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Home My WebLink AboutWELL-06-2016-073104.TIF s-i _• CATAWBA COUNTY Case N WELL-06-2016-073104 ,T an G Public Health Department Subdivision < ; 0 i ^v Environmental Health Division PINMI 371107792430 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT# 78,2 s. NAME ON PERMIT: *ANDUJAR CONSTRUCTION, INC., 3013 GRIFFITH ST, CHARLOTTE NC 28203 Site Address: 2115 HWY 70 SE, HICKORY NC 28602 Property Size: Square Feet:63,162.00 Acres:1.450 Directions: Hwy 70 SE, Across from Academy Sports 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. / As the property owner or authorized representative, I have received the above referenced permit(s) as requested in the application for service EHPR-06-2016-24003 by the following method(s): Received in Person yacsimile Transmittal (Return form with signature required) _s-/Electronic Image Transmittal/ E-mail (Return receipt required) As the property owner or authorized representative I have reviewed and understand the specific conditions rof 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: 06/06/2016 `: Owner/Authorized Representative Signature Date Documentation of Permit(s) Transmittal (permit tra smitted by electronic or other means) Permit tran i it e' b a' 11411 't IMk(name ofperson sending perjmit) �(� Signature 1.1 11tWA ,�l' i�,�, A� Date/TimeVia0 ( \7; I� Method: Fax .,11-ail US Mail Other O e 's re.uest to send by the above indicated method of transmittal in lieu of signature N e We want to hear' om you. Please to - a few moments to complete our customer service survey at: http://www.surveymonkey.com/s/EHCustomerService ehpennit 06/06/2016 10:19 Page 2 of 2 CATAWBA COUNTY D o h- 0 Case 4 WELL-06-2016-0731041 Qu 2 Public Health Department 4 'T " 14 Subdivision :�et „s, Environmental Health Division r G r5t i .' PIN/ 371107792430 t82 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT# NAME ON PERMIT: *ANDUJAR CONSTRUCTION, INC., 3013 GRIFFITH ST, CHARLOTTE NC 28203 Site Address: 2115 HWY 70 SE, HICKORY NC 28602 Property Size: Square Feet:63,162.00 Acres:1.450 Directions: Hwy 70 SE, Across from Academy Sports 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 Drilled Megen McBride 06/06/2016 ISSUED BY PERMIT ISSUANCE DATE ehpermit 06/06/2016 10:19 Page I of2