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HomeMy WebLinkAboutRBPR-09-2022-42223.TIF /111...• THIS IS NOTA PERMIT Case# RBPR-09-2022-42223 Q 4 t . CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES I$' S" Residential Building Plan Review- Building Addition IMPROVEMENT- AUTH CONST- EXPANSION Applicant LEO CAMPBELL, I 58b5 KINLOCKE DR,HUNTERSVILLEN NC 28078 C:9199068253 LEOFCAMPBELL.PE53(i_iIGMAIL.COM Owner *JOSHUA REEF,7745 LYNWOOD LN,SHERRILLS FORD NC 28673 C:7049295763 JOSHREEP@HOTMAIL.COM • NAME TO APPEAR ON PERMIT *Joshua Reep SITE ADDRESS: 7745 LYNWOOD LN,SHERRILLS FORD NC 28673 PIN# 460604715328 NAME of SUBDIVISION: _ Lot $ 1 Section/Block PROPERTY SIZE: Square Feet Acres 0.93 DIRECTIONS: Slanting Bridge to Keistler store rd,r on Lynwood LN PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480=1 WATER SUPPLY: Private Well DESCRIBE WORK: 'New 25x50 Two Story Addition Attached by roof line and breezeway- 1st Floor Garage/storage-2nd Story living space-One Bedroom-2 Bathrooms,on slab-20x40 future pool with 250 sq ft of concrete around pool""Curre nt home is 3 bedrooms, inlaw addition will have 1 bedroom for a total of 4 bedrooms-Spectic to be sized for a 4 bedroom system SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is"YES",then supporting documentation is required: Does this site contain any jurisdictional wetlands? Yes Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: ACCESSORY DWELLING FACILITY TYPE: Accessory Dwelling OTHER DESCRIPTION: DESCRIPTION OF 62x75 SFD, 3 Bdrs, No Basement • EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 62x75 NUMBER OF EXISTING BEDROOMS: 3 (#OF OCCUPANTS: j ) PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 50x25 Acc Dwell 1 Bedroom #OF NEW BEDROOMS:: 1 Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: ehapplicatiun 09/09/2022 14:37 Page I of 3 • 4#11111111‘• T THIS IS NOT A PERMIT Case# RBPR-09-2022-42223 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1+ w Residential Building Plan Review- Building Addition IMPROVEMENT-AUTH CONST- EXPANSION Applicant LEO CAMPBELL, 15805 KINLOCKE DR,HUNTERSVILLEN NC 28078 C:9I99068253 LEOFCAMPBELL.PE53@GMAIL.COM Owner *JOSHUA REEP,7745 LYNWOOD LN,SHERRILLS FORD NC 28673 C:7049295763 JOSHREEP@HOTMAIL.COM NAME TO APPEAR ON PERMIT *Joshua Reep SITE ADDRESS: 7745 LYNWOOD LN,SHERRILLS FORD NC 28673 PIN# 460604715328 NAME of SUBDIVISION: Lot f 1 Section/Block PROPERTY SIZE: Square Feet Acres 0.93 DIRECTIONS: Slanting Bridge to Keistler store rd,r on Lynwood LN PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 600 WATER SUPPLY: Private Well DESCRIBE WORK: New 25x50 Two Story Addition Attached by roof line and breezeway-1st Floor Garage/storage-2nd Story living space-One Bedroom-2 Bathrooms, on slab-20x40 future pool with 250 sq ft of concrete around pool""Curve nt home is 3 bedrooms, inlaw addition will have 1 bedroom for a total of 4 bedrooms-Spectic to be sized for a 5 bedroom system SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is"YES",then supporting documentation is required: Does this site contain any jurisdictional wetlands? Yes Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: ACCESSORY DWELLING FACILITY TYPE: Accessory Dwelling OTHER DESCRIPTION: DESCRIPTION OF 62x75 SFD, 3 Bdrs, No Basement EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 62x75 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 50x25 Acc Dwell 1 Bedroom #OF NEW BEDROOMS:: 1 Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: ehappliwtion 09/09/2022 13:22 Page 1 of 3 CATAWBA COUNTY # RBPR-09-2022-42223 •(e.�..46. Public Health Department Subdivision • . y Environmental Health Division PIN 460604715328 PO Box 389, l00 A Southwest Blvd,Newton,NC 28658 Case w NAME ON PERMIT: (*JOSHUA REEP),7745 LYNWOOD LN,SHERRILLS FORD NC 28673 (*Joshua Reep) Site Address: 7745 LYNWOOD LN,SHERRILLS FORD NC 28673 Property Size: Square Feet Acres 0.93 Directions: Slanting Bridge to Keistler store rd,r on Lynwood LN Completed applications are valid for a period of 2 years.Improvement Permits are valid:with complete site plan=60 months(5 years),with complete plat =without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid.An Authorization to Construct issued for septic repair is valid for 80 months(5 years).Permits may be revoked if the information on this application/site plan changes or if the intended use for the proposed facility changes. Permits may be revoked if site conditions are altered such that they effect permit conditions or installation requirements I have read this application and certify that the information provided herein is true.complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. The undersigned is the owner of the property or legal agent of the owner. Date: Signature of Applicant or Agent If you need further information or assistance please call 828-465-8270 AREAS ITIMS: 30'from 760 contour line, attached with breezeway FEENAME DATE FEE AMOUNT Authorization to Construct Fee(New/Expansion) 09/09/2022 