The URL can be used to link to this page

Home My WebLink AboutWELL-08-2016-075813.TIF A3A CATAWBA COUNTY Case# :Cm's*G Public Health Department Subdivision WYNSWEPT PH 1 < � ^ Environmental Health Division PINI! 367803414205 KPO Box 389. 100-A Southwest Blvd,Newton.NC 28658 LOTH 4 1841, s.w NAME ON PERMIT: MODLIN CONSTRUCTION, INC., 2382 SHINY LEAF DR, DENVER NC 28037 Site Address: 3315 CAYTON DR, MAIDEN NC 28650 Property Size: Square Feet:56,628.00 Acres:1.3 • Directions: Hwy 16 S, left on Cayton Dr, Lot on left Owner/Authorized Representative Acknowledgement of Permit Receipt 9 certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the .ropettyyddescribed above. 1/476 Lis the property owner or authorized representative, I have received the above referenced permit(s) as requested in the application for service RBPR-07-2016-24250 by the following method(s): v/ 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: 08/17/2016 _ - 3Owner/Authorized Representative Signature P — Date g'' 17— Ico 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 ehpermit 08/17/2016 09:03 • rte• CATAWBA COUNTY e '+,�!_ �� ';f�e Case# WELL-08-2016-075813 .0 Gt..I fes, Public Health Department *�� ` Subdivision WYNSWEPT PH 1 4 S &, ^; Environmental Health Division �_ `r 3.• PIN# 367803414205 � :�� PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 G � { LOT# 4 lgg2 } f '}i__ Tr JAL a NAME ON PERMIT: MODLIN CONSTRUCTION, INC., 2382 SHINY LEAF DR, DENVER NC 28037 Site Address: 3315 CAYTON DR, MAIDEN NC 28650 Property Size: Square Feet:56,628.00 Acres:1.3 Directions: Hwy 16 S, left on Cayton Dr, Lot on left 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 I-Iealth 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 ISA .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 08/17/2016 AUTHORIZED STATE AGENT APPROVAL DATE chpcmiil 08/17/2016 09:08 aPermit K RBPR 7-16-25250 CATAWBA COUNTY `Public Health DepartmentNume ��todlin Construction 1tvC Environmental t-Icalth Division Address 3315 Cayton Dr Maiden NC S' PIN.# 367803414205 PO Box 389, IOOA Southwest Bid,Newton NC 28658 76'0, su (828)465-8270 Fax (828)465-8276 T 0(828)465-8200 Site Plan rthorization to Construct Pr is t°r _ _ 10' 7_ _ -_ _ _ _ , 1.),, Ts ID I) r l•D tt< 9.. 5el, 2c.) is Zoo — • L 5 -er Sr I .pr Cl-- ice ' -1 '2.: ? SS 16,c- 11,_.` 4 ZS $sI 10 lkfti PA r- 7o 6 4`I q9 (iii a '., 0 c-Y I '' � 6 a Scale