HomeMy WebLinkAboutWELL-2-10-4831.TIF
$ *CATAWBA COUNTY Case # EBPR-2-10-3852
Subdivision
F 2 Public Health Department Section/Bl/Ph2ot#
Environmental Health Division PIN# 371118219724
PO Box 389, 100A Southwest Blvd, Newton NC 28658
8 (828) 465-8270 Fax (828) 465-8276 TDD (828) 465-8200 q b,31
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Applicant/Owner Virginia Wri
Site Address: 1885 Aztec Ct Newton
Property Size: 0.569
Directions:
WELL PERMIT
Proposed use: Private Public ❑ Semi-Public Q Other ~i
GROUTING DEPTH: NW41MUM 20 FEET
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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
1 Erna 6 -/o
ISSUED BY PERMIT ISSUAN ATE _
CUSTOMER ATURE DATE
WELL INSPECTIO .
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 SAMPLES TAKEN: BA ❑ IO ❑ N/N ❑ DATE: INITIALS:
WELL DRILLER DA LE
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
yy CATAWBA COUNTY Case # EHPR-2-10-3852
Public Health Department Subdivision
Environmental Health Division Section/Bl/Ph/Lot#
PO Box 389,100A Southwest Blvd, Newton NC 28658 PIN# 371118219724
(828) 465-8270 Fax (828) 465-8276 TDD (828) 465-8200
Ig SM
Applicant/Owner Virginia Wright
Site Address: 1885 Aztec Ct Newton
Property Size: 0.569
Directions:
Improvement Permit ❑ Authorization to Construct ❑ Well Permit
SITE PLAN
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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.
'S DATE
AUTHORIZED STATE AGENT