOO or ISA NCAC 02C A200 Well Construction Standards and:hat a !/this is a repair,fid rut known reel!con Until 0A mfarnunior am explain the nature of the rep)n/Anis rennet has been prnrided 10 the'eel myna. repair under N2!remants Becton or nn the Lc:.ofiki s Grin. b,Site diagram or additional well details: S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the name Vac may use the back of this page to provide additional well site details or well construction.only I GW-1 is needed. Indicate TOTAL NUMBER of wells cnostuction details. You may also attach additional pages i(necessary. drilled: SUBMITTAL INSTRUCTIONS 9.Total will depth below land surface: 245 (R) 29n, For AR Wells: Submit this form within 30 days of completion of well For mnlr'ple wells list all depths if different(example-3'd9(It'and 2(u;Mr) construction to the following: 10.Static water Icedbelow top of casing: 80 (It) Division of Water Resources,Information Processing Unit, If!suer level is abcre ensige,use'•.- 1617 Mail Service Center,Raleigh,NC 27699.1617 I I.Borehole dnmeter. 6 1/8 (in-it 216 For Initiation Wells: In addition to sealing the form to the address in 24a Rotary above,also submit one copy of this form within 30 days of completion of well l2 Well construction method: (c.e.mr ermtasy,cable,direct push,etc) construction to the following: R Division of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699.1636 nil 6 13a.Yield Method or test: 24c.For Wafer Supply a (ppm) Air/Stand Injection Wells: In addition to sending the form in chlorine the address(ss) above, also submit one copy of this form within 30 days of 131..Disinfection type: Aa,uot 8 oz completion of well construction to the county health department of the county whnc constructed. Farm OW-] North Carolina Department aEnvironmental Qaalav-pH:hi:n of Weer Recowees Revised 2-22-2016