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Home My WebLink AboutWELL-6-11-18569.TIF �q�. CATAWBA COUNTY Case # WELL-6-1 l-18�69 � G Public E[ealth Deparcment � ?' 2 Subdivision STONECROFT ` Environmental Health Division "'" $�J'�' PO Box 389, 100-A Southwest Blvd, Newton, NC 286�8 Lot # q 1442 '" P�# 369603112989 ApplicantlOwner TAMARA PEKERA Site Address: 5978 AQUARIAN WAY, Denver, NC �� I " ' I I 'I' �� Property Size: SF 0.73 ACRES Directions: HIGHWAY 16 S- CROSS OVER HIGHWAY 150 - TURN LEFT ONTO GRASSY CREEK RD AT ACCOUNTING FIRM THAT DOES TAXES ON LEFT -TURN L�FT ONTO AQUARIAN WAY - 1 ST HOUSE ON WGHT - CORNER OF AQUARIAN WAY AND GRASS CREEK RD WELL PERMIT WATER SUPPLY: Individual Well SETBACKS: 1. BUILDNG FOUNDATIONS 25 FT. 2. EXISTING & PROPOSED SEPTIC SYSTEMS - MIN.50 FT. 3. EXISTING & PROPOSED SEPTIC REPAIR AREA - MIN. 50 FT. 4. SEWAGE PUMP SUPPLY LINE 50 FT. 5. UNDERGROUND STORAGE TANKS 100 FT. 6. STREAMS/BROOKS/CREEKS 50 FT. 7. LAKES/PONDS RESERVOIRS 50 FT. ALL OTHER POSSIBLE SOURCES OF GROUND WATER CONTAMINATION 100 FT. The well driller must verify all setbacks before drilling the well. If the well driller is unable to maintain any of the above setbacks, contact Catawba County Environmental Health at (828) 465-8270 before drilling the well. Grouting Depth: Minimum 20 Feet Casing Height: 12" Above Land Surface SEE SITE PLAN FOR PERMITTED WELL LOCATION All newly constructed private drinking water wells in North Carolina are required to be sampled in accordance with 15A NCAC 18A .3800 (Rules Regarding Private Drinking Water Well Testing). The fee for this sampling is included in the cost of the well permit. It is the applicant or property owner's responsibility to notify Environmental Health when the well is ready for sampling. Robbie Phelps 06/03/2011 ISSUED BY PERMIT ISSUANCE 06/03/11 08:37 �� Permit # Well-6-11-18569 G CATAWBA COUNTY ti,� ' '2. Public Health Department Name Tamara Pekera Q �� ` Environmental Health Division Address 5978 A uarian Wa v � PO Box 389, 100A Southwest Blvd, Newton NC 28658 P � # 1$ `Z sn� � 465-8270 Fax (828) 465-8276 TDD (828) 465-8200 SITE PLAl�T �s. �5 r � � � � L � _ � Y ' ti �� ,� d S�' �� y`` s � , �- � � � r `1 � \J � v \ � � � � � � � I o J t,., � �. � �� s'� . i r � � � �o � o � � � �-- �5 ` �.�tV�l^luh �� U Scale � � b � �qA CATAWBA COUNTY Case # WELL-6-11-18�69 � G Public Health Department � » 2 Subdivision STONECROFT ' Environmental Health Division ""' �`� PO Box 389, 100-A Southwest Blvd, Newton, NC 286�8 Lot # 9 � � \ $ . w Pm# 369603112989 `•Applicant/Owner TAMARA PEKERA Site Address: 5978 AQUARIAN WAY, Denver, NC Property Size: SF 0.73 ACRES Directions: MGHWAY 16 S- CROSS OVER HIGHWAY l50 - TURN LEFT ONTO GRASSY CREEK RD AT ACCOUNTING FIRM THAT DOES TAXES ON LEFT -TURN LEFT ONTO AQUAR[AN WAY - 1 ST HOUSE ON RIGHT - CORNER OF AQUARIAN WAY AND GRASS CREEK RD Owner/Authorized Representative Acknowledgement of Permit Receipt ��rt that I am the owner or authorized aaent owner's authorization re uired) re resentin the owner of the _ fY b � q P g 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 EHPR-5-11-11057 , by the following method(s): ��(L Received in Person _ Facsimile Transmittal (Return form with signature required) _ Electronic Image Transmittal/ E-mail (Return receipt required) �� 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 Laws and Rules for Sewage Treatment and Disposal Systems (15A NCAC 18A .1900), and/or Well Construction 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: 06/03/2011 Owner/Authorized Representative Signat �?'Il!/I� �r—� Date � ----------------------------------------------------------------------------------------------------------- Documentation of Permit(s) Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name of person sending permit) Signature Date/Time Method: Fax Email US Mail Other Owner's request to send by the above indicated method of transmittal in lieu of signature acknowledges the conditions and statements above. 06/03/ l 1 08:37