HomeMy WebLinkAboutWELL-04-2018-098773.TIF agA CATAWBA COUNTY Case 0 WELL-04-2018-098773
^f 2 Public Health Department Subdivision
< ili 1) a v Environmental Ileallh Division PINII 366704639363
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'0- PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT/ 4
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NAME ON PERMIT: JEFF GRANGER, 3937 BAIN DR, MAIDEN NC 28650
Site Address: 3937 BAIN DR, MAIDEN NC 28650
Property Size: Square Feet:24,829.20 Acr s:0.57
Directions: Hwy 16 S, right Buffalo Shoals, 2 miles, left Bain Dr, last on left
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
�thhee property described above.
y () As the property owner or authorized representative, I have received the above referenced
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permit(s)as requested
permit(s))asrequested in the application for service EH PR-04-2018-28886, by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
AAs 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 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: 04/26/2018
Owner/Authorized Representative Signature / ) /..c.—CL4 � 7�tG�---
Date 7y�
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Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
. Permit transmitted by (name ofperson 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 wantt tto hear from yoiPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
ehpennit 04/26/2018 10:00
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_1H' � G\T..\w'&\COlLrry e r ■ Cased WELL-04-2018-098773.2'�.t.� , y Public Health Department 1�F+ "Pim Subdivision
oto ,_• Environmental Health Division I- •r F I'INd 366704639363
< n PO Box 389, 100.A Southwest Blvd,Newton,NC 28658 i• •r LOTl 4
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NAME ON PERMIT: JEFF GRANGER, 3937 BAIN DR, MAIDEN NC 28650
Site Address: 3937 BAIN DR, MAIDEN NC 28650
Property Size: Square Feet:24,829.20 Acres:0.57
Directions: Hwy 16 S, right Buffalo Shoals, 2 miles, left Bain Dr, last on left
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 ITER POSSIBLE SOURCES OF GROUND\\'ATER CONTAMINATION 1011 FT.
The well driller must verify all setbacks before drilling the well.
lithe wel l 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(I 5A 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 a County Environmental Health lth t(828)465-8270.
dTh 1/
04/26/2018
AUTI IORI''/.ED STATE AGENT APPROVAL DATE
Permit Expiration Date: 4/26/2023
elipcm:il 04/262018 10:00
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Parcel: 366704639363, 3937 BAIN DR MAIDEN, lin=40ft
28650 (J 4 p 8-
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the indeoendent verification of any data contained on this mao/report product by the user,The County of Catawba,its employees,agents,and