HomeMy WebLinkAboutWELL-08-2016-076190.TIF q CATAWBA COUNTY Case# WELL-08-2016-076190
.CV' ,"}' , Public Health Department Subdivision
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130 Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT#
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NAME ON PERMIT: `HICKORY CONSTRUCTION COMPANY, 1728 9TH AV NW, HICKORY NC 28601
Site Address: 826 21ST ST DR SE, HICKORY NC 28602
Property Size: Square Feet: 19,602.00 Acres:0.45
Directions: From McDonald Parkway, Right onto 21st St Dr SE&travel 1/4 mile, Property is on the Right just after 23rd
St Ct SE.
Owner/Authorized Representative Acknowledgement of Permit Receipt
certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the
A
property described above.
s the property owner or authorized representative, I have received the above referenced permit(s) as
Nj requested in the application for service EHPR-08-2016-24507 by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
s 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: 08/26/2016 £�✓` J
Owner/Authorized Representative Signature
Date l7,2t'p/l(,
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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ehpemut 08/26/2016 11:25
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dti CATAR'I3A COUNTY e y o e Case#2 WELL-08-2016-076190
TG/- •tiPublic Health Department l Subdivision
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2 PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 4�yt'�._ s LO'I'#t
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NAME ON PERMIT: `HICKORY CONSTRUCTION COMPANY, 1728 9TH AV NW, HICKORY NC 28601
Site Address: 826 21ST ST DR SE, HICKORY NC 28602
Property Size: Square Feet: 19,602.00 Acres:0.45
Directions: From McDonald Parkway, Right onto 21st St Dr SE &travel 1/4 mile, Property is on the Right just after 23rd
St Ct SE.
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 08/26/2016
ISSUED BY PERMIT ISSUANCE DATE
ebpermit 08/26/2016 11:25
Catawba County Environmental Health
EHPR 08-2016-24507
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Parcel: 372213043590, 826 21ST ST DR SE 1 in=60ft
HICKORY, 28602
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