HomeMy WebLinkAboutWELL-08-2016-075538.TIF 6ACATAWBA COUNTY Case#
,C gran'y Public Health Department Subdivision
4 Goff, ,4 Environmental Health Division PINE! 460716844357
\ 2� PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT# 2
NAME ON PERMIT: MCCALL BROTHERS, INC., 6740 BROOKSHIRE BLVD, CHARLOTTE NC 28216
Site Address: 3893 SLANTING BRIDGE RD, SHERRILLS FORD NC 28673
Property Size: Square Feet:61,855.20 Acres:1.42
Directions: Intersection of Hwy 150 & Sherrills Ford Rd, Next to Sherrills Ford Fire Dept.
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-07-2016-24382 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: 08/10/2016
\ Owner/Authorized Representative Signature
Date
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by �� Off, 1 �1�L'ncrme of person se id/n 'permit)
r t ��
Signature \��� [,1 Jt/ V l _ �� Date/Time g iV
Method: Fax \,-.‘nail US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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ehpennit 08/10/2016 08:30
• CATAWBA COUNTY Qin 7I';f0e Case# WELL-08-2016-075538
e ; Public Health Department ' - Subdivision
.^C Environmental Health Division iS � PIN# 460716844357
' I'0 Box 389. 100-A Southwest Blvd,Newton,NC 28658 o��_ LOT# 2
/842
e r
•
NAME ON PERMIT: MCCALL BROTHERS, INC., 6740 BROOKSHIRE BLVD, CHARLOTTE NC 28216
Site Address: 3893 SLANTING BRIDGE RD, SHERRILLS FORD NC 28673
Property Size: Square Feet:61,855.20 Acres:1.42
Directions: Intersection of Hwy 150 & Sherrills Ford Rd, Next to Sherrills Ford Fire Dept.
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
Jason Boyd 08/10/2016
ISSUED BY PERMIT ISSUANCE DATE
chpenuit 08/10/2016 08:31