HomeMy WebLinkAboutWELL-07-2016-074859.TIF CATAWBA COUNTY Case# WELL-07-2016-074859
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.7.:471111, Public Health Department Subdivision
Environmental Health Division PINK 375208976640
�< h PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 LOT#
/8/1 .
NAME ON PERMIT: DAVID TUCKER, 3458 N OXFORD ST, CLAREMONT NC 28610
Site Address: 3458 N OXFORD ST, CLAREMONT NC 28610
Property Size: Square Feet: 35,719.20 Acrcs:.820
Directions: 1-40 exit 135 North Oxford St, 1/2 mile on right second driveway past Keller St
Owner/Authorized Representative Acknowledgement of Permit Receipt
Sri certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the
property described above.
reqAs the property owner or authorized representative, I have received the above referenced permit(s) as
uested in the application for service EHPR-06-2016-24023 by the following method(s):
NZ/Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/ E-mail (Return receipt required)
NAs 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: 07/22/2016
Owner/Authorized Representative Signature C3IAJ7-r Ll�e
Date 7 - 26 - /6
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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dirt mu 07/22/2016 12:57
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CATA\IBA COUNTYe ❑ Case WELL-07-2016-074859
in r Q Public Health Department ' ? .JI' Subdivision
‘e/ Environmental health Division o o ' ;moo
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�„ PIN# 375208976640
�"Il`- PO Box 389. 100-A Southwest Blvd.Newton,NC 28658 ' 1 „ LOT#
❑- a+O G .
NAME ON PERMIT: DAVID TUCKER, 3458 N OXFORD ST, CLAREMONT NC 28610
Site Address: 3458 N OXFORD ST, CLAREMONT NC 28610
Property Size: Square Feet: 35,719.20 Acres:.820
Directions: 1-40 exit 135 North Oxford St, 1/2 mile on right second driveway past Keller St
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
Steven Price 07/22/2016
ISSUED BY PERMIT ISSUANCE DATE
chpennit 07/22/2016 12:57
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Parcel: 375208976640, 3458 N OXFORD ST 1 in=50ft
CLAREMONT, 28610
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