HomeMy WebLinkAboutWELL-03-2016-069837.TIF T 1`. \ CATAWBA;OUNTI, Case# __ __,_,
.i•.lil G, Public Health Department Subdivision
4 - Y Environmental Health Division PIM 366601260271
1842
PO Box 389. 100-A Southwest Blvd,Newton,NC 28658 1.,0'r#
,
NAME ON PERMIT: MICHAEL GABRIEL, 3182 E MAIDEN, MAIDEN NC 28650
Site Address: 3182 E MAIDEN RD, MAIDEN NC 28650
Property Size: Square Feet:700,880.40 Acres:16.09
Directions: Coming from town of Maiden - its 1/2 mile past Buiffalo Shoals Rd on the Left- Brick house with green roon on
left of driveway and white house on right at driveway
Owner/Authorized Representative Acknowledgement of Permit Receipt
GOcertify that lam the owner or authorized agent(owner's authorization required) representing the owner of the
property described above.
CSZ IA-A the property owner or authorized representative, I have received the above referenced permit(s) as
requested in the application for service RBPR-10-2015-22628 by the following method(s):
/Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/ E-mail (Return receipt required)
t. _ 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: 03/08/2016
Owner/Authorized Representative Signature t
Date EtZtb62
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
Lehpermit 03/08/2016 09:04 Page 3 of 3
CATAWBACOUNTY ❑e °• � Case rt WELL-03-2016-069837
of •f Public Health Department HT1 _C%. ❑° Subdivision
< cit� „`�,- Environmental Health Division ,• PIN# 366601260271
PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 ° ,}LI LOT#
tpt
Dr. •
NAME ON PERMIT: MICHAEL GABRIEL, 3182 E MAIDEN, MAIDEN NC 28650
Site Address: 3182 E MAIDEN RD, MAIDEN NC 28650
Property Size: Square Feet: 700,880.40 Acres:16.09
Directions: Coming from town of Maiden - its 1/2 mile past Buiffalo Shoals Rd on the Left- Brick house with green roon on
left of driveway and white house on right at driveway
WELL PERMIT
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 otherwise specified. Please note that all water samples are taken durins
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 03/08/2016
AUTHORIZED STATE AGENT APPROVAL DATE
ehpermit 03/08/2016 09:06 Page I of 3
IgA • CAtAWBA COUNTY Permit# RBPR-10-15-22628
4 In
c-, 2 Public Health Department Name Michael Gabriel
d 3182 E Maiden Rd Maiden NC
Environmental Health Division
,' y PO Box 389, 100A Southwest Blvd,Newton NC 28658 PIN# 366601280271
842 yw (828)465-8270 Fax (828)465-8276 TDD(828)465-8200 Address
Site Plan Authorization to Construct
9_o of
to
l'«C
1 ; ,.,a,
ro 1
1.
N4
I 1
�^ ✓ I I
Qii`o C /
o o fi I ) 1
No/
a 1f i U
l
Q , c 3 a
I 9. / , ,
— ' , ' / •`
l 4 --k. I
/ / VSu
, �A
ua yU
65 Lil\ �°
5t
St1 IIIS 2 f� ,,..i
Oi
r
6 6 ' ZS'
Lcc(' 4 ,-p rl-
li ,/
TTTT C'lsJ `1p, .... 1 / ltl
V
toe_
*#
W ( t\ v c."
/7,,/.
1
ti'sb..... tl � ''.��)1v..rc-
Q r c
350 1 -- o c rt.t.,k
c- v‘.,) to r “d ol4.
I
iG , O g OCrc. J Sc c c I e�,4I o�L � i
Scale ti^