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HomeMy WebLinkAboutWELL-06-2016-073184.TIF �gA • CATAWBA COUNTY Case# WELL-06-201 6-073184 ie !'. 11 Public Health Department Subdivision " �'E , Environmental Health Division PIN# 367702764478 �' � PO Box 389, 100-A Southwest Blvd,Nekton.NC 28658 LOT# Jg42 sy NAME ON PERMIT: HIGH POINT BUILDERS LLC, 5171 ELLEN AV, ARCHDALE NC 27263 Site Address: 4771 S NC 16 HWY, MAIDEN NC 28650 Property Size: Square Feet:61,855.20 Acres:1.420 Directions: Hwy 16 S, on right before Anderson Mountain Rd 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-05-2016-23989 by the following method(s): Received in Person Facsimile 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: 06/07/2016 Owner/Authorized Representative Signature Date Documentation of Permit(s) Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name of person sending permit) Signature Date/Time Method: Fax Email US Mail Other Owner's request to send by the above indicated method of transmittal in lieu of signature We want to hear from you. Please take a few moments to complete our customer service survey at: http://www.surveymonkey.com/s/EHCustomerService chpennit 06/0712016 11:39 Page 2 of 2 I CATAWBACOUNTY OW; WELL-06-2016-073184 �t� Case# .� G� Public Health Department NE r . Subdivision 4 Environmental Health Division -, ' : PIN# 367702764478 PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 ' 14 _ ° _ Lon 18.2 sx NAME ON PERMIT: HIGH POINT BUILDERS LLC, 5171 ELLEN AV, ARCHDALE NC 27263 Site Address: 4771 S NC 16 HWY, MAIDEN NC 28650 Property Size: Square Feet:61,855.20 Acres:1.420 Directions: Hwy 16 S, on right before Anderson Mountain Rd 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 Robbie Phelps 06/07/2016 ISSUED BY PERMIT ISSUANCE DATE ehpennit 06/07/2016 11:39 Page I oft catawba county public health December 13, 2022 High Point Builders, LLC 5171 Ellen Ave Archdale, NC 27263 Re: 4771 S NC 16 Hwy, Maiden NC 28650 To Whom It May Concern: Our records indicate you abandoned a well at the above address on or about 6/15/2016. To date, we have not received the Well Abandonment Record. Please forward the Well Abandonment Record to our office by either mail, fax or email. For your convenience, I have enclosed a self-addressed, stamped envelope. Our fax number is 828-465-8276. Our email address is EHAdmin(uiCatawbaCountyNC.gov Thank you, AA Mege McBride, REHS Environmental Health Administrator catawbacountync.gov Environmental Health Catawba County Government Center 25 Government Drive I PO Box 389 I Newton NC 28658 , 828,465.8270 MAKING. LIVING. BETTER. / Randeij Jones Well & Pump • 5311 Turner Smith Rd. .:'' Brown Summit NC,27 14 . Telephone: (336) 669-5079 Sold TO _ '`i' i '? �., J/ Oril:r�rMo. r Address C'r c. �; 1 :, 7= /`':. : rl cf.' ,_� SitfoTa _ IAddress Qty. L cti an Price P,nwur22 • , 2• i i C. ! 8. i r,�; "c I �l . Y0, t le 15. Charges of I I/2%(18%APR)will be added to all accounts after 30 days. Collection Fees&Attorney Fees will be added Purchased Br HIGH POINT BUILDERS LLC 8-5472 5171 ELLEN AVENUE 3845 ARCHDALE.NC 27263 DATE _6-�.�] 3./.fa eshilekr S rAyro "'. B c P TMEORoEcoF p ELJe ai -.ac, P ur, $ AID. 00 DO____LLA RS E- Lf `(77i� y 7 73�5194, CARaThai. N e cr:,j tit, • +sue riiff��".'� ;U C, M�O{\iC • ,�1 I - rti,@.. ii _DD�� Y, 1:0S3ii20391: 10200038 ?50 ,,....& '