S300.00 Fee Improvement Permit Fee 09/09/2022 S 150.00 TOTAL FEES 5450.00 FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) ehapplication 09/09/2022 13:22 Page 2 of 3 catawba county public health Application for Environmental Health Services THIS IS NOT A PERMIT Application is fore ®New Construction ❑Existing Facility ®Improvement Permit V Authorization to Construct ❑New Septic ❑Septic Repair/Malfunction ❑ Septic Relocation V] Septic Expansion ❑ Existing System Inspection or Reconnection I ❑New Well _ ❑ Replacement Well ❑Well Abandonment ❑Well Repair Property Address 7745 Lynwood lane. Sherrills Ford. NC Acres .94 Subdivision Lot# 1 Driving Directions to Propertv slanting bridge road to keistler store road _right onto lyuwood lane. Describe work Adding/bedroom addition on to an existing house. Applicant Name Leo Campbell Applicant Address 15805 Kinlocke drive, hutersville, NC 28078 Phone 9199068253 Email IeofcampbelLpe530gmail.com Owner Name Josh Reep Owner Address 7745 lynwood In. sherrills ford, nc 28673 Phone _ Email joshreep@gmail.com Contractor Name Contractor Address _ Phone Email Name to Appear on Permit? ®Owner ❑Applicant ❑Contractor Who will be the Primary Contact? ❑Owner ©Applicant ❑Contractor Proposed New Construction-Residential Primary Residence ❑ New Residence ® Addition to Residence #of New Bedrooms*t--3' #of Occupants .4' Project Description 1'1\\AlA) 0441S.V.DA Structure Dimensions,also specify dimensions of decks&porches ea e , (Choose One) ❑Basement ®Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' ® Yes ❑ No Accessory Dwelling #of New Bedrooms*t 1 #of Occupants 2 Structure Dimensions 3 p X I)j (Choose One) ❑Basement ❑Crawl Space ® Slab If Basement,Will There Be Water Using Fixtures In Basement ®Yes ❑ No Retaining Wall>2' ( ] Yes ❑ 1 .) Accessory Structure(s)Describe ( inlaw addition 2 story 1st fl. garage/storage Structure(s)Dimensions 25' x 50' Plumbing ®Yes ❑No Describe Plumbing Needed 2 bathrooms (Choose One) ❑Basement ❑Crawl Space ® Slab If Basement,Will There Be Water Using Fixtures In Basement Q Yes ❑ No Retaining Wall>2' ® Yes ❑ No Multi-Family Residence #of Apartments #Bedrooms per Apartment*t Total#Bedrooms in Structure st #of Occupants Structure Dimensions (Choose One) ❑Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' ❑ Yes ❑ No Well Construction/Abandonment/Repair Proposed Well Type ❑ individual Well ❑ Semi-Public Well ❑Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown I Well Repair Requested ❑Yes ❑No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank?U Yes ❑No ufii e P'e — 10I X ¢v I. 2,6o ti Gat azre I140141AJD Paa- " Environmental Health le5 Catawba County Government Center, 25 Government Drive I P0. Box 389, Newton, NC 28658 rev Phone: (828) 465-8270 I Fax: (828)465-8276 I EHAdmin@CatawbaCountyNC.gov 1105 Existing Structures on Site Describe see primary res. above Structure Dimensions 62' x 75' #of Bedrooms * 3 #of Occupants 4 Basement ❑ Yes ® No Basement Plumbing ❑Yes © No Existing Water Supply ®individual Well ❑Shared Well—Number of Connections ❑Community Well ❑Comity/City/Township Water Line Is a public water supply available? ** ❑ Yes ®No Commercial ❑ Proposed New Construction ❑ Existing/Change of Use ❑ Repair Food Service Specify Type Dining Area(Sq. Ft.) #Employees per Shift #of Shifts Church #of Seats Daycare❑Yes ❑No #of Children #of Employees per Shift #of Shifts Commercial Kitchen ❑Yes ❑No Residential Kitchen ❑Yes ❑No Daycare#of Children #of Employees per Shift #of Shifts Business/Other Specify Type Structure Dimensions Retail Floor Space #of Employees per Shift #of Shifts Other information Calculated Design Flow,Commercial f (This value will be determined by EH staff) The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in question. If the answer to any question is"yes",applicant must attach supporting documentation. Q Yes ❑ No Does the site contain any jurisdictional wetlands? 15i Yes 0 No Does the site contain any existing wastewater systems? O No Is any wastewater going to be generated on the site other than domestic sewage? Yes f�No Is the site subject to approval by any other public agency? O Yes l No Are there any easements or right of ways on this property? Describe If applying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) ❑Accepted 0 Alternative 0 Conventional I33 Innovative 0 Other ❑ Any *Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as a bedroom and counted on all applications. The number of bedrooms will be confirmed by rooms identified on floor plans as a bedroom at the time of building permit :ssuance. This may prevent the need for septic system expansion in the future. t If structure is plumbed but has no bedrooms,calculated design flow will be determined by EH Staff. **If No,a well permit must be issued with the Authorization to Construct. RETRIP TO THE PROPERTY AND/OR SYSTEM REDESIGN WiLL INCUR AN ADDITIONAL CHARGE(SEE FEE SCHEDULE) Environmental Health soillsite evaluations require digging,augering,and/or