HomeMy WebLinkAboutWELL-10-09-2186.TIF
gA CATAWBA COUNTY Case # EHPR-10-09-2186
G Subdivision
Public Health Department , Environmental Health Division SectionBl/Ph/Lot# 366602797845
PO Box 389, 100A Southwest Blvd, Newton NC 28658 PIN#
, G
184 2 SM (828) 465-8270 Fax (828) 465-8276 TDD (828) 465-8200 `ki D - 05- D I P
Applicant/Owner Jeffery Scott Korn
Site Address: 4342 Lane Road Maiden NC
Property Size:
Directions: Hwy 16 S, RT Buffalo Shoals RD, LT Laney RD, Lot on LT before Laney Farm RD
WELL PERMIT S.td
Proposed use: Private X❑ 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.
SEE SITE PLAN FOR PERMITTED WELL LOCATION
ISS4_~ PERMIT ISSUANCE DATE
UE G DATE
WELL INSPECTION:
GROUTED DEPTH: 20' Ee DATE: )1 l l (/O 'i INITIALS: S3
APPROVED CASING: PVC E STEEL DATE: !jJJt. / c INITIALS:
CASING HEIGHT 12' ABOVE LAND SURFACE DATE: a % INITIALS:
WELL COMPLETION REPORT RECEIVED DATE: O `Z3 -6) INITIALS: AX W\,
WELL HEAD APPROVED DATE: INITIALS: Ihlh
WATER SAMLES TAKEN: BA ❑ 10 ❑ N/N ❑ DATE: INITIALS:
cJ 0~►~ ~.iSnG n~ 1131
WELL DRILLER DATE DRILLED I
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
VA
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AUTHORIZED S TE AGENT APPROVAL D TE
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CDP File Number: 35738 County ID Number: 366602797845
Drawing Type: Construction Authorization Date: 1 0/ x 8 / a 0 0 9
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Scale: 1 . O Block = 6 0 ft.
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Page 3 of 3
NOV 23,2009 12:13A WHISNANT WELL SERVICE 000-000-00000 page 1
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ell ContraCtot Company Narno
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5, WELL OW R /
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~ r .S VCc ^ L DISINFECtIUN: 1 YVe„
PHIN 1,H) NAMI OF PF.4SQN (".)N<Tti I&: viFI I
Submit within 30 days of completion 1IR. _ visiun Of Watt*t Quality - Inlomtation Processing, Fora, Gvv-1a
1617 Mail Service Center, Raloigh, NC 27699.161, Phone : (919)8 07-6300 Rao 2101.4