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Home My WebLink AboutSAM-11-2023-208746.TIF $A Case# SAM-1 1-2023-208746 E71 )-1 CATAWBA COUNTY HEALTH DEPARTMENT OEnvironmental Health Section 1 g 4 Z sM 11/20/2023 WATER SAMPLE APPLICATION Applicant MORGAN LANE,2746 CAMDEN POINTE DR,SHERRILLS FORD NC 28673 C:704-928-5813 Site Address: 2746 CAMDEN POINTE DR, SHERRILLS FORD NC 28673 SELECTED SAMPLES Bacterial Name of Subdivision: Inorganic Parcel Number: 462801352768 Lot: Block: Nitrate/Nitrite Specific Directions Description: Well Variance Reason for Sample: well variance Type of Well Is the well on this same property? Yes Is outside spigot available to collect sample? Yes Is power on? Yes Has well been tested before? Yes Results good Does the plumbing come out the top of the well through a sanitary well seal? Unknown Does the well ever become cloudy or has there ever been a problem with taste and/or odor? No Explain Does the well top extend twelve(12)inches above the ground or well slab? Unknown The well is in: Rear Does this well supply water to more than one home? No Water samples will be drawn from an outside faucet unless otherwise specified. Please note that all water samples are taken during one visit. The processing laboratories have different protocols and timeframes for reporting results; therefore,you may receive several different reports concerning your water sample. For questions or more information, please contact Catawba County Environmental Health at(828)465-8270. Date Signature or Owner or Agent Jason Boyd FEE DESCRIPTION DATE FEE AMOUNT Bacteriological Sample Fee 11/20/2023 $58.00 Inorganic Chemical Sample Fee 11/20/2023 $128.00 Nitrate Sample Fee 11/20/2023 $99.00 TOTAL FEES $285.00 rsamapplication 11/20/2023 Page 1 of 1 catawba county Water Sample Application Sample Re quested B Morgan Lane 704-928-5813 4 y Home Phone Property Address 2746 Camden Pointe Drive Business Phone Mailing Address 2746 Camden Pointe Drive Sherrills Ford, NC 28673 Driving Directions Hwy 150 to Sherrills Ford Rd right onto Island Point Drive and right onto Camden Pointe Dr. Sample Requested: Bacteriological Inorganic Chemical X Other Patio near well Sample reason: Pool patio to be installed within 25' of well Type of Well: Drilled Bored Dug Other Not sure Is the well on this same property? Yes X No PLEASE NOTE:Sample will be taken at the well head. If well head is not accessible,sample will be taken from a spigot on outside of home, unless otherwise specified: Is outside spigot available to collect sample? Yes X No Is power on? Yes X No Has well been tested before? Yes X No Unknown Results Good Does the plumbing come out the top of the well through a sanitary well seal? Yes No Unknown X Does the water ever become cloudy or has there ever been a problem with taste or odor? Yes No X Explain Does the well top extend 12 inches above the ground or well slab? Yes No Unknown X The well is located in front rear X left side right side of the house. Does well supply water to more than one home? Yes No X Date 11.9.23 Signature of Owner or Agent CatawNCOUtttyatc:.goV Fnvironmental Health w, 7i 1". N`►�-R CAD for-/r'` a Cad' E� Cvra S O to �o0.q/ O Q+ al �,`�,, , ►-4 C5 N , �OJ.''53, �' N. I crACI ,Is"1 ' i\ - to \ 1 a 5� � Z 1 re r� 1 I 1 IN.