HomeMy WebLinkAboutWELL-03-2016-070087.TIF 03/16/2016 11: 16 FAX 2 002
1� CATAWWBA COUNTY Case" WELL-03-2016-070087
�`�' �s't: Subdivision
WaftP ub llc Health Department
'' '" " i Environmental Health Division PIN" 372013042044
+�yt : . .
��/� PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT"
NAME ON PERMIT: KENNETH TEMPLE, 3000 SANDY FORD RD, NEWTON NC 28658
Site Address: 3000 SANDY FORD RD, NEWTON NC 28658
Property Size: Square Feet:121,532.40 Acres:2.790
Directions: Startown Rd, left on Sandy Ford, .9 miles on right
Owner/Authorized Representative Acknowledgement of Permit Receipt
9C g I certify that tam the owner or authorized agent(owner's authorization required)representing the owner of the
property described above.
005 As the property owner or authorized representative,1 have received the above referenced permit(s)as
'E requested in the application for service EHPR 03.20113-23941 by the following rnethod(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
VElectronic Image Transmittal/E-mail (Return receipt required)
si( 1Yg As the property owner or authorized representative I have reviewed and understand the specific conditions
1 of the permit issued, and further understand that all applicable regulatory requirements specified under the North
Carolina Laws and Rules for Sewage Treatment and Disposal Systems (15A NCAC 18A .1900), and/or
Well Construction Standards (1SA NCAC 2C.0100), shall apply to the issuance of this permit and the
construction of the wastewater system and/or water supply well .enni ..
Permit Issue Date: 03/16/2016 /
Owner/Auth/orized Representative Signature V
Date 3f/6�6
Documentation of Permit(s)Transmittal
(permit tr:nsmitted by electronic or other means)
Permit transmits by t i,1 .1 Lss a_ um (name of person sending permit
SigtlatureYtU1 v ' TM —Date/Time-3 o f LAD
Method: _ Fax\/EmailUSMail Other
Owne 's request to send b the above indicated method of transmittal in lieu of signature
—_—
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chpcnnit 03/16/2016 09:36 Paae2 o12
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v48 \ CATAwBACOUNTI' 0 • o Case# WELL-03-2016-070087
¢OPublic Health Department k. tr '2* Subdivision
� 4 Environmental Health Division e •r't PINi1 372013042044
� PO Box 389, 100-A Southwest BIvd,Newton,NC 28658 ' •� Lon
I-4 • •
:a. Z OCa
NAME ON PERMIT: KENNETH TEMPLE, 3000 SANDY FORD RD, NEWTON NC 28658
Site Address: 3000 SANDY FORD RD, NEWTON NC 28658
Property Size: Square Feet: 121,532.40 Acres:2.790
Directions: Startown Rd, left on Sandy Ford, .9 miles on right
WELL ABANDONMENT PERMIT
Wells shall be abandoned in accordance with state regulations:
Article 15A North Carolina Administrative Code Subsection 2C
The Well Abandonment Report must be submitted to the Catawba County Environmental Health within 30 days upor
completion of a well abandonment.
Well contractor must schedule well abandonment inspection with Catawba County Environmental Health.
WELL TYPE
Dug
Steven Price 03/16/2016
ISSUED BY PERMIT ISSUANCE DATE
ehpennit 03/16/2016 09:36 Page 1 of2
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Parcel: 372013042044, 3000 SANDY FORD RD 1 in=100ft
NEWTON, 28658
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Copyright 2014 Catawba County NC I
03/07/2016
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