HomeMy WebLinkAboutWELL-05-2023-195610.TIF P
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, CATAWBA COUNTY Case# W E[,1,05-2023 195610
• Public Health Department Subdivision
Environmental Health Division PIN 461602593350
PO Box 389,25 Government Drive,Newton,NC 28658 LOP 2A
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Site Address: 4377 KISER ISLAND RD, TERRELL NC 28682
Name on Permit: *LUX CUSTOM HOMES LLC
Property Size: Acres 1.075
Directions: NC 150, right onto Kiser Island Rd, right onto Fieldstone Dr, left onto Beechwood Trail
Owner/Authorized Representative Acknowledgement of Permit Receipt
\J Jt i certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
\IA As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-04-2023-44057, by the following method(s):
t /1 eived in Person
Facsimile Transmittal (Return form with signature required)
/� Electronic Image Transmittal/ E-mail (Return receipt required)
�i )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 (15A NCAC 18A.1900),
and/or Well Construction Standards(l5A 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: 05/12/2023
Owner/Authorized Representative Signature
-----V
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—
Date OS '/,S I 2
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 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 aft
http://www.surveymonkey.com/s/EHCusttomerService
ehpcmvt 05/15/2023 08:38
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• CATAWBA COUNTY Case# WELL-05-2023-195610
F,(......tIII ,y Public Health Department ' t Subdivision
am '� Environmental Health Division PIN# 461602593350
PO Box 389,25 Government Drive,Newton,NC 28658 LOU 2A
1•. w
Site Address: 4377 KISER ISLAND RD,TERRELL NC 28682
Name on Permit: *LUX CUSTOM HOMES LLC
Property Size: Acres 1.075
Directions: NC 150, right onto Kiser Island Rd, right onto Fieldstone Dr, left onto Beechwood Trail
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 15A 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 I SA.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.
✓--,-------1. ..
ryr•'-Fo"k'e 05/12/2023
Authorized State Agent Permit Issuance Date
5/12/2028
Permit Expiration Date
ehpermit 05/15/2023 08:38
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the indaa ndent verifteation of iwiy` i . t this filch at(he user.'the Court),tp f Catawba,its G�, x�
tenet,d scam!,and shall not be hid Ratio far any and dataa .frassor tiabrlrty,whether d€rect.trtdxrect or consequential�anaes or may
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Copyttpitt 2023 Catawba County NC
t5 i 1/2023
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WPDT Screening Report
Area of Interest (AOI) Information
Area : 3,134,508.8 ft2
May 15 2023 16:30:13 Eastern Daylight Time
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..I Parcels(Polygons)-Parcels •' Projected Route 0 003 006 0 12n;
1 i N ti ti r 11
C' Canty Boundary — Ott'.er State Agency Route 0 0.05 0.1 0.2 Km
Nan-System Roads — Seondary Route
- Federal Route Primary Roads
Non-System — Interstate Esn ColimunPy cvareulors.Potful covey Stsle m Nxlh Cewrts
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Other System Roads — US Route tlesTWnmoycs,ba flETUNASA,USGS.EPA,NPS US Gem.Swap.
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— Ramps,Rest Areas,Non-Mainline — NC Route
4377 Kiser Island Rd,Terrell
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,
including but not limited to any warranties of merchantability or witness for
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concerning the Data's accuracy,reliability,completeness,timeliness,or
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(or refrain from acting)based upon information in the Data without
independently verifying the information and obtaining any necessary
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currency and other qualities of any products derived from or in connection with
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The NCDEQ disclaims responsibility for the spatial accuracy and attribution of
GIS features and makes no warranty concerning same.
0 n,STATE, 4312 District Drive
`
4,: North Carolina State Laboratoryof Public Health MSC 1918
l'-r-li
Raleigh,NC 27699-1918
, -"y Environmental Sciences http://slph.ncpublichealth.com
•4%. ,Ace Phone: 919-733-7308
Inorganic Chemistry Fax: 919-715-8611
Certificate of Analysis FINAL REPORT
Report to: ENVIRONMENTAL HEALTH Name of System:
CATAWBA COUNTY ENVIRONMENTAL HEALTH ZSM Properties LLC
P 0 BOX 389 4377 Kiser Island Rd
NEWTON,NC 28658 Terrell,NC 28682
EIN:566001814EH Delivery: NC Courier
StarLiMS ID: ES251110-0006 Date Collected: 11/06/2025 Time Collected: 09:36 By: Dwight Mikeal
Date Received: 11/10/2025 Time Received: 09:06
Sample Type: Raw Sampling Point: Well head Well Permit No. WELL-250409-01
Sample Source: New Well Receipt Temp. : GPS Number:
Profile:New Well-No Nitrate I
Analyte Test Result Allowable Limit Unit Qualifier(s)
Arsenic <0.001 0.010 mg/L
Barium <0.1 2.0 mg/L
Cadmium <0.0005 0.005 mg/L
Calcium 7 mg/L
Chloride <5 250 mg/L
Chromium <0.02 0.10 mg/L
Copper <0.01 1.3 mg/L
Fluoride 0.193 4.00 mg/L
Iron 0.137 0.300 mg/L
Lead <0.003 0.015 mg/L
Magnesium 3 mg/L
Manganese <0.005 0.05 mg/L
Mercury <0.0004 0.002 mg/L
Nickel <0.01 0.1 mg/L
pH• 6.8 N/A
Selenium <0.005 0.05 mg/L
Silver <0.01 0.10 mg/L
Sodium 8.3 mg/L
Sulfate <5 250 mg/L
Total Alkalinity 40 mg/L
Total Hardness 30 mg/L
Zinc <0.05 5.0 mg/L
Report Date: 11/20/2025 RECEIVED Reported By: dr,,,Z4.2Z-----------.-%
Marc Komios
DEC 5 2025
Environmental Health
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