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HomeMy WebLinkAboutWELL-11-09-2953.TIF CATAWBA COUNTY Case # EHPR-10-09-2026 G Subdivision Long Island Air ark Public Health Department Section/Bl/Ph/Lot# 15 Q Environmental Health Division PO Box 389, 100A Southwest Blvd, Newton NC 28658 PIN# 4710-03-31-5473 1$ 42 sM (828) 465-8270 Fax (828)465-8276 TDD (828) 465-8200 wbq. A licant/Owner Richard & Susan Slater Site Address: 1186 N. Saunders Dr. Catawba, NC Property 1.05 acres Directions: WELL PERMIT Proposed use: Private ® Public ❑ Semi-Public ❑ Other GROUTING DEPTH: MINIMUM 20 FEET SETBACKS: 1. BUILDING 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. SE ITE PL FO PER ITTED WELL LOCATION l► Y6 a-oo~ ISSU BY PERMIT I UAN E DATE ' L2 Z Z r;;,10o ~i 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 ofa well. CERTIFICATE OF COMPLETION AUTHORIZED STATE AGENT APPROVAL DATE CDP File Number: 36340 County ID Number: EHPR-10-09-2026 Drawing Type: Construction Authorization Date: 1 1/ 0 3 / a 0 0 9 O Inoh Dia~ving Scale: BIOCk = ft. N /A t ~c~d~~'i ovtat Ir2!lvire.►'lenc~5 t S~'baC. or ~re-VOLA pQq¢ vnr~,ev- ~F ~QYPA'4~fv n,.~iv\ bit' 6 MSS Co -ices od w4~, -~Gvtk dva i~l-~iCIR Kee 4t S~S+ilv\ `V? -tke 0 V~ 64 ~Z oK wIIl b Ins areq . 4 IS s nbI cumf ak e, c C U► t~ Y rvcS 5 roves a cvj, gee\c IU 0 C i j"iK I~5+0.I( J C t I- TjctSeM 2570 ReAvc,;'RM 5- ~ 4 ~J 4v'v lneS A\ ~9 it `'bra . O- r< < To talc. 4%--~ {o+hc 45x33 •~`9~v 5© Yi v t? VJa tl c %J s ~.~y .3t~` o w Nei V)~,ors }~,ina,Ee Wett lea' ~ W21t ~ S drnt~e re ~ ~ Page 3 of 3