HomeMy WebLinkAboutReiner-Well.docxCase#
EHPR-2-10-3862
Subdivision
Section/Bl/Ph/Lot#
PIN#
Applicant/Owner
Jason Reiner
Site Address:
7794 Long Bay Catawba NC
Property Size:
1.059
Directions:
WELL PERMIT
Proposed use: Private X
Public Semi-Public Other
GROUTING DEPTH: MINIMUM 20 FEET
SETBACKS:
1. BUILDNG FOUNDATIONS 25 FT.
5. UNDERGROUND STORAGE TANKS 100 FT.
2. EXISTING & PROPOSED SEPTIC SYSTEMS MIN. 50 FT.
6. STREAMS/BROOKS/CREEKS 50 FT.
3. EXISTING & PROPOSED SEPTIC REPAIR AREA MIN. 50 FT.
7. LAKES/PONDS RESERVOIRS 50 FT
4. SEWAGE PUMP SUPPLY LINE 50 FT.
ALL OTHER POSSIBLE SOURCES OF GROUND WATER CONTAMINATION 100 FT.
The well driller must verify all separations are adhered to before drilling the well.
If the well driller is unable to maintain any of the above separations, contact the Health Department at (828) 465-8270 before drilling the well.
SEE SITE PLAN FOR PERMITTED WELL LOCATION
ISSUED BY PERMIT ISSUANCE DATE
CUSTOMER SIGNATURE DATE
WELL INSPECTION:
GROUTED DEPTH: 20’ DATE: INITIALS:
APPROVED CASING: PVC STEEL DATE: INITIALS:
CASING HEIGHT 12’ ABOVE LAND SURFACE DATE: INITIALS:
WELL COMPLETION REPORT RECEIVED DATE: INITIALS:
WELL HEAD APPROVED DATE: INITIALS:
WATER SAMLES TAKEN: BA IO N/N DATE: 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 for 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.
CERTIFICATE OF COMPLETION
AUTHORIZED STATE AGENT APPROVAL DATE
Case #
EHPR-2-10-3862
Subdivision
Section/Bl/Ph/Lot#
PIN#
Applicant/Owner
Jason Reiner
Site Address:
7794 Long Bay Catawba NC
Property Size:
1.059
Directions:
Improvement Permit Authorization to Construct Well Permit
SITE PLAN
System components represent approximate contours only. The contractor must flag the system prior to beginning the installation to ensure that proper grade is maintained. Do not install
system under wet conditions. This permit is subject to revocation if the site plan or site conditions are altered.
AUTHORIZED STATE AGENT DATE