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HomeMy WebLinkAboutSAM-3-10-5648.TIF CO Case N SAM-3-10-5648 G CATAWBA COUNTY HEALTH DEPARTMENT v°s Environmental Health Section 1i 1842 sm 03/22/2010 WATER SAMPLE APPLICATION APPLICANT OWNER MELISSA SHOOK MELISSA SHOOK 3006 LYDIA LN 3006 LYDIA LN NEWTON NC 28658 NEWTON NC 28658 828-466-0086 828-466-0086 Site Address 3006 LYDIA LN, Newton, NC Name of Subdivision Parcel Number 364816822963 Lot 10 Block B Specific Directions HWY 321 S - TURN LEFT ONTO SMYRE FARM RD - TURN RIGHT ONTO ST. JAMES CHURCH RD - TURN RIGHT INTO OAKCREST ONTO FORREST ST - TURN LEFT ONTO LYDIA LN - I ST HOUSE ON LEFT Type of Sample NEED BACTERIOLOGICAL WATER SAMPLE Reason for Sample: Type of Well Drilled Bored Dug Spring City Is the well on this same property? yes no Is outside spigot available to collect sample? yes no Is power on? yes no Has well been tested before? yes no Results Does the plumbing come out the top of the well through a sanitary well seal? des no Does the well ever become cloudy or has there ever been a problem with taste and/or odor? yes no Explain Does the well top extend twelve (12) inches above the ground or well slab? _ yes no The well is in: Front Rear left side right side of the house Is this well required to be tested anually for a semi public water source? yes no Does this well supply water to more than one home? yes no Date Signature or Owner or Agent N Fo.X An Environmental Health Specialist will contact you within 2 working days of application date. If you need further information or assistance please call 828-466-7291 AREA 1 FEE DESCRIPTION DATE FEE AMOUNT Bacteriological Sample Fee 03/22/2010 $0.00 Bacteriological Sample Fee 03/22/2010 $58.00 TOTAL FEES $58.00 3/22/2010 03/22/2010 10:51 FAX 410 423 1492 NEW DAY IA001 MAR-22-2010 08:18 CATAWBA COUNTY GOUT 1 828 465 8276 P.02 CATAWBA COUIy'lX HEAL-111 I)NrAKil LIN 1 ENVIRONMENTAL 19EALTH SECTION Request for Water Sample Sample Requested By ! t C ~i SS S~ o Home Phone State RoadNumberiName 46 L~~ V, Business Phone Mailing Address gO©G L cic. Lone-, LJ0-L4V---, AI L tGn Name of Subdivision, 0C1Oc Cr c-4 . Lot 4 ID Section/Block Phase Rive* U~ 1► 4 Specific Directions akt- L-tj / tt 1n C) C G►~ \ ° y1(,~ c7~ f -~iC 1 , `GC / r J ~l Vy1f, 7~ rcl.. v [ , h--) Ve On ~ n ~ Usk (~'1Ctti. Q. ~n'So QG G l~sd a ( oh L c, La.-w I Str~du Sample Requested for: Bacteriological Inorganic Chemical Other - Dug Other type of Well: Drilled Bored 1_c the well on this same property? -y-yes no is power on and is an outside spigot available to collect sample? des no Has well been tested before? yes no (Results 1 Does the plumbing come out the top of the well through a sanitary well seal? es no ~y L,,le \1 houc9 Does the well ever become cloudy or has there ever been a problem with taste and/or odor? J\/ Explain: r/ y e\tfr CA 0-t4 e k. Yes no Does the well top extend six (6) inches above the ground or well slab? des no The well is in. front rear left side right side of the house *Notes: Contact the EHS listed below to initiate the sampling. Wells must be inspected for proper cor auction before sampling. The owner or person requesting the sample is responsible for providing access to the we 1 enclosure, If a county employee must remove any lid, cover or other item in order