probing into the ground. Property owner/applicant is responsible for marking all underground utilities,including but not limited to:underground power,cable,telephone,gas,water lines,and irrigation systems/sprinkler systems.Catawba County Environmental Health is not responsible for damage to unmarked utilities. Completed applications are valid for a period of 2 years. Improvement Permits are valid:with complete site plan=60 months(5 years); with complete plat=without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid. An Authorization to Construct,issued for septic repair is valid for 60 months(5 years). Permits may be revoked if the information on this application/site plan changes or if the intended use for the proposed facility changes.Permits may be revoked if site conditions are altered such that they effect permit conditions or installation requirements. I have read this application and certify that the information provided herein is true,complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. The undersigned is the owner of the pro. or local agent of the owner. 40. Signature of Owner or Legal Agent or ' �. EN' Date 9-8-22 Printed Name of Owner or Legal Agent leo Campbell • Catawba County Environmental Health •T752 ,(•,? 103.00 fir • 0,7% 6. 5 CP * 41 45 * 11. 4'� 128.29 it 4� 1` -S la lc/ '-''.‘.,:, ' '''-:-. c- ryb44111 :,:.11.::' 1 cr IZP 1eP. co 11/3 153.03 1t r .56 VT 25.62 ? isii ITS„ �' , i (382) 16.93 Parcel: 460604715328, 7745 LYNWOOD LN 1in=60ft SHERRILLS FORD, 28673 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,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 2021 Catawba County NC 09/09/2022 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 460604715328 Owner: REEP JOSHUA ERIC Parcel Address: 7745 LYNWOOD LN Owner2: REEP MARIAN GREER City: SHERRILLS FORD, 28673 Address: 7745 LYNWOOD LN LRK(REID): 801915 Address2: Deed Book/Page: 2865/0106 City: SHERRILLS FORD Subdivision: State/Zip: NC 28673-9228 Lots/Block: 1/ Last Sale: School Information: School District: COUNTY Plat Book/Page: 52/146 Elementary School: SHERRILLS FORD Legal: LOT 1 1 PL52-146 LYNWOOD LANE PL Middle School: MILL CREEK 52-146 High School: BANDYS Calculated Acreage: .930 Tax Map: School Map Township: MOUNTAIN CREEK State Road #: 1999 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoningl: R-30 Building(s) Value: $384,000 Zoning2: Land Value: $33,500 Zoning3: Assessed Total Value: $417,500 Zoning Overlay: CRC-O,WP-O,FPM-O Year Built/Remodeled: 2007/ Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permit Address Search for this parcel. Firm Panel #: 3710460600J If available, Building Permits for this parcel. Septic 2010 Census Block: 4041 links are not permits. 2010 Census Tract: 011504 Septic Final Permits prior to 08/2018, contact Agricultural District: Environmental Health. }� Cc. Building Details C 1 1-�t�cn�l �o�� ,� 3bejco�r�, lc.\aQ..) WaterShed: WS-IV Critical Area [ Qr\ tid lr, ff To Voter Precinct: P41/ Voting Map �J( 1 r (1, -kat Parcel Report Data Descriptions � 4 I .cck �� * > � C'„ Li List all Owners Deed History Report Assessment Report' •��— 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,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. ©2022, Catawba County Government, North Carolina. All rights reserved. .' 4,. wAlvgwwfllrw.IrlUwlrRWw `. 5 iliX4iiiFii1Fw11M.L110i6�11 111111 f CI • 11111111111111111111111) /-* ; *I iiiIIIiiIIIUI!1lIIIilhP f IA Y t,�, �.� 'q ' `1 • 7. : :I.,... / ., _. , *7-.4.-. \ 48, ,.........., . › ./.$4‘ • . , ..•-•-• \ , ‘, 4. N"'- ' 1 \ • .•' . It It.1 1' r1 ,i, 4rt' \ 1 li ei ,,,v4:4-% ‘ 4...er. w .. ' A ♦\ 1 a I /".... \\ ** ‘1. ' ,-....--A ,. , ‘ (yr. .....„, „,„ \ v. _ ti. \ . ‘ r/dr IP.. tea ,s, . ‘ .:\ -_,, ,--, _,... 1cr 2.1 .1� y d y t C -% a _ ‘‘ 0., Ni,. .,.. i. 10, _I i TI am^ t ..' Am t1N+ej - ‘ \ 515 \ ' icick." , 4 ` • t . . .4 ♦‘ f ♦ P 1 • COPY OPERATIONS PERMIT FOR TYPE III WASTEWATER SYSTEM PERMIT NUMBER W1s2007-00395 In accordance with the provisions of Article 11 of Chapter 130A, General Statutes of North Carolina as amended, and other applicable Laws and Rules. PERMISSION IS HEREBY GRANTED TO Joshua Reep operation of a wastewater collection, treatment, and disposal LA system to serve: PIN NUMBER 460604715328 pursuant to 15 A NCAC 18A t) . 1900 et seq. and in conformity with the application, improvement permit, and other supporting data subsequently filed and approved ,4 by the Catawba County Health Department and considered a part of ti this permit . 4 CAI Facilities to be served: (Address and specific type of facility) 3 Bedroom Residence 7745 Lynwood Dr Sherrills Ford NC 0 System Type IIIbg ock The approved wastewater collection, treatment, and disposal system y consists of : (1) 10g,llon Septic Tank, 1000 Gallon Pump Tank (2) UptucklIhmacrEffluent Pump (3) Pump eb pressure manifold (4) 4 trenches 25% reduction infiltrator (3' x 75' ) The owner shall be subject to all applicable provisions of Article 11 of Chapter 130A of the General Statutes and 15A NCAC 18A . 