HomeMy WebLinkAboutWELL-11-09-2935.TIF
A CAi AW$A COUNTY Case # EHPR-10-09-2362
Subdivision The Knolls
Q 2 Public Health Department Section/Bl/Ph/Lot# 8
Environmental Health Division PIN# 363808799351
PO Box 389, 100A Southwest Blvd, Newton NC 28658
1$ 42 sFa (828) 465-8270 Fax (828) 465-8276 TDD (828) 465-8200 1 /v Dq
s GIB
A licantiOwner Joseph Lichtenwalner
Site Address: 1205 Knolls Drive Newton NC
Property 1.509
Directions: Hwy 321 Bus. S, RT Rome Jones RD, RT Knolls DR, Lot on LT
WELL PERMIT
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 F'r. 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 ISSUA CE DATE
/61/O~
CUSTOMERS NATURE DATE
WELL INSPECTION:
GROUTED DEPTH: 20' [r DATE: I1 -~J INITIALS:
APPROVED CASING: PVC STEEL ❑ DATE: INITIALS: ;~t_
CASING HEIGHT 12' ABOVE LAND SURFACE ❑ DATE: INITIALS:
WELL COMPLETION REPORT RECEIVED ❑ DATE: INITIALS:
WELL HEAD APPROVED ❑ DATE: INITIALS:
WATER SAMLES TAKEN: BA ❑ 10 ❑ 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
C.\Documents and Settings\ienglishTocal Settingffemporaty Internet Files\Content.Outlook\PP83W9G6\EHPR-10-09-2362WELL PERMIT (2).docx
CDP'File Number. 35914 County ID Number: 363808799351
Drawing Type: Construction Authorization Date: 1/ 0 6 a 0 0 9
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Dra«rina Scale: 1 k~B6ock = 0 6 Oft.
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