WI0100594_Application Attachment_20200915

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Maton County NEW WELL CONSTRUCTION
Public Health CONSTRUCTION AUTHORIZATION
PRIVATE DRINKING WATER WELL
Gary and Mary Coleman 12U519-� 122919-P
_._ .._ .- ---- T _ _ ..._..._ .. --
Sin le-Farnlh� Well, Residential b53I 196153 3.69
Rainbow Falls Rd. Lot 6B
64Wa Ron Rainbow Falls Rd.a G.C. 7692 a Continue 5rt. On Dirt Rd.a Last Rd On Ly First Drive on L �...
Permit Conditions
Well shall be constructed in compliance with all NCAC 2C Rules.
Maintain minimum setbacks as applicable.
Diagraln (Not to Scale)
P Ll
PL lye
V) 1D5'
Well Are
'D 75' min Drive
Proposed 4 BR
ST 5 min
1[1'
156
4' 5' min
74' Steep
i 74' - Q
,L 2so/a Reduction Repair Area i
801
Draw
s Lot 8
IP
��'
�� Raln�W �a4is
N
ki—. ;s it rt eWwrnlnm that there has been a material change in any fact of
This permit Is va'il[{ ipT a perjoa or "VjC Y=a! a CALcNL U 101 1 L IkIUf The well shall be inspected �r
,arcurnstanfe upon which the permit Is issued. Welt locatlon, installation, and protection must meet state regulations. and appro y Macon
Public. Health before it Is put into use. the location Of the tivell indicated by i~1CP3i is to provide protection from Passible sources of contamination. Flotiv volume (well yield) is NOT
guaranteed at any site by h1CPH.
A WELLHEAD COMPLETION INSPECTION MUST BE APPROVED BEFORE FINAL POWER I5 GRANTED 0 THE WELL IS PLACED INTO
SERVICE. PLEASE SCHEDULE A WELLHEAD INSPECTION AFTER PUMP INSTALLATION. QUESTIONS? [phone]
Issue Date,. 119j2020 Darrell McE}aniels, Rl"H5 2552'
j Authorized 5tatP Agent