HomeMy WebLinkAboutWELL-06-2016-073461.TIF ,gA \ CATAWBA COUNTY Case# WELL-06-2016-073461
4a Public Health Department Subdivision
,�r� „�; Environmental Health Division PINK 374016932160
Ddb ' PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LU'l'#
/842 SM NAME ON PERMIT: PACHI XIONG, 1939 E NC 10 HWY, NEWTON NC 28658
Site Address: 1939 E NC 10 HWY, NEWTON NC 28658
Property Size: Square Feet: 14,374.80 Acres:0.33
Directions: Hwy 10 East, House is on the corner of Hwy 10 East & Caleb Setzer Road, Once you turn on Caleb Setzer
Rd the driveway is on the Right.
Owner/Authorized Representative Acknowledgement of Permit Receipt
0/i 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
7C requested in the application for service EHPR-05-2016-23951 by the following method(s):
J Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/ E-mail (Return receipt required)
i 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: 06/14/2016
> Owner/Authorized Representative Signature id Ce
O — f 6-00 '
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
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1 clipermit 06/14/2016 11:30 Page 2 oft
tl3A CATAWBA COUNTY D 117-13-7.1.'1.1 0 Case# WEL,L-06-2016-073461
Skin y Public Health Department
Subdivision
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Environmental Health Division ?ti' , • 7V:it PIN# 374016932160
-41- PO Box 389, 100-A Southwest Blvd.Newton,NC 28658 • r G G
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NAME ON PERMIT: PACHI XIONG, 1939 E NC 10 HWY, NEWTON NC 28658
Site Address: 1939 E NC 10 HWY, NEWTON NC 28658
Property Size: Square Feet: 14,374.80 Acres:0.33
Directions: Hwy 10 East, House is on the corner of Hwy 10 East & Caleb Setzer Road, Once you turn on Caleb Setzer
Rd the driveway is 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
Dug
Megen McBride 06/14/2016
ISSUED BY PERMIT ISSUANCE DATE
ehperntil 06/14/2016 t Page l oft