1900 et seq. The owner is especially referred to Rules . 1935 (31) , . 1937 (e) , . 1938 (g) , . 1945 (a,b) , . 1950 (a through i) , . 1961 (a through d) , . 1965, . 1967, and. 1968 . The owner shall also be subject to the following specified conditions and limitations as they apply: I . GENERAL CONDITIONS • This permit is effective only with respect to the number and type of proposed facilities and volume and nature of wastes specified. In the event that the facilities fail to perform satisfactorily, including the creation of nuisance conditions, the Owner/Operator shall take immediate corrective actions to correct the problem, including actions as may be required by the Catawba County Health Dept . , such as the construction of or replacement of wastewater treatment or disposal facilities, upon receipt of a repair permit . The septage generated from this system shall be disposed of in accordance with Article 9 of Chapter 130A of the General Statutes and 15A NCAC 13B . 0100 et seq. and in a manner approved by the North Carolina Division Of Solid Waste Management . The issuance of this permit shall not relieve the Owner of the responsibility for damages to surface or groundwaters resulting from the operation of this system. Neither does the issuance of this permit exempt the Owner from complying with any and all statutes, rules, regulations, or ordinances which may be imposed by other government agencies (local , state, and federal) which have jurisdiction. This permit may become suspended or revoked if the soils fail to adequately absorb and treat the wastes or if the facilities are not maintained and operated as designed. The system must be operated and maintained in a manner which will not create a public health hazard or nuisance by surfacing of effluent or discharge directly into ground water or surface water any time during the operation of the system. Adequate measures shall be taken to divert stormwater from the disposal field area and to prevent wastewater runoff . Diversion or bypassing of the untreated wastewater from the treatment facilities is prohibited. Prior to the transfer of this land to a new owner, a notice shall be given to the new owner that gives full details about the system and the materials applied or incorporated at this site . At the time of the sale of the property a new Operations Permit will have to be issued. Operations permits are nontransferable . The designated repair area shall be reserved for the installation of additional nitrification fields and is not to be covered with structures or impervious materials. No addition, expansion, alteration or other repairs shall be made to the wastewater system without first obtaining an improvement permit from the Catawba County Health Dept . in accordance with GS 130A-336 . Failure to abide by the conditions and limitations contained in this permit may subject the Owner to an enforcement action in accordance with North Carolina General Statute 130A-18, 130A-22C, 130A-23, and/or 130A-25 . In the event that the facilities fail to perform satisfactorily, including the creation of nuisance conditions, the Owner/Operator shall contact the Catawba County Environmental Health Section of the Health Dept . within 48 hrs . of discovering this failure or problem. A suitable cover, preferably fescue, shall be maintained over the drainfields . Grassed areas shall be kept mowed and the clippings and other debris removed as needed to prevent thatch build-up. No traffic (including parking of RV' s, boats, trailers as well as other vehicles) or other equipment shall be allowed on the drainfields with the exception of mowing equipment . Non-biodegradable products (plastics, metals, etc . ) chemicals (disinfectants, drain cleaners, acids, alkalies, pesticides, petroleum products, etc. ) or grease shall not be discharged into the septic system. The owner shall keep the plumbing system in the facility in good repair and eliminate leaks, drips, or excess flows as they are found. Use of ultra low fixtures and conservative water use practices are recommended. PERMIT ISSUED THIS THE Up DAY OF /.�'� , 2007 . CATAWBA CO. HEALTH DEPT. etw er S'gn ture ENV RONMENTAL HEALTH SECT. S. ' Ri o• CATAWBA COUNTY • U,;l_ @`fit Public 1-lcaltli Department Case# WLS2007-00395 I 1 1 Envi onwentill Heakh Division Subdivision 1'1 - -// PO Box 389,IUD-A Southwest Blvd,Newton.NC 28648 Sect/13UPh/Lit# 1 `. 828)4 )�..,.�,, ,� ( _ , 65=S27t1 FAX fx2x 4G5-x27b TDll(828)465.8200 PIN# 4606U4715328 Applicant/Owner: JOSHUA REEP Site Address: 7745 LYNWOOD LN Sf IERRILLS FORD NC Property Size: SF .94 ACRES Directions: HWY 16 TO DENVER/ Li ON CAMPGROUND RD/TURN INTO SLANTING BRIDGE RD/RT ON KEISTLER STORE RD/RT ON LYNWOOD LN/4TH LOT ON LT Catawba County Health Department Operation Permit 10..q-01 ‘Arl +o_4457 Q Lt`.4..e-5 1 7914 fu f 'PI 24ed. 0 17, IQ-I Lo- Ica' aLcl ii,...._ cloidok. Pk. hp ..,. 