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HomeMy WebLinkAboutWELL-08-2016-076188.TIF 1aA CATAWBA COUNTY Case# WELL-08-2016-076188 ,,yrti Public Health Department Subdivision 2 ��t„� Environmental Health Division PINK 266701387436 ^wt- PO Boy 389. 100-A Southwest Blvd,Newton,NC 28658 LOT# 1H.1 ,V NAME ON PERMIT: COOKSVILLE VOL FIRE DEPT INC, 6942 OLD SHELBY RD, VALE NC 28168 Site Address: 6942 OLD SHELBY RD, VALE NC 28168 Property Size: Square Feet:29,185.20 Acres:0.67 Directions: Hwy 10 W, right Old Shelby Rd, on right approx 1 miles Owner/Authorized Representative Acknowledgement of Permit Receipt ‘)C1 eca 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-08-2016-24474 by the following method(s): Received in Person Facsimile Transmittal (Return form with signature required) Electronic Image Transmittal/ E-mail (Return receipt required) /4! 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: 08/26/2016 Owner/Authorized Representative Signature lC-e,--- — r Date ©r 3(- zof Documentation of Permit(s) Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name ofperson 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 elipen»it 08/26/2016 11:28 .w~nA \ CATAWVBA COUNTY ❑� +D' ❑� Case# WELL-08-2016-076188 7• t'.af.1 _> Public Health Department '� Subdivision 4®H1 Environmental Health Division I .rt ' B.. .1- PIN# 266701387436 "�� PO Box 389. 100-A Southwest Blvd,Newton,NC 28658 �n � 7� � LO'f# ;8 4. u ' Y NAME ON PERMIT: COOKSVILLE VOL FIRE DEPT INC, 6942 OLD SHELBY RD, VALE NC 28168 Site Address: 6942 OLD SHELBY RD, VALE NC 28168 Property Size: Square Feet:29,185.20 Acres:0.67 Directions: Hwy 10 W, right Old Shelby Rd, on right approx 1 miles WELL ABANDONMENT PERMIT Wells shall be abandoned in accordance with state regulations: Article 1SA 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 Bored Steven Price 08/26/2016 ISSUED BY PERMIT ISSUANCE DATE ehpermit 08/26/2016 1 128 Catawba County Environmental Health EHPR 08-2016-24474 • (254) 6942 Old Shelby Rd,Vale L.-1 (185) 8i t t,.ti( o im ' Il 7 / Ts L . . . ...,, .... -- \-- - - - - - - -- - -- -- N \KI.J g S (58) 2503 Parcel: 266701387436, 6942 OLD SHELBY RD 1 in=60ft VALE, 28168 This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and