HomeMy WebLinkAboutWELL-04-2016-071519.TIF A1A .N CATAWBA COUNTY Case#
�Atm Public Health Department Subdivision
. g°•1 4 Environmental Health Division PIN# 373115740202
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L . PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 LOT#
NAME ON PERMIT: QUANTUM SOLUTIONS OF NA, LLC, 1901 CONOVER BLVD E A, CONOVER NC
28613
Site Address: 2611 OLD CONOVER STARTOWN RD, NEWTON NC 28658
Property Size: Square Feet:41,817.60 Acres:0.96
Directions: Off Hwy 70 Turn at Hardees, Go straight thru 4 way stop, Pass 2 apartment complexes on the right, House
will be the 3rd house on the Right.
Owner/Authorized Representative Acknowledgement of Permit Receipt
,� I certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the
property described above.
X As the property owner or authorized representative, I have received the above referenced permit(s) as
requested in the application for service EHPR-04-2016-23660 by the following method(s):
Received in Person
acsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/ E-mail (Return receipt required)
As the property owner or authorized representative I have reviewed and understand the specific conditions
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 1SA .1900), and/or
Well Construction Standards (15A NCAC 2C .0100), shall apply to the issuance of this permit and the
construction of the wastewater system and/or water supply well permitted.
Permit Issue Date: 04/22/2016
Owner/Authorized Representative Signature
Date
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by _ t 1f 140 ' II (name ofperson�sendin• permit) _
Signature tilt y 1 i /Lift Date/Time `"1 F* ( (j1•1
Method: Fax \,y nail US Mail Other
Owner's request to send y t e above i dicated method of transmittal in lieu of signature
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ehpermit 04/22/2016 13:12 Page 2 o12
.�A CATAWBA COUNTY Q a oY•• 0 Case# WELL-04-2016-071519
,Q&II 4 Public Health Department •• ce :1 Subdivision
C w' ,',,- Environmental Health Division ? r ry PIN# 373115740202
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PO Box 389. 100-A Southwest Blvd,Newton, NC 28658 0 • O LOT#
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NAME ON PERMIT: QUANTUM SOLUTIONS OF NA, LLC, 1901 CONOVER BLVD E A, CONOVER NC
28613
Site Address: 2611 OLD CONOVER STARTOWN RD, NEWTON NC 28658
Property Size: Square Feet:41,817.60 Acres:0.96
Directions: Off Hwy 70 Turn at Hardees, Go straight thru 4 way stop, Pass 2 apartment complexes on the right, House
will be the 3rd house on the 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
Megen McBride 04/22/2016
ISSUED BY PERMIT ISSUANCE DATE
ehpennil 04/22/2016 13:12 Page 1 oft