019 System Code System Type: Description: "l T�� LLLC , "fe; ypes V and V stems expire in 5 years. (In accordance with Tat31e Va) Owner must contact health dep rtment 6 months prior to exiratlon for permit renewal. PERMIT CONDITIONS: 1. Performance: System shall perform in accordance with Rule.1961. II. Monitoring: As required by Rule. 1961. III. Maintenance As required by Rule. 1961. Other: Subsurface system operator required? Yes No If yes, see attached sheet for additional operation conditions, maintenance and reporting. IV. Operation: This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and All conditions f the Improvement Permit and Construction Authorization. 1-Irm, i4 .f r0s MI-NI -al-0 System Installer Ins a lation ate u iz ae en &D-lill O"1 Date of Operation Permit Issurance Form F r,V idn na rk1 F-n nn l vit7sa w,.ry i '• 1) —�� CA'�'AVVl3�► COUNTY Case# WLS2007-00395 7ye--mac., �,PatbliVhcaltli bepartutent ) iiuvinum ttal Health Division Subdivision \'\ l j PO Box 89,3 100-A Southwest Blvd,Newton,NC 28658 SectBLfPh/Lol# I \'` � (828)465-8270 FAX(82,8)465-8276 'MD(828)465 8200 / PIN# 460604715328 Applicant/Owner JOSHUA REEP0 Site Address: 7745 LYNWOOD LN SHERRILLS FORD NC Property Size: SF .94 ACRES Directions: HWY 16 TO DENVER/LT ON CAMPGROUND RD/TURN INTO SLANTING BRIDGE RD/ RT ON KEISTLER STORE RD/RT ON LYNWOOD LN/4TH LOT ON LT , Improvement Permit Permit Valid For: Five years No Expiration . _.. Facility(Residential): House House X Mobile Home Multi-Family Bedrooms 3 New? _ Addition? Projected Daily Flow g.p.d Water Supply Private Well? Public? Semi-Public? Basement: N Basement Plumbing: N HotTub/Spa: N Special Fixtures(explain): Proposed Wastewater System: Type: Proposed Repair: Permit Conditions: — — - - ---- Owner or Legal Representative Signature: Date: Authorized State Agent: Date: The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the applicant/property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are met. This Improvement Permit is subject to revocation if the site plan,plat or the intended use changes,or if site conditions are altered. The Improvement Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina 'Laws and Rules for Sewage Treatment and Disposal Systems' (15A NCAC IRA.1900). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for ahy given period of time. Authorization to Construct Wastewater System (Required for Building Permit) * See site plan and additional attachments(_____ _) . Propos d Wastewater System:� n 5—JG je : Type: 3 k _ Wastewater Flow at g-p.d New ,( Repair xpansi Soil LTAR: C ... g.p.dJft2 Type of Facility: Basement: N Basement Plumbing: N Hotlub/Spa: N Special Fixtures(explain): Wastewater System Requirements Tank Size: Septic Tank )O04 gal Pump Tank 1b gal Grease Trap gal Dralnfield: Total Area: `ISq ft Total Length: Maximum Trench Depth in Trench Width `3 ft Minimum Soil Cover ( p Minimum Trench Seperation LP ft Distribution: Distribution Box SerirfDistribution Pressure Manifold X LPP Other Additional Specifications: Authorized State Agent: / Date: ZQ Permit Expiration Date: 0'2' /9. /2 I have read and accept the specifications and all conditions of this permit as indicated. 1(\ Owner or Legal Representative Signature: 1 y,,,4 • r, Date:• 7j . 7 dgq _/U�' Form B rATidnn.,,AFannYnr(s..w.ra, r '1-'"` --i CATAWBA COUNTY ' I "i\ Puh]it Health Depa truant • Case# WLS2007-00395 • ' / 1ti Sulidivision �L j Environmental l lealzr Division \,'\ T ,/ PO Box�89,100-A Southwest Blvd„Newton,NC 28658 Sect/I I JPh/Lot# I ; , ' (828)465-8270 FAX(828)465-8276 TDD(828)46.5-8200 IIN#/ 4606047t532S • Applicant/Owner JOSHUA DEEP Site Address: 7745 LYNWOOD LN SHERRILLS FORD NC Property S SF .94 ACRES Directions: I iWY 16 TO DENVER/LT ON CAMPGROUND RD/TURN INTO SLANTING BRIDGE RD/ RT ON KEISTLER STORE RD/RT ON LYNWOOD LN/4TH LOT ON LT ® Improvement Permit © Authorization To construct Eti Weil t'ermil • SITE PLAN o 1 _ - f_e A-w y11,><.L�r' I . • " rvlanu4 ,I, p�� sic, - ibvi -GurvkajuiPt-t-e--. I 5 tt 0 ►A- Le-5 •C. rii-t ... - l : 0 � p-1/77 -7-7--RiTcu-" - I W' -Priffrvl wail Lid � " - 10 r • YOYVI- ; , , 41 I 2.0 4ez S - om i. tY' r1 ti� v A t, e l- dri yr r cQs 3 kkiji / 1....„ D Lou 174 .0, Scale System components represent approximate co urs only he contractor must flag the system prior to beginning the installation to ensure that proper grade is maintai . I. not install system under wet conditions. This permit is subject of revoc tion if the site plan or site conditions are alter e. 3, zi..)• 40-7 uthor' .ed Stat gen Date form C ,\lidcmark\tormIVW(\'auu.rvi .