%, �, k�U / I M `/ / / N / / / ,- / N. /� \ I 1 "co a // / f1 a.4 I1:tA1i,, , / i v \ / ,) 't / / 0 O GD / \, mi ; f 'o 14 q o ` I / b ,C / / ' P ! 4 1-2 f ab / U ! / V r. / ja / �.- 1; .,,, ,/, I 6. , Y VrS / c. = ::;' 0;.) / 3Q15 ,S II ---- ---- on / / a.45 ' / I d.L0.1. i. (ONjeib3g 3sv 9 N • i nA 1li 2 >- in" if N . �N /().'tH - (/).;..30 ,3-'30 CATAWBACOUNTYH;EALTHDEPARTMENT N~. 5712'~ Telephone: (828) 465-827<v6'D: (828) 465-8200 . - J Imp,'Prmt. 1/ Auth, to Canst. VRpr. Prmt. Opr. Prmt.4Sys, Typ~~/~Well Prmt. ~Well Rpr.,Prmt. Owner/Agent e: ~ J~~01Jf; ~~.5, H4~~Rb Phone ~~37f#-~ Address .:;t '7 ~ . /A. Subdivision () ILl, I.!TH Sjfr.R!?jIJ"'s I={JP?J) /V, C. ~.f"C7":'~ Section/Block/Phase LotH ..30 Lot Size , 8t; ~D Directions: ' / R. Facility: House c./' Mobile Home_Business _Multi-family _ ,Other: Tax Map or Pin Number /?'j.. -,).. '7 Other . Zoning Approval # 2. 99 () 15K :;J.. 'I # Bedrooms # Employees . Application Rate ~ ,..8 GPD Flow qto Hot Tub or Spa yes 0 pecial Fixtures Basemen(ici)no . 100% Repair Are~~. . .. Bas~ment Plumbing es 0 Water Supply: Pnvate Well~bhc_ SeIll1-Pubhc_ ***~*********************~************************************************************************************************* Type of System: Trench ~d -Pump Pump/Panel~anel_ LPP _ Other ~~d e~lt<..,.. ~~ .""' Septic Tank Size /Ot5 ;-Pump Tank Size /;;;;(; Nitrification Field: Total Square Feet Illt:fifJ Depth of Stone - ~ Bed Size Trench Width ''11' Total Length of All Trenches .:(~ Number of Trenches III Trench Length~/ci:iJM /11.5./ -C Feet on Center R I Maximum Trench Dep~ ;;ut',+- Distance f Neare.st Well ..s~ 4- *DO NOT INSTALL SEPTIC WH WET;'fIoo *WEJ,I!RECORD REQU D.~OMPLETION* ******************************** ************************************************************** *****~*{*************** Tapa .5 % Slope I L-,9-K e- Texture ~7 I Structu~e ~Lf',d(,Y I Clay Mill, L:.1 I Soil Wetness " I Soil Depth ~ ;J.... " I Restric. Hoz. at~' I Available space es 0 I Overall Class S S I Comments: oS;;;<=? S(~I t.. I NIiT$:.f/ _ o....'i.~. i,}r4lJllPU ~~~)$: fi' r..e t'/I)6f!t:S I )J ? fI>~ I )( <3 J I ~ ,~~... .. A ~,...,.... '';, . I. C ~ "u. :.I" .J /}~p ~.5>-" &0 ~,.,~~ ~~' r I .. I I I .. . It I Pilter Required " I Riser required when I.I;~. !ank is more than 6~ I mches deep. I **NO GUARANTEE OR WILl: ******************************************* t- cP77c. T-4AJJ.( v70e. Ti) Cfr-4.,. \" -Pfl'tS .6t'r-OI(i: IS / ..Il.IS(,.,.<...c.G'~ / "'4\J/H.. II\) f-O f..;o,4.1"J ~~~ ~ - : S';;:N,iJ ') ~r:: 'c..--33 ~~\.v~~ mt; SIDi4l84,J e If.'';(.