HomeMy WebLinkAboutWELL-6-11-18936.TIF �� CATAWBA COUNTY Case # WELL-6-11-18936
p Public Health Department Subdivision
�' '" � Environmental Health Division
� o�v '�' PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Lot # �
�s s� P�# 268703335734
Applicant/Owner pouglas Matthew Sain t^,(�S ;�pD,S - Od�g I
Site Address: 3994 BANOAK RD, Vale, NC �
Property Size: SF 3.119 ACRES
Directions: 10 W LEFT ON BANOAK RD APPROX 1/2 MILE ON LEFT IN CURVE
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. 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 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.
Megen McBride 06/15/2011
ISSUED BY PERMIT ISSUANCE
06/15/11 09:11
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PO Box 389. �OQA Soar.h^.�mt Bl�d, 2:aatan NC 2$6S6 �� # 1
� ,� PIN� 25b;0�335731
,�ppucarrt/Owr;or poug�2s Mdtt�l�rv 5ain
S11c Address�: 3994 BANOAF� Fu7. �alc, NC
Propw�tar S"�zo: SF 3.� 19 ACRES
ar�eat�ns: lo wLEFT o1� B�aNOnIC xn APPRO;� 1!? NiLP UN LE'FT IN cURVc
OwnerlAuthorized Regresentative Ac�owledgement of Permit Receipt
v I ccrt that 1 am the own�r or aut}�oriux3 agent (owner's authori�ation required) reprrser.c:r.$ the o�vner of the
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provcriy dc�scn'oad abovc.
V A� the proper�� on�e: ar �.u.*.horized re�presenta�.tive, I 1�av rcceivcd th� 3bove r�fe[enced �erm it(s) as
reciu�stbd iri the applieatioa �or service W'fLSZ0a3-4(T281 , b}l tbc fvllow�i�g �:et�od(s):
�` �R�eived in Pcrson
���'3csimile Trausxnittal (RetuFr, rorm with si�.arurc reqiu-cd)
_ Elec�rnnie Image Trans:nina]I �mail (Retucn receipt r�ui:ed)
As the groperty owner ar authorizai re�'esentative [ h�f e revie�ved an� understand tiae spacific
coriditio�s of the pcs'mit i�sued, a�d. furthe: undersia�nd that all applicable regtilatorc' rcquir:,�ments 9pecifiad
under the 1�T�rth Carol�aa La�v$ anci �ules for Sewa�e Trestment and Dispasal Systsms (15A NCAC
18A .1900), and/or Wt1Y Co[►skrurti4� SEandard.y �15A NCAC 2C .U100), sh�.l anply to the issuancz of
ihis permit and tho cons*�vcdon oi t};e wgste�•a*xr s��stem and/or. �rater su�ply u��ll permittea.
Permit Is�u� Dato: U6.�1512011
Own�r/Author�c;d Representativ� Signaturc r���-�+-�"'� . �
Dai� f� �� -
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Documentadoa of Permit(s) Tranbmittal
{per trAnsmitted by e�ec�ronic or other mcwns)
Pesrmit u�ausmittkd _^_ �iE($II(Q Of�Je7'SOF2 StIl�J1Yo permit)
Si�turc ,_ ^ •� ' � �' v.te�"T'irr�e � r I : y(����';
Mct�od: .� a�; Lmail iJS _Ntz.il Other
Owuer'ss request to sead by the abovc �ndicaked uncthod of tr�asm.ittal �n liza� �f xi�n�tupe
ackttowk-a�ges t�h.e oonditiony and Jtate'�twts s�ove.
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