� --t: CATAWBA COUNTY Iy u\,Publid Health tjepaAtnent Case# WLS2007-00395 r ) Envimunental Healilt Division Subdivision ;,'\ % PO Box 389.100-A Soutlnvest Blvd.,Newton,NC 28658 Sect/III/Pit/Lot# 1 ‘` ,yam 1 (828)465-8270 FAX(828)465.8276 TDD(828)465-8200 PlN# 460604715328 Applicant/Owner: JOSHUA REEP Site Address: 7745 LYNWOOD LN SI- RRILLS FORD NC Property size: SF .94 ACRES Directions: HWY 16 TO DENVER/LT ON CAMPGROUND RD/TURN INTO SLANTING BRIDGE RD/RT ON KEISTLER STORE RD/RT ON LYNWOOD LN/4TH LOT ON LT WELL PERMIT Proposed Use: Private ✓ Public_ Semi-Public Other GROUTING DEPTH: MINIMUM 20 FEET SETBACKS: 1. BUILDNO FOUNDATIONS 25 Fr. 5. UNDERGROUND STORAGE TANKS 100 FT. 2. EXISTING&PROPOSED SEPTIC SYSTEMS-MIN. 50Fr. 6. STREAMS/BROOKS/CREEKS 50 FT. 3. EXISTING&PROPOSED SEPTIC REPAIR AREA-MIN. 50 FT. 7. LAKES/PONDS RESERVOIRS 50 Fr. 4. SEWAGE PUMP SUPPLY LINE 50 FT. ALL OTHER POSSIBLE SOURCES OF GROUND WATER CONTAMINATION 100 FT. The well driller nmst verify all sepearations are adhered to before drilling the well. If the well driller is unable to maintain any of the above separations,contact the Iiealth Department at(828)465-8270 before drilling the well. SEE SITE PLAN FOR PERMITTED WELL LOCATION �.rl. L 3.ao•i Tssnt+ll Ili: ll Permit Issuance Date: )t... Customer Sigoat re: WELL INSPECTION: GROUTED DEPTH: 20' DATE: 5'4.01 INITIALS: APPROVED CASING: PVC STEEL DATE: I INITIALS: CASING HEIGHT 12" ABOVE LAND SURFACE ✓ DATE: INITIALS: 1 WELL COMPLETION REPORT RECEIVED DATE: INITIALS: WELL HEAD APPROVED V DATE: Le-15't71 INITIALS: Well Driller Date Drilled Well permits are valid for 5 years from the date of issuance and are subject to suspension and/or revocation fro non-compliance with appropriate state and local rules and regulations,or if false information was given in order to obtain a permit. Wells shall be constructed in accordance with all state and local regulations and rules. The Well Completion Report must be submitted to the Health Department within 30 days upon completion of a well. alCiA.1. /'� l0'f*Sr 7 Authorized State ent Final Approval Date Form D r:VSAmmrk\P ,,,Va7Sr,r,p rn, DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES Sheet of DIVISION OF ENVIRONMENTAL HEALTH PROPERTY ID ti: 'ON-SITE WASTEWATER SECTION COUNTY: • SOIL/SITE EVALUATION WLS 2vo"7 . taGnd s for ON-SITE WASTEWATER SYSTEM OWNER: JOS-h OS APPLICATION DATE /-.2."D ADDRESS: 1 1'15 1 lin,►.)oi c DATE EVALUATED:of•/le-0-7PROPOSED FACILITY: PROPOSED DESIGN FLOW(.1949): 3(oD PROPERTY SIZE: LOCATION OF SITE: PROPERTY RECORDED: WATER SUPPLY: JV Private 0 Public 0 Well 0 Spring 0 Other EVALUATION METHOD: 0 Auger Boring Ng Pit 0 Cut - GG ors)* �/� TYPE OF WASTEWATER] 0 Sewage 0 Industrial Process 0 Mixed ................... . : P: ......................... : : .......... .. ................... ....................... .1940..... . .. L 194I 3. . ............. tlK�►IY" : • ,1 .. ; S -A :fin : 19i11 : 19d1 SO1L 94 1956 i44; PROPILR-i +icE1 WTNES! : SOIL SAl RCR•ESIR:]16 POSTION! DEPTH :::.rt.tUCTUR :. .. GoNSLS1R . . . . . CLASS ;:: . .SLOPE+f. ......��) .. : TF��R��•: ::' ......i1UQGY.:. ::: CO;OR:[:[ ::DEPTfi .:.�I~ :::. �i(R� dLTAR:. 0-ram 5CL- 'Pr /i-#8 e It._ pi i° 1 yS . , 3 a-/9. & 1g-4ea c emu_, • s3 1 3 • DESCRIPTION INITIAL SYSTEM REPMR SYSTEM OTHER FACTORS(.1946): � n l� G SITE CLASSIFICATION(.194$): /5 Available Space(.1945) Me Sys-tern Type(s) Alit, d C 6 led EVALU�THER(SATED ) BY: Ping' r .I � PRESEA[T: Site LTAR . 3 , 3 COMMENTS: • • LEGEND use the following standard abbreviations SOIL CONVENTIONAL LPP MINERALOGY/ LANDSCAPE POSITION GROUP TEXTURE .1955 LTAR* .1957(,TAR* CONSISTENCE STRUCTURE CC(Concave Slope) I S(Sand) 12-0.8 0.6.0.4 NE3CP(Non-expansive) G(Single Grain) CV(Convex Slope) LS(Loamy Sand) SEXP(Slightly Expansive) M(Massive) D(Drainage Way) EXP(Fvpancive) CR(Crumb) DS(Debris Slump) II SL(Sandy Loam) 0.8-0.6 0.4-0.3 CR(Granular) FP(Flood Plain) L(Loam) SBK(Subangular Blocky) FS(Fool Slope) ABK(Angular Blocky) H(Th'M Slope) )31 . SCL(Sandy Clay Loam) 0.6-0.3 0.3-0.15 PL(Platy) L(Linear Slope) Sit.(SW Loam) PR(Prinnatic) N(Nose Slope) CL(Clay Loam) R(Rldge) SiCL(Silty Clay Loam) MOIST WET S(Shoulder Slope) Si(Silt) T(Terrace) VFR(Vey Friable) NS(Nor-sticky) IV SC(Sandy Clay) 0.4-0.1 0.2-0.05 FR(Friable) SS(Slightly Sticky) SiC(Silty Clay) Fl(Fine) S(Sticky) C(Clay) VF1(Very Fem v.Very Sticky) VS(Vey Stay) 0(Organic) None EI'l(Extremely Firm) NP(No-plastic) SP(Slightly Plante) *Adjust LTAR due to depth,consistence,structure,son wetneq landscape,position,wastewater flow and quality. P(Plastic) NOTES VP(Very Plartie) HORLZONDEPTH In inches below natural soil surface DEEM OF FILL In inches from land surface RESTRICTIYEHORIZON Thickness and depth from land surface SAPROLITE S(suitable)or U(tmsuitable) SOIL WETNESS Inches from land ewface to free water or inches from land surface to soil colors with clrorna 2 or less-record Mumsoll calor chip designation CL(SSIFICATION S(Suitable),PS(Provisionally Suitable),or U(Unsuitable) Evaluation of sapnolite shall be by pits. Long-tern Acceptance Rate(LTAR):gal/day/ft Show probe locations and other site features(dimensions,reference or benchmark,and North). i S it a a••••••o o a i s tr i P y r �/ 1 [ ••+ i • e a •a a a a••.•.•a E I : i . i i r i I i i i i. ) [ 1 4......J i.»..........4 4 e.._.-a a S i 4 4 4 f a a 4 i r i o•••••q•••• r i + a a a a 4 4 a t a•....y..---a-....a .a 4 a ........«.«a.�..a._W� o a.........._._... i 1 i j»...a.»