to gain access to inspect the w.;ll, the County is not responsible for any damage that may occur. By signing this document you agree to hold h4-.mless Catawba County, its elected officials, employees and agents for any pro e a t(may occur. r ~•-i1L-12-3_ 6n~ ` /219 Date ! V Signature of Owner or Agent P. Ck-c.l \ w~ ~ / vv v2 y ~ lit S~ Gc'1,' (For Office Use Only) Please Contact Pr~ between 8 am and 9 am Phone Fee Date Paid Receipt # Initial _ Whitt - Me Copy Yellow - Oworr/Apat Copy TOTAL P.02 Catawba County, North Carolina N This map product was prepared from the Catawba County, NC, Geographic /reformation System. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map. Catawba County promotes and recommends the independent verification of any data contained on this map product by the user. The County of Catawba, its employees, agents and personnel disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential which wises or may wise from this map product or the use thereof by any person or entity. Legend Selected Parcel Number: 3648-16-82-2963 1 inch = 60 feet Prepared for: I O 1'`.38A o 6.. ~QQ 00 / B 7 8 ° PI at .1, 7-61 . 0 4 ...........403,8 Plat 16-108 0 9 ° 2QQ QO 2QQ QO w •0 2QQ QO z QQ r 495-7 20Q- Plat 24-20 0 3 1 ° 10 2001'QQ 2963 ~ t O O o '2 39 .QQ 0 2 487 J O V` O 11 X1- 28 3 0 O 200.06 .o i rn cr - I ~ X 1 THIS IS NOT A LEGAL DOCUMENT Mon, March 22, 2010 02:31 PM 001 CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3648-16-82-2963 Name: SHOOK RICKY NEIL Name2: SHOOK MELISSA SARAH Address: 3006 LYDIA LANE Address2: City: NEWTON State: NC Zip: 28658-9000 Account: 61262850 Calc Acreage: 0.45 Tax Map: 096N 02008 LRK: 44006 Deed Book: 1659 Deed Page: 0657 Subdivision Name: OAKCREST Subdivision Block: B Lots: 10 Plat Book: 24 Plat Page: 205 Building Number: 3006 Street Name: LYDIA LN Site Zip: 28658 Township: NEWTON Fire Code: MAIDEN RURAL City Code: COUNTY State Road: Total Bldgs Value: $130,500 Land Value: $12,300 Total Value: $142,800 Year Built: 1991 Year Remodeled: Last Sale Date: 3/1/1990 Last Sale Amount: $6,000 Neighborhood: 113 Watershed: Watershed Split: Voter Precinct: P20 E911 District: COUNTY Zoning: R-40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: MAIDEN Middle School: MAIDEN High School: MAIDEN School Split: NO P&Z Case Number: Census Tract 2010: 011600 Census Block 2010: 1047 Small Area Plan: BALLS CREEK Agricultural District: PROXIMITY Printed: Mon, March 22, 2010 02:31 PM g,A C~ CATAWBA COUNTY, NC 100-A South West Blvd Newton, NC 28658- PERMIT RECEIPT Phone: (828)465-8399 Tuesday, March 23, 2010 1$ 4'L sM www.catawbacountync.gov Permit Number: SAM-3-10-5648 Invoice Number: SAM-3-10-260653 Permit Type: Water Sample Receipt Number: RCPT-800490 Work Class: Bacterial Site Address: 3006 LYDIA LN, Newton, NC APPLICANT OWNER MELISSA SHOOK MELISSA SHOOK 3006 LYDIA LN 3006 LYDIA LN NEWTON NC 28658 NEWTON NC 28658 828-466-0086 Payer: Sarah M Shook Contractor: Fees: FEE DESCRIPTION DATE FEE AMOUNT Bacterioloeical Sample Fee 03/22/2010 S0.00 Bacterioloeical Sample Fee 03/22/2010 $58.00 TOTAL FEES 558.00 Payments: Date Payment Type Check Number Amount Change 03/23/2010 Credit Card $58.00 $0.00 Memo: ******9553 Total Payment: $58.00 permitrcccipt;erOhix)c0-i15:ir-40(i{-82ie-()9_'(?~1'ecd2(>d;.rpt 03/23/2010 08:59 Page 1 of 1