~((. *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility. An Authorization to Construct is valid for (5) five years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. The siting of the well by the Health Department staff is to provide protection from known possible sources of contamination. No volume of water is guaranteed at any site by t e Health Department. Permit Date /h ~ Owner/Agent EHS WelI Head Approval Dat~ Date of Results White - Office EHS Septic Tank InstalIed By WelI InstalIed By d3 r'llJUJ t.!..JFc:::.C Date Sample ColIected c_ S' EHS Q4 Date rout Approval Datt(J:. ""I ~JS /991 ~- -~ es Yello\}' - Owner/Agent Green. Building Inspection Authorization to Construct #-)A • CATAWBA COUNTY �' I00A SOUTHWEST BLVD : NEWTON,NORTH CAROLINA 28658 RECEIPT O 7 PHONE: 828.465.8399 Monday,November 20,2023 Ig 47 5M www.catawbacountync.gov PAYOR: Lane,Morgan PAYMENTS TRANSACTION NUMBER: TRC-78247574-20-11-2023 PAYMENT DATE: 11/20/2023 PAYMENT TYPE: Credit Card 313393805 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 11-23-430644 110.580200-663000 Bacteriological Sample Fee $58.00 11-23-430644 110-580200-663000 Nitrate Sample Fee $99.00 11-23-430644 110-580200-663000 Inorganic Chemical Sample Fee $128.00 TOTAL PAYMENTS: $285.00 SAM-11-2023-208746 CASE TYPE: Water Sample WORK CLASS: Multiple Different Samples SITE ADDRESS: 2746 CAMDEN POINTE DR,SHERRILLS FORD NC 28673 Applicant MORGAN LANE,2746 CAMDEN POINTE DR,SHERRILLS FORD NC 28673 C:704-928-5813 **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 11/20/2023 16:29 Page 1 of 1 alp 4'A Case# SAM-11-2023-208746 f.� 1.1 CATAWBA COUNTY HEALTH DEPARTMENT V1111! Environmental Health Section 18 42 sM 11/20/2023 WATER SAMPLE TEST RESULTS Applicant MORGAN LANE,2746 CAMDEN POINTE DR,SHERRILLS FORD NC 28673 C:704-928-5813 Site Address: 2746 CAMDEN POINTE DR,SHERRILLS FORD NC 28673 Parcel Number: 462801352768 Lab Coliform Analysis Results: Total Coliforms: Fecal/E.Coli: O 4.ucs No Collection Date Over 30 hours old Invalid Results: Excessive turbidity Excessive Chlorine Lab Accident d (35t ffrr- rybo Lab Tech Initials 644— Date/Time Received IZ-' /3 ' .Z-3 Date/Time Completed 12/,4/2e RECEIVED Fr' 1 5 123 Environmental Health rsamfieldreport 11/20/2023 16:31 Page 2 of 2 �$A Case# SAM-11-2023-208746 �� CATAWBA COUNTY HEALTH DEPARTMENT nee G � Arc wit V . Environmental Health Section 1 g 4 2 sM II/20/2023 WATER SAMPLE FIELD REPORT Applicant MORGAN LANE,2746 CAMDEN POINTE DR,SHERRILLS FORD NC 28673 C:704-928-5813 Site Address: 2746 CAMDEN POINTE DR,SHERRILLS FORD NC 28673 Parcel Number: 462801352768 Driving Directions E NC 150,left Sherrills Ford Rd,right Island Point Dr,right Camden Pointe Dr / Sample Collected by: 1�07 c) R S II`� Date/Time Sampled: 12 I it 2 3 J v • 2. a Sampling Point: 0 u 5 1 L- se lb-4- A 1,01-1 I Is well head accessible? Yes /No Reason for inaccessibility Well New or Existing? New ‘,//Existing Type of Well: Drilled V Bored Hand Dug P/uy1 ch Does well meet adequate construction standards from what can be observed: V Yes No Items of non-compliance: Evidence of improper grouting or no grouting Well does not meet a required setback(comment) Improperly constructed sanitary well seal Well head not term at>= 12"above finished grade Well head missing vent Well head does not have a threadless tap Well missing identification plate or pump tag Wire conduit opening not sealed `/ Other(comment) Comment: �! 1cnc ( z- •,eS FDr j ", r- • , p ` - f r ° W..11 / 1L6( ni'? rsamfieldreport I1/20/2023 16:31 Page 1 of2