..»».....a a•---.o a a 1. tr a a F11 i1(..........) a a } a iri riiip1 Yii t i ) ii......a a....................o 4 0..•.., a...--.a 4L a iis i [! i : r [ :i i I { i I 4 • r r n e••--•4 r r-•---r a * a 4•-•-•a r r r i i i i e } ` r • t a....-.a F i ir.............r...... .1....4 : a......4 e ! 4 e i 1 i i r i r 1 a ----........a +.-••••4 : e i•••••••b r t d a t i i I i: 1 1 • I i [ [ DENR(#k444) Review(k##8K) • • • TilIS IS NOT A PERMIT wLS# • CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Servic IP AC-S. T. Rpr. Exist. S. T. — --'- Well Print. Replacement Well I. Name to Appear on Permit 1Hi4A E . k 4-. jo 2. Permit Requested By Tsyu,I e. /E'EE14 Address � Z V Business Phone ap y1- ��?,�- �[�e Qu ',c,4'4, D • dig G'oserinlr'ur Alet,94/(Home Phone 7a5'- 3 o 9 -28?V .7. 3. Property Owner Aonni e . DeM o,p Sol, WV '4ePtve a /VG Z 5/03 7 Business Phone Address p 70`f- z/$� - ��9 4. Name of Subdivision o,� � Home Phone 7�`f -Y$�-/�p� • 'omit. Perim ' PQtittleict S-, dOci pa.1 Lot# / Section/Block/Phase Property Address 7711 S- Lyhioroci In S4e,e,,tr,•//r Ca,/ /VC 673 Directions to Property: fltu y Ho -to Pen vc le j L aft en ea. .,ci res.,.c.6 4J --corn- ;„/- 4h/ r :of A� la f Oto )S.ti4-3len. S-It:,n•e_ f. 1..1- en L h I.�toC / j 4 4of orti Le?f . + Lf t>•wj 5. Property Size: Square Feet 4' f /7 Acres 4 • 95/ Date Platted/Recorded /Z — 6 TYPE OF FACILITY: House //— Z 0 o a X Mobile Home Dimension of Structure ' / 62' ,''�Y roo..a � .e n e� c'i�°for�s � � Yi X p'Bedroorns* 3 th � re h +� /'af`e 2 6 .rp 4,,11.; 3 ;. 7,- ; v� G , -, , e i.9 '-'�ri e S ';�^ ,. .,.. ,,, . o rt�C o It[e i¢Td,,i, °� . t> vt¢tCa 3 1x11, r,..t7t"ut t1V1I '1l�tIp flrrt 1,`�ttx .)l"Y 1'f� �.'�XUf41(10C. ., 11)kai. PI I tt.i:,,,1It�$iifti f + ,Al Eli,he;,t¢, d6,,:oyea , sycpg. fit} '? i 1S •i:1 T- a"tt '�� 7 6 c1.6. } r. )- ,q t:.. ::f..wr 1,a' ,:" Aj`:hly�X�LilI�i, l`.1�11'�:.Ls�"C�X.li��l,.lEt.:t t: Basement: yes67 Water Using Fixtures in Basement: ye No, in Family Z Whirlpool Tub yes t9 Gallon Capacity N/A MULTIPLE FAMILY RESIDENCES: Units N/4 Total Number of Bedrooms A//Iq DAY CARE: Number of Children NIA RESTAURANT: Seats /V/,q Square Feet Dining Area N/4 Square Feet Food stand/Meat Market Floor Space l4/01 TYPE OF BUSINESS: 1\1 J11 Number of Employees 1st 2nd OTHER: (Specify) r 3rd Nr A 7. Do you anticipate any additions to Facility? Yes / \lp If so, describe: N 8. Has any grading, removal, or addition of soil been done to this property? Yes C9 If so, describe: ,U/A 9. Are there easements/right-of--ways recorded on this property? Yes /01 10, Is a public water supply available on or adjacent to the above property? Yes /U Check type that is available: [ ] Community well [ ]'Semi-public well **If No, a Well Permit must be issued with the Septic Permit.** [ ] County/City/Township water line 11. Monitoring Well Request? Yes /e19 #of wells Name of Site 4/4/ I understand that this is a formal application for a well permit, Improvement Permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is transferable and b`e r •i1 . , but be revoked if thisplans or intended use changes for the proposed facility• Authorization to construccttay issued by this department sation vali, site d for (5) five years from the date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. **IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE T HE PROPERTY,THERE IS AN ADDITIONAL$50 CHARGE.** Dat, 1—[ t -Gr Signature of Owner or Agent ___KILLy 4 (FOR OFFICE USE ONLY) Please Cont- between 8 am and 9 am Phone ** I have cor find tthat no municipal water line exists adjacent to the above property if well permit is being issued.** Signature \i) `. . Date 3 r — 0 � �'"_-mac\ . 3/14/2007 3 O CATAWBA COUNTY 10:07AM ,/ a�7 j ZONING AUTHORIZATION PERMIT 1~ U *•�• RESIDENTIAL d( PO BOX 389 PERMIT NO.: ZON2007-00322 v �. F. J !/ 100 A SOUTHWEST BLVD NEWTON.NC 28658 APPLIED: 03/14I2007 \ \ �, ISSUED: 03/14/2007 _ _� / // PHONE 828-465-8380 EXPIRES: 09/14/2007 `Ig 4? / FAX 828-465-8484 Applicant: Owner: Contractor: JOSHUA REEP RONNIE DEDMON 18824 NAUTICAL DR#32 PO BO 494 CORNELIUS NC 28031 DENVER NC LOCATION: PIN NUMBER 460604715328 E-91 I ADDRESS 7745 LYNWOOD LN CENSUS TRACT 115 SETBACKS TYPE OF PERMIT: SINGLE FAMILY RESIDENTIAL Front 30 Side 15 INFORMATION: ZONING CLASSIFICATION: R-30 Rear 30 SIZE OF LOT: 0.94 100 YEAR FLOOD PLAIN? Y Maximum Wall Height: 35 FLOOD PLAIN,STRUCTURE? N PROPERTY OWNERSHIP PVT I. Before an inspection can be made by the Building Inspection Office,the applicant must pull a string to designate the side and rear property lines where the structure is being placed or constructed. 