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Home My WebLink AboutSAM-3-10-5811.TIF $A CO Case # SAM-3-10-5811 ti CATAWBA COUNTY HEALTH DEPARTMENT Environmental Health Section 0 184 2 sM 03/29/2010 WATER SAMPLE APPLICATION APPLICANT OWNER LANE WESSON LANE WESSON 1262 RING TAIL RD 1262 RING TAIL RD CLAREMONT NC 28610 CLAREMONT NC 28610 828-241-2394 828-241-2394 Site Address 1262 RING TAIL RD, Claremont, NC Name of Subdivision Parcel Number 376004744723 Lot Block Specific Directions HWY 10 E TOWARD CATAWBA, PASS COUNTRY MARKET (ON RIGHT) PASS WESSON SAND/GRAVEL (ON RIGHT), NEXT RIGHT IS RING TAIL,HOUSE IS 1/4 MILE ON LEFT, 2 RED WAGON WHEELS AT DRIVE. Type of Sample 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? 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? des 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 thi231416 ell supply water to more than one home? yes no Date Signature or Owner or-Aent 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 L, !1e 147& 55 n Home Phone , Business Phone State Road Number/Name 19 tied .2 n is Mailing Address 1"9 lo r'p rpi 01 f' Name of Subdivision Llj ) Lot # SectionA31ock Phase Specific Directions_ ~,fy T(,1J~td2~ (~Cc CtLj PASS 6D~IlI'~/ ~°~lurL l`e-4-Zm c ilk n r~ - ~k r-4 1-n rr t wile. ! aL 'A r/' ht 0 D ~l L"j h cc /j- a4 , Sample Requested for: Bacteriological Inorganic Chemical Other Type of Well: Drilled Bored Dug Other ( ) Is the well on this same property? yes 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? es no 7 Does the well ever become cloudy or has there ever been a problem with taste and/or odocr?/ Explain: I D I~CW O bb u r cad m~~n 1 G-eX! 4~ Gr u~ rt f S7U r n^ yes no Does the well top extend six (6) inches above the ground or well slab? ✓ yes no The well is in: V 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 that may occur. Date 3 ' R C Signature of Owner or Ag 'Z, 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 accuracy of location and labeling information contained on this map. Catmvba County promotes and recommends the independent verification of any data contained on this map product by the user. The County of Catmvba, 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 entity. Legend Selected Parcel Number: 3760-04-74-4723 1 inch = 100 feet Prepared for: 74A w 1917 W 5.12A W 4723 co 3.28A BAN 0,~1 2.51 A CATA rb 5.74A 7556 C0 348 THIS IS NOT A LEGAL DOCUMENT Monday, March 29, 2010 09:41 AM CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3760-04-74-4723 Name: NANCE MONICA L Name2: WESSON RUTH LANE Address: 1262 RING TAIL RD Address2: City: CLAREMONT State: NC Zip: 28610-8316 Account: 202337 Calc Acreage: 5.12 Tax Map: LRK: 301681 Deed Book: 2703 Deed Page: 1745 Subdivision Name: Subdivision Block: Lots: Plat Book: Plat Page: Building Number: 1262 Street Name: RING TAIL RD Site Zip: 28610 Township: CATAWBA Fire Code: CATAWBA RURAL City Code: COUNTY State Road: Total Bldgs Value: $132,100 Land Value: $31,100 Total Value: $163,200 Year Built: 1982 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-0,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 09:41 AM