HomeMy WebLinkAboutSAM-9-10-10990.TIF B4_.? j Case # SAM -9 -10 -10990
a CATAWBA COUNTY HEALTH DEPARTMENT
L . ) .14g. �' Environmental Health Section
/842 sM 09/13/2010
, WATER SAMPLE APPLICATION
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0937 WW; . 1'0 6937 W NC 10 HWY
VALE NC 28168 VALE NC 28168
828 - 244 - 6254 828 - 244 -6254
Site Address 6937 W NC 10 HWY, Vale, NC
Name of Subdivision
Parcel Number 268804616936 Lot 2 Block
Specific Directions HIGHWAY 10 W - 2 -3 MILES PAST PROPST'S CROSSROADS (BRICK & VINYL HOUSE) ON LEFT ACROSS
FROM MALCOM DR
Type of Sample NEED BACTERIOLOGICAL WATER SAMPLE FOR REFINANCING
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? yes 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 su.ply water to more than one home? yes no/ -
Date h Signature or Owner or Agent J
g g ,
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
AREA2
, 9`"'�p.p,:��« , ,.�"° I P
Bacteriological Samp e ee , 09/13/2010 '$0.0 r
ac eriolo 'ical am le ee 09/1 /2u10
TOTAL FEES $58.00
9/13/2010
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`� • Catawba County Public Health Department Print Form
0 Environmental Health Division
is
1842 �� Request for Water Sample
511
Sample Requested By: i A i 1 n ^cN I _ Home Phone: I s-2,---' z j� c-V
State Road Number /Name: I 6937 /tJ H k ' 0 Business Phone: I
Mailing Address: 1 6x'37 1,_,) -1--\-1,._)y f v L£ V1 J C— Zg'�6
Name of Subdivision I ,/ Lot #: " Section /Block Phase: I
Specific Directions:) G - S Pcofist C S +Ake__
1\--\ I w 7.s rnril-es. .E,c.t cK U. n I s-e
I Ca`Y\i1 isQ,V G G `Cc�Ss 1 cir 0 r ' 1 4 . I Gc.}YThA Pri JAL._
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Sample Requested for: r r Inorganic Chemical Other I
Type of Well: 50 Drilled f! Bored r Dug Other I
Is the well on this same property? I'Yes r No
Is the power on and is an outside spigot available to collect a sample? ' Yes r No
Has the well been tested before? ryGYes r No Results: I Goc o
Does the plumbing come out the top of the well through a sanitary well seal? ?Yes r No
Does the well ever become cloudy or has there ever been a problem with taste and/or order? f Yes y No
If yes, explain I
Does the well top extend six (6) inches above the ground or well slab? Yes r No
The well is in: r Front FeRear r Left Side r Right Side of the house
*Notes: Contact the ENS listed below to initiate the sampling. Wells must be inspected for proper construction before sampling. The owner or person requesting
the sample is responsible for providing access to the well enclosure. If a county employee must remove any lid, cover or other item in order to gain access to
inspect the well, the County is not responsible for any damage that may occur. By signing this document you agree to hold harmless Catawba County, its
elected officials, employees and agents for any property damage that may occur.
Date: rl I O Signature of Owner or Agent , Ir r /
I /
(For Office Use Only)
Please Contact: I Between 8 am and 9am Phone: I
Fee I Date Paid I Receipt # I Initial 1
Catawba County, North Carolina
N This map product ivrepared front the Catawba County, NC, Geographic Information Sy stem.
Catawba County has made p substantial efforts to ensure the nccaracy oflocation and labeling injornmtion
contained on this :tap. Catawba County promotes and recommends the Independent verifrcation of any
A data contained on this ntap product by the user. The County of Caton
its employees, agents and
personnel disclaim, and shall 1101 be held liable for any and all damages, loss or liability, whether direct, indirect
or consequential which arises or ntny arise f rom this map product or the use thereof by any person or entity. Legend
Selected Parcel Number: 2688 - 04 - 61 - 6936
1 inch = 80 feet Prepared for:
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THIS IS NOT A LEGAL DOCUMENT Mon, September 13, 2010 11:03 AM
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CATAWBA'COUNTY NC - Parcel Report
Information Regarding Selected Parcel(s)
Parcel ID: 2688 -04 -61 -6936
Name: BARNETT LEONARD E JR
Name2: BARNETT LYNN M
Address: 6937 W NC 10 HWY
Address2:
City: VALE
State: NC
Zip: 28168 -9503
Account: 159754992
Calc Acreage: 4.69
Tax Map: 009 B 04006
LRK: 8582
Deed Book: 2987
Deed Page: 1460
Subdivision Name:
Subdivision Block:
Lots: 2
Plat Book: 49
Plat Page: 37
Building Number: 6937
Street Name: W NC 10 HWY
Site Zip: 28168
Township: BANDY'S
Fire Code: PROPST
City Code: COUNTY
State Road:
Total Bldgs Value: $96,100
Land Value: $28,300
Total Value: $124,400
Year Built: 1950
Year Remodeled:
Last Sale Date: 8/12/2009
Last Sale Amount: $152,000
Neighborhood: 89
Watershed:
Watershed Split:
Voter Precinct: P3
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: BANOAK
Middle School: JACOBS FORK
High School: FRED T FOARD
School Split: NO
P &Z Case Number:
Census Tract 2010: 011802
Census Block 2010: 3014
Small Area Plan: PLATEAU
Agricultural District: PROXIMITY
Printed: Mon, September 13, 2010 11:03 AM
-V '•A . Co Q CATAWBA COUNTY, NC t lik E�'' ,� 100 -A South West Blvd
H Newton, NC 28658- PERMIT RECEIPT
V t Phone: (828)465 - 8399 Monday, September 13, 2010
I8 4 Z sM www.catawbacountync.gov
Permit Number: SAM -9 -10 -10990 Invoice Number: SAM -9 -10- 266899
Permit Type: Water Sample
Work Class: Bacterial Receipt Number:
Site Address: 6937 W NC 10 HWY, Vale, NC
APPLICANT OWNER
LYNN & LEONARD BARNETT LYNN & LEONARD BARNETT
6937 W NC 10 HWY 6937 W NC 10 HWY
VALE NC 28168 VALE NC 28168
828 - 244 -6254
Contractor:
FEES
FEE DESCRIPTION DATE FEE AMOUNT
Bacterioloeical Sample Fee 09/13/2010 $0.00
Bacterioloeical Sample Fee 09/13/2010 $58.00
TOTAL FEES $58.00
PAYMENTS
PAYER: LYNN BARNETT
Date Payment Type Check Number Amount Change
09/13/2010 Check 3156 $58.00 $0.00
Memo:
Total Payment: $58.00
permit receipt ( 4Oac7ah5- I2a3- 48cc- 821a- Oda4c971c025;silt 09/13/2010 11:18 Page 1 of 1