HomeMy WebLinkAboutWELL-2-10-4872.TIF
BA CATAWBA COUNTY Case # EHPR-2-10-3725
G Subdivision Deerfield 4
Public Health Department Section/BUPh/Lot# 48
Environmental Health Division pIN# 268902880978
PO Box 389, 100A Southwest Blvd, Newton NC 28658 ~j l
1$ Z SM (828) 465-8270 Fax (828) 465-8276 TDD (828) 465-8200 l0"
Applicant/Owner Balan Adrian
Site Address: 1359 Shadowfax WYND Hickory
Property Size: 1.23
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. STREAMSBROOKS/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
2-17-10
ISSUE PERMIT ISSUANCE DATE
9_ -2_2~ ^ l
CUSTOMER SIGNATURE DATE
WELL INSPECTION:
GROUTED DEPTH: 20' 2 DATE: SJ-10 INITIALS: 9&
APPROVED CASING: PVC STEEL DATE: 3-0,-10 INITIALS: ' (O
CASING HEIGHT 12' ABOVE LAND SURFACE R DATE: INITIALS: S6
WELL COMPLETION REPORT RECEIVED ❑ DATE: INITIALS:
WELL HEAD APPROVED ❑ DATE: INITIALS:
WATER SAMPLES TAKEN: BA ❑ 10 ❑ N/N ❑ DATE: INITIALS:
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WELL R LLE 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
BA CATAWBA COUNTY Case # EHPR-2-10-3725
Public Health Department Subdivision Deerfield 4
Environmental Health Division Section/BVPh/Lot# 48
a►~ PO Box 389, 100A Southwest Blvd, Newton NC 28658 PIN# 26890288978
a (828) 465-8270 Fax (828) 465-8276 TDD (828) 465-8200
1842 5M
Applicant/Owner Balan Adrian
Site Address: 1359 Shadowfax W nd
Property Size: 1.23
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.
AUTHORIZED STATE AGENT DATE
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1$4 sM Public Health — Environmental Health Division
Memorandum
June 2, 2011
To: Eric Steward
From: Michael Cash, Environmental Health Supervisor
Re: Well Samples Required: WELL-2-10-4872, Site Address: 1359 Shadowfax Wynd
Since July 1 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 6/6/11
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(a�catawbacountYnc.qov.
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