HomeMy WebLinkAboutWELL-09-2016-076492.TIF vhq CATAWBA COUNTY
4jE L Public Health Department Subdivision
47.c7 Environmental Health Division PIN# 365605189139
PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT# 2 A
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NAME ON PERMIT: ROCKY HILTON, 847 OAK ST, NEWTON NC 28658
Site Address: 2237 E MAIDEN RD, MAIDEN NC 28677
Property Size: Square Feet:435,600.00 Acres:10.00
Directions: E Main St toward E Maiden Rd, Property across from Withers Rd
// Owner/Authorized Representative Acknowledgement of Permit Receipt
�(U" I certify that I am the owner or authorized agent (owner's authorization required) representing the owner of the
property described above.
411•As the property owner or authorized representative, I have received the above referenced permit(s) as
requested in the application for service RBPR-07-2016-24344 by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
Y' .) AAs 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: 09/06/2016
Owner/Authorized Representative Signature (2,..—j�) ��-----_____
Date ?— ? - /(o
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
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ehpermit 09/07/2016 16:07
BA • CATAWBA COUNTY Q E.C, Case# WELL-09-2016-076492
E l Public Health Department I � 'N.A` Subdivision
v "r v H Environmental Health Division •L,.,} ;r I.._ PIN# 365605189139
°"t^ PU Box 389, 100-A Southwest Blvd,Newton,NC 28658 - Y� O LOT# 2 A
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NAME ON PERMIT: ROCKY HILTON, 847 OAK ST, NEWTON NC 28658
Site Address: 2237 E MAIDEN RD, MAIDEN NC 28677
Property Size: Square Feet:435,600.00 Acres:10.00
Directions: E Main St toward E Maiden Rd, Property across from Withers Rd
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 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 09/06/2016
AUTHORIZED STATE AGENT APPROVAL DATE
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Catawba County Environmental Health
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Parcel: 365605189139, 2237 E MAIDEN RD 1in=80ft
MAIDEN, 28650
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the independent verification of any data contained on this map/report product by the user.The County of 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 or may
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Copyright 2014 Catawba County NC
09/06/2016