HomeMy WebLinkAboutWELL-04-2018-098331 ■ WI,
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^6A CATAWBA COUNTY ❑c, r 1 NPLL-04-2018-098331
fUf Public Health Department �Rr. � � Subdivision
< ,' Environmental Health Division 4 }• '3 PIN# 373506372815
PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 �. i' , + LOTH
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NAME ON PERMIT: JONATHAN SPATZ, 4068 PINECREST DR, HICKORY NC 28601-8750
Site Address: 5593 37TH ST NE, HICKORY NC 28601
Property Size: Square Feet:51,400.80 Acres:1.18
Directions: Left off of Sulphur Springs Rd onto 37th St Dr NE, turn left on 37th St NE, property at end
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(ISA 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. 'line 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.
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04/17/2018
AU'INORIZED STATE AGENT APPROVAL DATE
Permit Expiration Date: 4/19/2023
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HA H CATAWBA COUNTY Case N .
.7 $ ,4 Public Health Department Subdivision
< ,�r4 „� Environmental Health Division PINI 373506372815
o 184 w PO Box 389,100-A Southwest Blvd,Newton,NC 28658
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NAME ON PERMIT: JONATHAN SPATZ, 4068 PINECREST DR, HICKORY NC 28601-8750
Site Address: 5593 37TH ST NE, HICKORY NC 28601
Property Size: Square Feet:51,400.80 Acres:1.18
Directions: Left off of Sulphur Springs Rd onto 37th St Dr NE, turn left on 37th St NE, property at end
Owner/Authorized Representative Acknowledgement of Permit Receipt
/(2 I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
l3 As the property owner or authorized representative, I have received the above referenced
j.permit(s) as requested in the application for service ltBP12-01-2018-28135, by the following method(s):
/Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/ E-mail (Return receipt required)
1 As the property owner or authorized representative I have reviewed and understand the specific conditions
o 'the permit issued, and further understand that all applicable regulatory requirements specified tinder the
North Carolina Laws and Rules for Sewage Treatment and Disposal Systems (ISA NCAC 18A.1900),
and/or Well Construction Standards (ISA 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: 04/17/2018
Owner/Authorized Representative Signature ..-_ 'I—
Date y/34//p /
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 Entail US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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http://www.surveymonkey.com/s/EHCusttomerService
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Parcel: 373506372815, 5593 37TH ST NE -, . 1in=60ft
HICKORY, 28601 • 40 1a4,;,
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This map/report product was prepared horn the Catawba County,NC Geospatial Information Sen ices. Catawba County has made substantial efforts
to ensure the ac Tracy,of location and labeling information contained on this map or data on this repon.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 ail damages,loss or liability,whether direct,indirect or consequential which arises or may
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Copyright 2014 Catawba County NC
04/17/2018