HomeMy WebLinkAboutWELL-04-2023-193785.TIF 4.4`t (Am cot IN II. Cute fit
41 a Public Itealth Department Subdivision SHERWOOD SHORES
�� . _ }s Environmental Ilealth Di. swn I'INU 461902652582
+\/f Pt)liuA 389,25 Gusemment Drnc Noaton,NC 28658 I t)lU 15
tilt Sits Address: 8666 DOG LEG RD, SHERRILLS FORD NC 28873
Name on Pon* HETTION BOOKER
Property Size: Acres 0.47
Directions: NC16, Left onto Balls Creek Rd,right W Bandys Cross Rd, Left Buffalo Shoals Rd, Right E Bandys, Right
Sherrills Ford Rd, Left Mollys Backbone, Right Azalea,Left Dog Leg Rd, Property on Left
Owner/Authorized Representative Acknowledgement of Permit Receipt
lali[ 1tfA I certiti that I am the owner or authorized agent(owner's uuthoriiation required)representing the owner of
the property described atxn e.
0,A As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-01-2023-43175,by the following method(s):
•
__ Received in Person
} Facsimile Transmittal(Return form with signature required)
I Electronic Image Transmittal!E-mail (Return receipt required)
As the property owner or authorized representative I have reviewed and understand the specific conditions
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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(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:04/17/2023
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Owner Authorized Representative Signature(\ 1 'Y� ILL/2.).
Date- 4"',21 0 " Q
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by hrunre of'person
( l sending permit)
Signature €..
Date/Time 1 I II i 1` 3
i j
Method: Fax 4 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 yorPlease ttake a few momentts tto complette our custtomer service survey att
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http://www.surveymonkey.com/s/EHCusttomerService
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, CATAWBA COUNTY Case# WELL-04-2023-193785
•
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Public Health Department Subdivision SHERWOOD SHORES
g(,' Environmental Health Division PIN# 461902652562
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 15
Site Address: 8666 DOG LEG RD, SHERRILLS FORD NC 28673
Name on Permit: HETTION BOOKER
Property Size: Acres 0.47
Directions: NC16, Left onto Balls Creek Rd, right W Bandys Cross Rd, Left Buffalo Shoals Rd, Right E Bandys, Right
Sherrills Ford Rd, Left Mollys Backbone, Right Azalea, Left Dog Leg Rd, Property on Left
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.
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 spell.
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 Health.
fliik
04/17/2023
Authorized State Agent Permit Issuance Date
4/17/2028
Permit Expiration Date
ehpernn 04/18/2023 15:43
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WPDT Screening Report
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Area of Interest (AOI) Information
Area : 3,134,508.7 ft2
Apr 18 2023 16:25:42 Eastern Daylight Time
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8666 Dog Leg Rd
All North Carolina Department of Environmental Quality
(NCDEQ)GIS data is expressly provided"AS IS"and"WITH ALL FAULTS".The NCDEQ
makes no warranty of any kind,express or implied,concerning this information,
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