HomeMy WebLinkAboutWELL-08-2016-075424.TIF r13A CATAWBA COUNTY Case# -
Public Health Department Subdivision CLIFTON S POPE REVISE
G ,0q_ ,' ' Environmental Health Division PIN# 375014426904
ti PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT#
NAME ON PERMIT: JEFFREY POPE, 1212 LITTLE RD, NEWTON NC 28658
Site Address: 2472 ALBERT DR, NEWTON NC 28658
Property Size: Square Feet:629,877.60 Acres:14.46
Directions: STRAIGHT ON MT OLIVE CHURCH RD UNTIL YOU PASS JIMS JUNK YARD, ABOUT 1/2 MILE TURN LEFT
ON LITTLE RD IN 1/2 MILE TURN LEFT ON ALBERT DR, TAKE 1st RIGHT AWAY ON RIGHT OFF ALBERT
DR(GRAVEL DRIVE WAY)
Owner/Authorized Representative Acknowledgement of Permit Receipt
5I certify that I am the owner or authorized agent (owner's authorization required) representing the owner of the
pro
erty described above.
J I As the property owner or authorized representative, I have received the above referenced permit(s) as
requested in thep plication for service RBPR-07-2016-24292 by the following method(s):
\R4eived 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: 08/08/2016 /
•
Owner/Authorized Representative Signature 401/.,,,_z , , lae
Date SP-9-110
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
elipennit 08/08/2016 10:07
�aA • CATAWBA COUNTY Q: a 0 i`.'Q Case# WELL-08-2016-075424
•
(%4Public Health Departments ?� q Subdivision CLIFTON S POPE REVISE
q 0 ,.'ss,) Environmental Health Division Frarriarr, • PIN# 375014426904
ci
tiPO Box 389, 100-A Southwest Blvd.Newton,NC 28658 } • L0'f#
1�g42 u
• •
NAME ON PERMIT: JEFFREY POPE, 1212 LITTLE RD, NEWTON NC 28658
Site Address: 2472 ALBERT DR, NEWTON NC 28658
Property Size: Square Feet:629,877.60 Acres:14.46
Directions: STRAIGHT ON MT OLIVE CHURCH RD UNTIL YOU PASS JIMS JUNK YARD, ABOUT 1/2 MILE TURN LEFT
ON LITTLE RD IN 1/2 MILE TURN LEFT ON ALBERT DR, TAKE 1st RIGHT AWAY ON RIGHT OFF ALBERT
DR(GRAVEL DRIVE WAY)
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 (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 othenvise 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 08/08/2016
AUTHORIZED STAFF AGENT APPROVAL DATE
elipennit 08/08/2016 10:08
v413A permit a I f2BPR 7-16-24292
CATAWBA COUNTY
G Name Jefferey Pope
n� Z PublicDepartment
Address 12472 Albert Dr Newton NC
•< Wrioa} Environmentmens al Health Division
�'��` / PO Box 389, 100A Southwest Blvd, Newton NC 28658 PIN f 373014426904
/ • . 2 w (828)165-8270 Fax (828)465-8276 TDD(828)465-8200
InfCr,.rt Cr '
i Site Plan Authorization to Construct
K' 1` ,0- eF ".---1
•
J 1
0 2 • fr
N 7 P
P CC
f
r
''.--.--------- *\ EA.8 2
fC`41Do
(-3l� -
c• •
* - - - -
p
'rjl q u
____----- _
1 W 'A Vr. �C.O�.J 4, v
,-t- e r� I sre y ',S rye it...)
0
—b el
u
P cr
e P
.1/1It I „t.tdt
I�
I L 3 P ''4- Lac - 4— ns
Scale
� ut iob