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CATAWBA COUNTY PERMIT DETAIL OLD INSPECTIONS REPORT d „ WELL � WELL-04-2018-098428 LB Z sM New Well CONTACT LIST Owner MOLENE BENFIELD,7424 OLD SHELBY RD,VALE NC 28168 GENERAL INFORMATION GIS PROPERTY ID#: 266703438525 STREET ADDRESS: 7424 OLD SHELBY RD,VALE NC 28168 PROJECT: PROJECT DESCRIPTION: New Well APPLIED: 04/19/2018 EXPIRES: 04/19/2023 ISSUED: 04/19/2018 STATUS: Issued RELATED PERMITS RELATED PLAN CASES PLAN CASE STATUS COMPLETED WORK CLASS DISTURBED ACRES EHPR-04-2018-28873 Under Review OSWP PLAN REVIEW NOTES FOR PERMIT ACTIVITIES DATE ACTIVTY COMMENTS 06/11/2018 Water Sample-Nitrate/Nitrite 06/11/2018 Water Sample-Inorganic 06/11/2018 Water Sample-Bacterial INSPECTION HISTORY SCHEDULED INSPECTION TYPE STATUS COMPLETED EH Well Record Received Eli Admin Approved 05/29/2018 EH Well Grouting Megen McBride Approved 828-465-8268 06/01/2018 EH GPS Data Collection Eric Price Approved 06/11/2018 EH Well Head Eric Price Failed 06/11/2018 Missing pump tag. Notified Roy Price to attach one. EH Well Head Eric Price Failed 02/03/2020 Still missing pump tag as of 2/3/20 Well Co(, nc- issued. \Nell head clic4 v04- reSS final ins fe . or- f'>-rpcmmidrt:nl old!'iv../E m:s 02/22/2023 09:35 Page I of I Catawba County Environmental Health eNPe`Dy-Za18'- Z8373 Well iocalioirl Srfe Plan (4) 78.45 0 /00.68 10 01 ,.a 9 6{1 o 5 •7 \l'ke Wail 3%61 245.72 •7446 Parcel: 266703438525, 7424 OLD SHELBY RD 1in=40ft VALE, 28168 This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy 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 the user.The County of Catawba,its employees,agents,and personnel,dsctaim,and shall not be held liable for any and ab damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. Copyright 2021 Catawba County NC 06/0212022 �\'r_ C.XIAWIBA COUNTY Case It WELL-N-2018-098,123 (/� km Public Health Department Subdivision C �r�< Environmental Ienith Division !'INU 266703438525 Vn" PO Ila 359,!OG..4 Southwest Glad,Neo;en,NC 23658 I.OTd NAME ON PERMIT: MOLENE BENFIELD, 7424 OLD SHELBY RD, VALE NC 28168 site Address: 7424 OLD SHELBY RD.VALE NC 28168 Property Size: Square Feet:328,006.80 Acres:7.53 Directions: Hwy 10 W to Old Shelby Rd.6th house on right, blue siding split-level w/coiumns at driveway Owner/Authorized Representative Acknowledgement of Permit Receipt /c mhbecrtify that I am the otcner or authorized agent(owner's authorization required) representing the owner of / the property described above. mhb4s the property owner or authorized representative, I have received the above referenced perntit(s)as requested in the application lbr service E111'R-04-21)18-28873, by the following method(s): __ Received in Person _ Facsimile Transmittal (Return form with signature required) v/Electronic Image Transmittal/E-mail (Return receipt required) t 1 bAs the property owner or authorized representative I have reviewed and understand the specific conditions ofithe permit issued, and further understand that all applicable regulatory requirements specified under the North Carolina haws and Rules for Sewage Treatment and Disposal Systems (ISA NCAC ISA.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:04/19/2018 �Owter/Authorized Representative Signature Molene Benfield Date 4/19/18 Documentation of Permit(s) Transmittal (permit transmitted by elect runic or other means) Permit transmitted by 1 J,Jr r, 6'r / (name of person sending permit) • Signature �c'}r}'i2.. Date/-Time 4'~��— I/: 2m Method: Fax mail US Mail Other r J" , . Owner's request to send by the above indicated method of transmittal in lieu of signature We wantt tto hear from yotPlease take a few momentts tto complete our customer service survey att http://www.surveymonkey.com/s/EHCusttomerService MO 142__ b2_rF (c(i } I .r=gm chmTni, 0409/20 IS 11:27 `13* • CXI'AWRA COUNTY ❑v ; O.. -_j� Case 4Case WELL-04-2018-098428 _,T [an ,y Public Health Depunntenl �ti� � r Subdivision �/!pr 5 Environmental Health Division ret -{1 I" 3 . PIN!' 266703438525 ti'fFw PO Box 369, 100-A Southwest Blvd,Newton,NC 23618 '�"• r IUD/ 842 s. it •:•. 71r Ora �u e . r NAME ON PERMIT: MOLENE BENFIELD, 7424 OLD SHELBY RD, VALE NC 28168 Site Address: 7424 OLD SHELBY RD, VALE NC 28168 Property Size: Square Feet:328,006.80 Acres:7.53 Directions: Hwy 10 W to Old Shelby Rd, 6th house on right, blue siding split-level w/columns at driveway 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 CON"I)WIINATION 100 FT. The well driller must verify all setbacks before drilling the well. l f 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(ISA 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 Inv sampling. Water samples will he drawn from an outside faucet unless otherwise specified. Please note that all water samples arc 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. V V'� 04/19/2018 AUTHORIZED STATE AGENT APPROVAL DATE Permit Expiration Date: 4/19/2023 ctipcmiis 04/19/2018 11:27 Catawba County Environmental Health 14a-L-O`l-2o(8-o` q2$ I I 1 1 I I ,IP fMGX S&j+' Aim I ❑ m 1 / ix w _ 0u ? / 0 i5' 2.5 f p Illy j well �f�v �' 1r. lot 40' I 39" ,, I AfEek \ 75' II &SI j I I 1 •1 Parcel: 266703438525, 7424 OLD SHELBY RD 1in=40ft VALE, 28168 This map/report product was prepared front the Catawba County, NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling info.matron 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 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 arise from this map/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 04/19/2018