HomeMy WebLinkAboutWELL-5-11-18193.TIF ��y CATAWBA COUNTY Case # WELL-5-11-18193
G Public Health Department
Q � � 2 Subdivision
.� Environmental Health Division
v v�v 't' PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Lot #
I =� P�N# 268702685275
ApplicanUOwner EMMA TOWNSEND
Site Address: 7263 W NC 10 HWY, Vale, NC `� ��� '�', I l v ��S
Property Size: SF 3.15 ACRES
Directions: 321 BUSINESS TO HIGHWAY 10 GO WEST ON lOABOUT 15 MI (APPROX 3 MI PASSED PROST XRDS) PASSED
BANOAK FOOD CENTER ON LEFT FORTH DRiVE ON LEFT GO TO END OF DWVE
WELL PE�II'T
WATER SUPPLY:
SETBACKS:
1. BUILDNG FOUNDATIONS 25 FT.
2. EXISTING & PROPOSED SEPTIC SYSTEMS - MIN.50 FT.
3. EXISTING & PROPOSED SEPTIC REPAIR AREA - MIN. 50 FT.
4. SEWAGE PUIvIP SUPPLY LINE 50 FT.
5. UNDERGROUND STORAGE TANKS 100 FT.
6. STREAMSBROOKS/CREEKS 50 FT.
7. LAKES/PONDS RESERVOIRS 50 FT.
ALL OTHER POSSIBLE SOURCES OF GROUND WATER CONTAMINATION 100 FT.
The well driller must verify all setbacks before drilling the well.
If the well driller is unable to maintain any of the above setbacks,
contact Catawba County Environmental Health at (828) 465-8270
before drilling the well.
Grouting Depth: Minimum 20 Feet
Casing I�eight: 12" Above I,and Surface
SEE SITE PLAN FOR PERMITTED WELL LOCATION
All newly constructed private drinking water wells in No�th Carolina are
required to be sampled in accordance with
15A NCAC 18A .3800 (Rules Regarding Private Drinking Water Well Testing).
The fee for this sampling is included in the cost of the well permit.
It is the applicant or property owner's responsibility to notify Environmental Health
when the well is ready for sampling.
Susan Bumgarner OS/20/2011
ISSUED BY PERMIT ISSUANCE
OS/23/11 09:00
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�gp CATAWBA C�IJNTY Case # WELL-5-11-18193
Public Health Department
�' � Subdivision
�' a Environmental Health Division t
� 's' PO Box 389 100-A Southwest Blvd, Newton, NC 286�8 Lot #
�s w PIN# 268702685275
Applicantl0wner EMMA TOWNSEND
Site Address: 7263 W NC 10 HWY, Vale, NC
Property Size: SF 3.15 ACRES
Directions: 321 BUSINESS TO HIGHWAY 10 GO WEST ON lOABOUT 15 MI (APPROX 3 MI PASSED PROST XRDS) PASSED
BANOAK FOOD CENTER ON LEFT FORTH DRIVE ON LEFT GO TO END OF DRIVE
Owner/Authorized Representative Ackrgowledgement of Pera�it Receipt
I� / I certify that I am the owner or authorized agent (owner's autharization required) representing the owner of the
property described above.
��As the property owner or authorized representative, I have received the above referenced permit(s) as
requested in the application for service EHP12-5-11-10945 , by the following method(s):
�/ Received in Person
_ Facsimile Transmittal (Return form with signature required)
� Electronic Image Transmittal/ E-mail (Return receipt required)
�L As the property owner or authorized representative I have reviewed and understand the specific
conditions of the permit issued, and further understand that all applicable regulatory requirements specified
under the North Carolina I,aws and 12ules for Sewage Treatanent and ]Disposal Systems (15A NCAC
18A .1900), and/or Well �onstruction Standards (15A NCAC 2C .0100), shall apply to the issuance of
this permit and the construction of the wastewater system and/or water supply well permitted.
Permit Issue Date: OS/20/2011
Owner/Authorized Re resentative Signature �� i�
r
,
Date � o� d 1�
-----------------------------------------------------------------------------------------------------------
Documentation of Permit(s) T'ransmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Date/Time
Method: Fax Email US 1VIai1 Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
acknowledges the conditions and statements above.
OS/23/11 09:00
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