HomeMy WebLinkAboutWELL-06-2022-174606.TIF 4404 rt. CATAWBA COUNTY
•f• " Public}With Department Subdivision CHERRY GROVE
oli b 1 Environmental h ealth Division PIN 361909077168
PO Rev 3R4,2S Government[love,Newton,NC 2565t LOTH 15
Site Address 3925 CHERRY GROVE DR,HICKORY NC 28602
Name on Permit: 'BENJAMIN AGNEW
Property Size: Acres 1.64
Directions: Off Zion Church RD Left onto Cherry Grove DR tot is on the right
Owner/Authorized Representative Acknowledgement of Permit Receipt
4 certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
1(BA-As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-04-2022-40816,by the following method(s):
_ Received in Person
Facsimile'Transmittal(Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
134 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(I5A 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:06/27/2022
Owner/Authorized Representative Signature _ " s _._...._ .._.__._—._.....
li Date b `30 ,9- -
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature _ ._______ Date/Time to ' in (D)
Method: Fax V Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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�8i \ CATAWBA COUNTY Case# WELL-06-2022-174606
i.�-\ Public Health Department Subdivision CHERRY GROVE
d ,H Environmental Health Division PIN# 361909077168
PO Box 389,25 Government Drive,Newton,NC 28658 1,OT# 15
Site Address: 3925 CHERRY GROVE DR, HICKORY NC 28602
Name on Permit: *BENJAMIN AGNEW
Property Size: Acres 1.64
Directions: Off Zion Church RD Left onto Cherry Grove DR lot is on the right
NEW WELL PERMIT
REQUIRED WELL SETBACKS:
Septic Systems and Repair Areas for Single Family Dwellings 50 ft.
Septic Systems and Repair Areas for Businesses and Multi-Family Residences 100 ft.
Underground Storage Tanks 100 ft.
Animal Barns 100 ft.
Lakes/Ponds 50 ft.
Streams/Brooks/Creeks/Rivers 25 ft.
Building Foundations 25 ft.
All Other Sources of Groundwater Contamination 100 ft.
Saprolite Septic Systems and Repair Areas 100 ft.
Septic Systems and Repair Areas to Wells with 2 or more connections 100 ft.
PERMIT CONDITIONS
-ROAD R/W MUST BE MARKED PRIOR TO DRILLING.
-WELL MUST REMAIN ON PROPERTY AND OUT OF road R/W.
-WELL HAS TWO CONNECTIONS AND MUST BE 100 FEET FROM ANY SEPTIC SYSTEM.
Wells shall be constructed in accordance with state regulations:
Article I5A North Carolina Administrative Code Subchapter 2C
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:20 feet minimum
Casing Height: 12 inches minimum above finished grade
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.For questions or for more information,please contact Environmental I lealth.
371Wt 1471(
06/27/2022
Authorized State Agent Permit Issuance Date
6/27/2027
Permit Expiration Date
06/28/2022 10:17
4
Catawba County Environmental Health
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Parcel: 361909077168, 3925 CHERRY GROVE 1 in=50ft
DR HICKORY, 28602
This map/report product was prepared from the Catawba County.NC Geos atlal 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. Thu County of Catawba,its employees,agents,and
personnel.disdain,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 2021 Catawba County NC
06/24/2022