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Home My WebLink AboutWELL-08-2016-075884.TIF TArgA • CATAWBA COUNTY ll.4 Public Health Department Subdivision SHERWOOD SHORES < : (Df ,, Environmental Health Division PIN# 461902752332 °> PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT# 4 & 5 /g.n m NAME ON PERMIT: GEORGE CRENSHAW, PO BOX 1421, MOORESVILLE NC 28115 Site Address: 8800 DOG LEG RD, SHERRILLS FORD NC 28673 Property Size: Square Feet:41,817.60 Acres:.96 Directions: MOLLYS BACKBONE TO AZAELA LEFT ONTO HOME PLACE SIGN Owner/Authorized Representative Acknowledgement of Permit Receipt / //I certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the .. 4 property described above. X As the property owner or authorized representative, I have received the above referenced permit(s) as requested in the application for service RBPR-07-2016-24242 by the following method(s): nt 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 f 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 Owner/Authorized Representative Signature ( Date ,-.2)-le 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 08/19/2016 09:34 ,• r CATAWBACOUNTY De ; �e Case# WELL-08-2016-075884 TG Public Health Department i� A]� Subdivision SHERWOOD SHORES t ,��g Environmental Health Division +' �rr PIN# 461902752332 `4- PO l3ox 389, 100-A Southwest Blvd.Newton,NC 28658 T 64 4FI,i - LOT# 4 & 5 18.2 su - � -1.-- .c." + y v S Oe-t.0. 01 NAME ON PERMIT: GEORGE CRENSHAW, PO BOX 1421, MOORESVILLE NC 28115 Site Address: 8800 DOG LEG RD, SHERRILLS FORD NC 28673 Property Size: Square Feet:41,817.60 Acres:.96 Directions: MOLLYS BACKBONE TO AZAELA LEFT ONTO HOME PLACE SIGN 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 I 8A .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. Robbie Phelps 08/18/2016 AUTHORIZED STALE AGENT APPROVAL DATE ehpermit 08/19/2016 09:33 Avi-ii- 6- '10(6 - 073- 3 38 GatC1'o ha Cel:,ni.y `:fVIrOflfilefta Health wi l(. 8- 20((_ 0 7s 3,I "1<,•U 1 ,o(riolkitz. tzrr ._ 0 (len r ,.r 01,4 C. f�1 ti o { p, le Pe St • Ei H is • -41's, ,5s- 1 '3--y 83- I?ji1 • •• v5 rit; ✓ y9k V a` S4 /will ------7- IL-oka ��..------ ~__~ OOG LAG�O 1 ----\-- . . • • ----------------------------...-------------V" Parcel: 461902752332, 8800 DOG LEG RD 1in=50ft SHERRILLS FORD, 28673 This map/report product was prepared from the Catawba County,NC Geospabal Intomiation Services. Catawba County has made substantial efforts to ensure the accumry of location and labeling information contained on this map or data on this report Catawba County promotes and recommends the independent verification of any data contained on this map/report product by tee user.The County o:Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct.indirect or consequential which arises cr may arise from this map/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 0&1912016 I