HomeMy WebLinkAboutWELL-09-2016-076367.TIF v,O • CATAWBA COUNTY Case#
' F i Public Health Department Subdivision
; �� Environmental Health Division PIM 268904746576
�ti,iP PO Box 389. 100-A Southwest Blvd. Newton. NC 28658 LOP/
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NAME ON PERMIT: DANIEL ESPEY, 1670 2ND ST NW, HICKORY NC 28601
Site Address: 6418 GREEDY HWY, HICKORY NC 28602 .
Property Size: Square Feet:393,346.80 Acres:9.03
Directions: Hwy 127 to Greedy Hwy, Go about 1.4 miles and property will be on the Right. # is on the mailbox.
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
property described above.
�/ As the property owner or authorized representative. I have received the above referenced permit(s) as
r requested in the application for service EHPR-07-2016-24331 by the following method(s):
Received in Person
eacsimile Transmittal (Return form with signature required)
lectronic 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: 09/01/2016
Owner/Authorized Representative Signature
Date
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by Auit' 11 $ ti .ti (name ofperson •en did ngperm(`iitt)
Signature MI Date/Time0 101.��
Method: Fax , Amail US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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ehpenni1 09/01/2016 10:32
t)A CATAWBA COUNTY Dr �' ` Q Case# WELL-09-2016-076367
�' Public Health Department T ' Y i Subdivision
��} yy r ' 268904746576
Q -'-^-'•�. � ,,, Environmental Health Division sr r PIM+"r1PI�� PO Box 389. 100-A Southwest Blvd,Newton.NC 28658CI q i• I et LOT#
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NAME ON PERMIT: DANIEL ESPEY, 1670 2ND ST NW, HICKORY NC 28601
Site Address: 6418 GREEDY HWY, HICKORY NC 28602
Property Size: Square Feet: 393,346.80 Acres:9.03
Directions: Hwy 127 to Greedy Hwy, Go about 1.4 miles and property will be on the Right. # is on the mailbox.
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 (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.
Steven Price 09/01/2016
AUTHORIZED STATE AGENT APPROVAL DATE
chile mit 0910172016 10:33
IP, AC,WELL EHPR 07-2016124331
6418 Greedy I-Ivry,Hickory
AC
• Do not cut, drive,fill, or grade over septic or repair areas.
• Septic system must be 10 ft from property lines; 50 ft from wells; 5 fl from building
foundations and appurtenances;and out of right-of-ways and easements.
• Install a new 1,000 gallon septic tank and 100 linear feet of 25%reduction system with
maximum trench depth of 20 inches; proposed (2) lines 50 ft each on contour.
• Final grade of septic area must shed surface water off and away from system.
WELL
• Well should be 5 ft from property lines; 25 ft from structures; 50 ft from septic systems;
and out of right-of-ways and easements.
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