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Home My WebLink AboutSAM-3-10-5809.TIF $A r✓'~ Case # SAM-3-10-5809 E~~ ! CATAWBA COUNTY HEALTH DEPARTMENT Environmental Health Section 184 2 sM 03/29/2010 WATER SAMPLE APPLICATION APPLICANT OWNER RUTH PAYNE RUTH PAYNE 3858 LOVE RD 3858 LOVE RD CLAREMONT NC 28610 CLAREMONT NC 28610 828-241-2068 828-241-2068 Site Address 3858 LOVE RD, Claremont, NC Name of Subdivision Parcel Number 376004844531 Lot Block Specific Directions HWY 10 E PASS COUNTRY MARKET, RIGHT ON BALLS CREEK SCHOOL RD, IMMEDIATE RIGHT ON LOVE RD HOUSE ON RIGHT (APPROX 1.5 MILES) Type of Sample WATER SAM 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 problern 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 n Date 3 I & Signature or Owner or ent 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 FEE DESCRIPTION DATE FEE AMOUNT. Bacteriological Sample Fee 03/29/2010 $58.00 TOTAL FEES $58.00 3/29/2010 CATAWBA COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION Request for Water Sample Sample Requested By 422na 40e=&~ Pa q Y, Home Phone ' , 9 _q 1. 0 State Road Number/Name L a v e k"O'q Business Phone Mailing Address AJ e 1 As2 M on t I u C -2~ L l b Name of Subdivision Lot # Section/Block Phase / G I Specific Directions- /V W q /0 Cc .t &Ike 01 - 1~ /.S C re c- k- 56/ nw r S) 2 . u r ! j S- Sample Requested for: Bacteriological_ norganic Chemical Other Type of Well: Drilled Bored Dug Other ( ) Is the well on this same property? _ es no Is power on and is an outside spigot available to collect sample? ✓ 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? Explain: yes '✓no Does the well top extend six (6) inches above the ground or well slab? V~7 es 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 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 t~ay occur. /h Signature of Owner or A Date L (For Office Use Only) Please Contact between 8 am and 9 am Phone Fee Date Paid Receipt # Initial White - Office Copy Yellow - Owner/Agent Copy Catawba County, North Carolina N This map product was prepared from the Catawba County, NC, Geographic Information System. Catawba County has made substantial efforts to ensure the accuracv 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 Comity 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 arises or may arise from this map product or the use thereof by any person or entiy. Legend Selected Parcel Number: 3760-04-84-4531 1 inch = 80 feet Prepared for: i i 996 570 (12 2.71A 4531 *CP N 7 4nA ~ THIS IS NOT A LEGAL DOCUMENT Monday, March 29, 2010 09:42 AM L W _ - CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3760-04-84-4531 Name: PAYNE RUTH THRONEBURG Name2: Address: 3858 LOVE RD Address2: City: CLAREMONT State: NC Zip: 28610-9592 Account: 51068550 Calc Acreage: 2.71 Tax Map: 022 Y 03034 LRK: 22315 Deed Book: 1247 Deed Page: 0183 Subdivision Name: Subdivision Block: Lots: Plat Book: Plat Page: Building Number: 3858 Street Name: LOVE RD Site Zip: 28610 Township: CATAWBA Fire Code: BANDY'S City Code: COUNTY State Road: 1809 Total Bldgs Value: $52,000 Land Value: $29,400 Total Value: $81,400 Year Built: 1974 Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 122 Watershed: WS-IV Protected Area Watershed Split: NO Voter Precinct: P5 E911 District: COUNTY Zoning: R-30 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: DWMH-O,WP-0 Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: BALLS CREEK Middle School: MILL CREEK High School: BANDYS School Split: NO P&Z Case Number: Census Tract 2010: 011400 Census Block 2010: 3001 Small Area Plan: BALLS CREEK Agricultural District: Printed: Monday, March 29, 2010 09:42 AM