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Home My WebLink AboutEHPR-08-2023-45076.TIF 1 r.k =r. CATAWBA COUNTY t Q% Public Health Department Subdivision DOUGLAS CORNERS C; , , ls` Environmental Health Division PINK 268701251295 `� .4 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 19 f:E11 She Address: 37B9 AMBER DR,VALE NC 28168 Name on Permit 'CMH HOMES,INC./DBA OAKWOOD HOMES#712(NEWTON) Property Stze: Acres 0.6 Directions: Right SW blvd,Right NC 10,Left Banoak RD,Left West Lee Dr,Right Amber DR Owner/Authorized Representative Acknowledgement of Permit Receipt _I certify that l am the owner or authorized agent(owner's authorization required)representing the owner of the property described above. _ As the property owner or authorized representative,1 have received the above referenced permit(s)as requested in the application for service RBPR-03-2 PP 023 43759,by the following method(s): Received in Person Facsimile Transmittal (Return form with signature required) 7 Electronic Image Transmittal/E-mail (Return receipt required) 16 _ 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.I900), 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:07/17/2023 / � �� —�jDateOwner/Authorized Representative Signature /� 1 ---- __-- Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by _ (name of person sending permit) Signature °if,_ Date/Time 45J433 Method: Fax V Email US Mail Other Owner's request to send by the above indicated method of transmittal in lieu of signature We wantt ttto hear from yoaPlease ttake a few momentts tto complette our custtomer service survey att http://www.sudnA rveymonkey.com/s/EHCusttomerService A, OdditiOgris0 alYi 3c 6(1I" rhprmii 07/13/2023 13:44 a NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES VARIANCE APPLICATION FOR 2C.0100 WELL CONSTRUCTION STANDARDS: PRIVATE DRINKING WATER WELLS UNDER 15A NCAC 02C.0300 WATER SUPPLY WELLS UNDER 154 NCAC O2C.0107 Al wersr.ngply weUe not cpuidered"Prkat Drinking Water Me end Ind udbg krt.:Wo r,Old:unid,and eornanerrial wells, WELLS OTHER TBAN WATER SUPPLY UNDER 1SA NCAC 02C.0108 hulwding monitoring and recovery wont Mat dearly or ope brfarnradoa. Illegible submittals xdil be reamed uy incomplete, DATE: 071o3 , 20a3 PERMIT NO.:-HPP1"01•2o -ti5.511, _(tobecompletedbyDWQIDPII) A. WELL OWNER—For single family residences list the property owner(s). For all others,list name of the business, organization,or government agency end person delegated signature authority: 3€Ffray NekI e,r _ Mailing Address: 71(4 G o,b el Si- City: her e i I t s nod State: Zip Codea.103 County;Caibovbt, Day Tele No,: Cell No.:104/-57 6-141 EMAIL Address:5 3d )it.,A; •CO rvn Fax No.: B. PHYSICAL LOCATION OF WELL SITE (I) Parcel Identification Number(PIN)of well site:460703ii3bb1Y2, County:Ce.4-*,+✓ S,. (2) Physical Address(if different than mailing address): City: State:lic Zip Coda: C, WELL DRILLER INFORMATION(if known) Well Drilling Contractor's Name: • NC Well Drilling Contractor Certification No.: Company Name: Contact Person; City: State: Zip Code: County: Day Tele No.: Cell No.: EMAIL.Address: _ Fax No.: PamGW.22V P.E.t Risked Mow 2013 D. REASON FOR VARIANCE REQUEST-Include typo of well(s)to be constructed;mle for which the variance is being requested; description of bow the alternate construction will not endanger human health and welfare and the environment;and reason why construction and/or operation in accordance with the standards is cot technically feasible and/or provides equal or better protection of the groundwater. fnecc.cAchivi ► eo✓N 1 & ck irt QP�I✓` &itCa S�C�t•,c{C is riol- i,1e: gGC4C�;� +Q e-rwle- I0 iilc c c. ,�1d7 0%) (P'. Dv !lei . ,✓c11 peci r+tcl-cc-. E. ATTACHMENTS-Provide the following information as anacbmcnts to tbis application: (1) A map showing general location of the property(including road names,NC Suite Route Number,distances, any key landmarks,eta,)sufficient for finding tho well location. (2) Detailed site map with scale showing location of proposed well relevant to septic system(s), building foundations,property lines,water bodies,potential sources of contamination,other wells,etc. (3) Submit a copy of the local well permit application and site evaluation map(if applicable). (4) Any other information relevant to the variance request such as a well construction diagram showing proposed well liner or atypical construction materials/methods. F. OTHER MINIMUM CONSTRUCTION REQUIREMENTS For water supply wells. approval of a variance will require that additional construction requirements beyond those specified in ISA NCAC 02C .0107 be met. Minimum additional construction requirements for Coastal Plain and Piedmont and Mountain region wells are referenced on Attachments A and B on pages 4 and 5 of this application. Approval of a variance will not be considered in cases where the specified minimum additional construction requirements cannot be met, G. SIGNATURES Signature of Person Res Namibia lbr Well Construction(typically the well drilkr) Print or Type Fall Name of Person Responsible far Well Construction (typiciny the well driller) Suture of County lensironmeetal Aakb Specialist �7cyc rot-see- Print Type Roll Name of County Environmental Health Spedal at Per.13d NCAC 02C.0118 the Secretary oj the Division of Water Quaky or the Division of Public Health may require submittal of information deemed necessary to make a decision on the glance, may impose conditions as pan of the decision, and shall respond in writing to the request within 30 days of receipt of the variance request, A variance applicant who is dissatisfied with the decision of the Director may continence a contested case by filing a pettion as • described in 0,S 1508-23 within 60 days gfter receipt of the decision. Forst 0W-22V pap 2 gevisedVtnsary 2013 Catawba County Environmental Health et.- ----1‘-''-----.''."---) Se ��•t . p • r /popyes 1. I 5 � i ,4 Afiki ,..F c P. lqy� ill t V �y J • 4.1 3'1 11 • . 430 i 2019 - G tsI olbl Se.Q'l;� �.a3 8 Parcel:460703430652, 7462 GABRIEL ST 11n=40ft SHERRILLS FORD, 28873 This Inaphaportproduct tau prepared from the Catawba CorM,NC eleospallei Information Services. Cabled*County has made substrntisi efforts to ensue the aoaew of Widen and blob.Information Ined on this nap or data on this report Columba Cairn promotes and reoo m ends the kidspsrdent Nbi cn of any date oontelned on Mk map/raped product by the uses.TheCounty of CatawO..Ns ureloyees,wads,and pa d1som d, dim and shall not be held liable for any and a1 damages.las or tisbity,whalher dl ect,indirect or consequential vriich irises or may also Nan dais mop/report product or the use thereof by anpersoor►laht ren* 08J01/2023