HomeMy WebLinkAboutWELL-11-09-2971.TIF
~t. Case# EI-IPR-11-09-2849
CATAWBA COUNTY
Public Health Department Subdivision
Environmental Health Division Section/Bl/Ph/Lot#
PO Box 389, 100A Southwest Blvd, Newton NC 28658 PIN#
1 g 42 sn{ (828) 465-8270 Fax (828) 465-8276 TDD (828) 465-8200 VIC bq' 7~
Applicant/Owner William Bumgardner
Site Address: 1260 Sam Rd Hickory NC 28602
Property Size: .99
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 FTC 6. STREAMS/BROOKS/CREEKS 50 FT.
3. EXISTING & PROPOSED SEPTIC REPAIR AREA MIN. 50 FT. 7. LAKES/PONDS RESERVOIRS 50 FT V `
4. SEWAGE PUMP SUPPLY LINE 5o 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 2tAN F ERMITTED WELL LOCATION
ISSUED BY PERMIT ISSUANCE DATE
` 2 y v 9
CUSTOMER SIG URE DATE.
WELL INSPECTION:
GROUTED DEPTH: 20' ❑ DATE: ~ i -69 INITIALS:
APPROVED CASING: PVC ❑ STEEL ❑ DATE: l~ o9 INITIALS:
CASING HEIGHT 12' ABOVE LAND SURFACE ❑ DATE:' '`ai Try INITIALS:
WELL COMPLETION REPORT RECEIVED ❑ DATE: INITIALS:
WELL HEAD APPROVED ❑ DATE: INITIALS:
WATER SAMLES TAKEN: BA ❑ IO ❑ N/N ❑ DATE: INITIALS:
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ff. 2 7 s
WELL'DRILL _R 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 STA E A IGE~ T__.__~ APPROVAL DATE
C:\Documents and Settings\jenglish\Local Settings\Temporarv Internet Files\Content.Outlook\PP83 W9G6\Bumgardner well-2849.doex
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Case # EHPR-11-09-2849
CATAWBA COUNTY Subdivision
Public Health Department
U •a► Environmental Health Division Section/Bl/Ph/Lot#
PIN#
1842 se PO Box 389, 100A Southwest Blvd, Newton NC 28658
(828) 465-8270 Fax (828) 465-8276 TDD (828) 465-8200
Applicant/Owner William Bumgardner
Site Address: 1260 Sam Rd Hickory NC 28602
Property Size: .99
Directions:
Improvement Permit ❑ Authorization to Construct ❑ Well Permit
SITE PLAN
3a- Well must be placed
outside of Rd Right of way
- Well must be 100' from
all parts of septic system.
- Call Environmental
Health with any questions.
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System compo e s represent pproximate contours only. The contractor must flag the system prior to beginning the installation to ensure that proper grade is maintained. Do not
install system er wet con it ons. This permit is subject to revocation if the site plan or site conditions are altered.
AUTHO IZED STATE AGENT DATE
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; v��v '�' P O Box 389 - Newton, Nortll Carolina 28658 -(828) 465-8270 - Fax (828) 465-8276 - TDD (828) 465-8200
Ig 42 SM Public Health — Environmental Health Division
Memorandum
May 12, 2011
To: William Bumgarner
From: Michael Cash, Environmental Health Supervisor
Re: Well Samples Required: WELL-11-09-2971, Site Address: 1260 Sain Rd
Since July 1 St , 2008, a program mandated by the State of North Carolina to regulate private
drinking water wells required all county well programs to sample new wells constructed after
that date. According to Rule .3801 of the North Carolina Administrative Code (15A NCAC 18A)
all wells must be sampled for bacteria, nitrate, nitrite, pH, and a number of naturally occurring
inorganic minerals.
Our records indicate that we have not taken the required samples for your new well. In order
to satisfy our obligation in this regard, we are planning to visit your property the week of
5/23/11 to collect these water samples. The fees normally charged for these samples were
included in the cost of your well permit, so there is no additional charge for this service. The
samples will be taken from an outside source, so there is no obligation for you to be present.
The sample test results will be sent to you when they are received by our office. Please allow
6-8 weeks for processing.
Please contact our office if we can answer any questions or provide additional assistance. You
may reach our office at (828) 465-8270, or by e-mail at:
EHAdministrativeAssistants(cr�catawbacountync.c�ov.
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