2. Home shall be placed on the lot in harmony with the site-built structures,or have the front door face the road frontage. COMMENTS: SINGLE FAMILY DWELLING/ATTACHED GARAGE/FINISHED BONUS ABOVE GARAGE I NO BASEMENT/LOT a The applicant hereby certifies that all information and attachments to this Certificate of ZoninaLCompliance are true and correct,and acknowledges that this permit was issued on the basis of the information required herein. The applicant further acknowledges that any construction,alteration or addition which differs from this application shall be subject to removal or alteration so as to bring said structure into conformance with the specifications and standards of the Catawba County Zoning Ordinance. Such corrective action shall be at the expense of the applicant. It is the responsibility of Applicant to comply with all existing deed restrictions pertaining to the property. Issuance of this permit is not certification of such compliance and does not relieve Applicant of the duty to comply. **This Zoning Authorization Permit shall expire six months from the date of issuance unless a building permit is secured and remains active. I C 1 yi Fees I 'ANTS SI RE Type By Date Amount Residential Permits RAG 03/14/2007 25.00 ZONING APPROVED BY ***ZONING FEES ARE NON-REFUNDABLE*** r:\TidemarkFForms\lZONRESprmt.rpt CATAWBA COUNTY rr..' Case# Wl ti2uu7-oO u8 .�. Public Heuhh Dchintfnent >�' $.1 Subdivision • I'Envinnunentel Hullth Division \'\' V1.1 • TO Box 389,100-A Southwest Blva,Newton,NC 28658 Sect/BUPhfbal# I =1� (828)465-827(1 FAX(r28)465.8276 TOD(828i 465-8200 PIN# 46060471532R Applicant/Owner JOSHUA REEP Site Address: 7745 LYNWOOD LN SHERRILLS FORD NC Property S SF .94 ACRES Directions: HWY 16 TO DENVER/LT ON CAMPGROUND RD/TURN INTO SLANTING BRIDGE RD/ RT ON KEISTLER STORE RD/RT ON LYNWOOD LW 4TH LOT ON LT • lmprovetnent Permit El Authorization To Construct 0 Weil Permit SITE PLAN <19,91 )4,4 ..\\, i ne, ,..; ...i .,.. O<,..,.....) O -....„, 3 i,' 1 nwaoA Pai 10 U9102 -----\ Apry 4nr * ,- C Y U..t_SI- bLsi — 1tW - rovv-k/� t �� 04,1 'r iD' �-YcflX_ • 44 1 D Y1-ot` at i Ve. CtaCkt, C E' y VP' * L SI-at e-r ui 11'=)cant Scale System components represent approximate contours only. a ontract nust flag the system prior to beginning the installation to ensure that proper grade is maintained. Do not t m under wet conditions. This permit is subject of revocation if the site plan or site conditions are altered. AuthOF'ied State en Dote Form C ,:17ulr„1,".0.F,,n,vwLcn ,,,,vi NORTH CAROLINA DEPARThENT of NATURAL RESOURCES AND COIWM DEVELOtPIIIENT FOR OFFICE USE ONLY DIVISION Of ET4VfROME1wTAL MANA(1EAE]4T -OROUWWATt3R SECTION P.O.SOX 27557-RALEXPOLC. 2TS11,PHONE Me)733-6053 Quad. No. Serial No. Let. Long. Pc Minor Basin WELL CONSTRUCTION RECORD Basin Code Header Ent. GW-1 Ent, DRILLING CONTRACTORal-Z-17076 SATE WELL CONSTRUCTION // (b?-a639s DRILLER REGISTRATION NUMBER 7 PERMIT NUMBER: �'/G 1. WELL LOCATION: (Show sketch[ of the location below)_ ra�, Nearest Own 77"!-`l /✓hpe f hN County: L" "�1 P- a- /44 /'J Depth DRILLING LOG (Road. Corn unity, r Subdivision and Lot No.) From To Formation Description 2. OWNER • f1 1 - £ _ 4 ADDRESS ((JJ (Street or Route No.) J /0/� ��k � City or Town Stale �n_ �Zip Code /Or L/'i 1 3. DATE DRILLED rS7Wer� USE OF WELL ! /17 T cv•-... + - 4. TOTAL DEPTH �li" CUTTINGS COLLECTED ❑Yes �No 5. DOES WELL REPLACE EXISTING WELL? 0 Yes LJ No - 6. STATIC WATER LEVEL:22 ' FT. 4g above TOP OF CASING, �� B"below • TOP OF CASING IS FT. ABOVE LAND SURFACE. --- 7. YIELD (gpm)• 1-0' METHOD OF TEST Qr B. WATER ZONES (depth): '_ 5-y .. ie Q -- 9. CHLORINATION: Type /1711 Amount 10. CASING. Wall Thickness If additional space is needed use back of form. Depth Diameter or Weight/Ft. Material - ` / — LOCATION SKETCH � From _ To i/ Ft. 4 (Show direction and distance from at least two Stale Roads. From To Ft. _ or other map' reference points) From To Ft. `+` 11. GROUT: / G Depth �y Material Method From 0 To Ft. �5o'75 From To F1. 12. SCREEN. //ppyy���� Depth Diameter Slot Size Material 4,0- • "'`-'-4 e,,,jp a 4''/� From To Ft. in. in. ,gyp From To Ft. in. in. r� "f Cam` From_ To Ft. in. tr.. ,13. GRAVEL PACK: • )y Depth Size Material Al 4 ` From To F1. �} From To Ft. 14. REMARKS I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEE ,OVI TO T}E W.E OWNER.! • . . . T . . $ aA' a• J j i i OP;a F NI !iii a ii1�� 11 \ 6 po ■ ■ v a � 6 appg ' ; ilil: a I . 11 !I 441 1 /stil iqf IP NA !.i ti ' iiL,h b 11! , .0 ii.' lr E 11041 Ai c . 171 11A411 ' i- ilillialill 1 i ci) il v;1 1 gi w 5 it! it! i1110 h gi Wil—gPv-11"-- j itig zle D r1,111: IF di Rg 41 1 4 if i § . ,,N \ tp . ',Aim i , i i: lc, 4 r I 4,q;,g, --- - \ ---, N !D 1 In ti � \ \ r ; ; ..1 i 8 riiiiiiii .---;... N!il ( c4P-4 i.,,'.i.'.; \ \ , kill !! ifilla 1 I g . (4 1, off\\� bw� a�. i iii I -04f A 2 ` qq ci _ iliii 9 fIf 1f w • I 4r Q a IN i' i 1.• O It� \( \ Alt Al* �� � � 9l l� a\ qBL$:�N�pt \, \po;\ p: i ill \ CO\-a ° ‘• 0.4 � �\, tv { \', \.L'e Z O Iir \1-\ 1 YR S w p ��\ g`,9- 'o, ON s;; t§o r L 'D \ „'A $j \ N0stA` \ \ N \ Ay IF 1g 'e b 1 �$ao \ 1 14 Ii vR 9y\9L i � . `, \ 9itl ! Cfti". 4Ir 1"- ' ^„ ‘ \ 1 k fit,,. -' yyga`'`'^ N\ !b$a , f 1' "- r,.e X 0 i \ 1 V , NA_ y�ycy o�`1 •1` N p JJ�CCCC fig. E 1 a .1 b ,o. a"In o ti R 41 6. kA.s, 4"�"• 1. 4 C7 O ,3'kYP: be $ `� - R t »16� Maio a •• cc n ato k'G4 sP f7 wr. d n t ► C7 � s» • 1.• z e $i v . 4 g Z % WAT s2� p�CF laE 9iiii R. f 7 n