HomeMy WebLinkAboutWELL-04-2016-071520.TIF ,rc5 V CATAWBA COUNTY Case 4
e:tti'y, Public Health Department Subdivision
j Environmental Health Division PIN#T# 373115740202
10 44 PO Box 389. 100-A Southwest Blvd.Newton. NC 28658 LO
1.42 s.
NAME ON PERMIT: QUANTUM SOLUTIONS OF NA, LLC, 1901 CONOVER BLVD E A CONOVER NC
O ,
28613
Site Address: 2611 OLD CONOVER STARTOWN RD, NEWTON NC 28658
Property Size: Square Peet: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
,y _ I certify that I am the owner or authorized agent (owner's authorization required) representing the owner of the
property described above.
)C 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 18A .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 ._tilt , (I / 11 (name of person(se din /penrmit) _
Signature all t I f It 1'I�► Date/Time `�f `,.Y g t SS
Method: Fax \/N:mailUS Mail Other
Owner's request to send ,y t e above i dicated method of transmittal in lieu of signature
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el,penuii 04/22/2016 13:12 Page 2 of2
�gA CATAWBA COUNTY D ; 1 Q Case# WELL-04-2016-071520
� l Public Health Department pA Subdivision
n Environmental Health Division tO O - O PIN# 373115740202
''.t- PO Box 389. 100-A Southwest Blvd,Newton,NC 28658 ti • i LOT#
/A.z ,. i . }
.a. • .t
4.11
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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
ehpennit 04/22/2016 13:14 Page 1 of2