HomeMy WebLinkAboutWELL-09-2016-076525.TIF CATAWBA COUNTY Case N
's Public HealthDepartmentSubdivision
CRESCENT LAND AND TIN
�yr Environmental Health Division
rPINK 460604545994
\16` PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT# 138
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NAME ON PERMIT: JAMES "MICHAEL" STRICKLAND, 1136 TORRENCE CIR, DAVIDSON NC 28036
Site Address: 4869 TRESTLE LN, DENVER NC 28037
Property Size: Square Feet:47,916.00 Acres:1.1
Directions: Campground Rd, left on Catawba Burris, Right on Bankhead, left on Trestle Ln, left on driveway
Owner/Authorized Representative Acknowledgement of Permit Receipt
1. I certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the
rr property described above.
t 4. As the property owner or authorized representative, I have received the above referenced permit(s)as
requested in the application for service REP R-05-2016-23865 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 i
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: 09/06/2016
Owner/Authorized'Representative Signature ., � _ 1000,-//
n/ �.
Date `I '/ y
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitte yk i (name ofperson sending permit)
Signature Date/Time i/
'1�J11'Q
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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e]permit 09/07/2016 10:00
1
A --NipCATAWBA COUNTY Ern;o- r-6e Case# WELL-09-2016-076525
.r . • Subdivision
r G Public Health Department } ., CRESCENT LAND AND TIN
1 r
< , ,5, Environmental Health Division r • 6 ±;11; PIN# 460604545994
�� PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 a �;� a LOT# 138
7842 s. t 7i A
NAME ON PERMIT: JAMES "MICHAEL" STRICKLAND, 1136 TORRENCE CIR, DAVIDSON NC 28036
Site Address: 4869 TRESTLE LN, DENVER NC 28037
Property Size: Square Feet:47,916.00 Acres:1.1
Directions: Campground Rd, left on Catawba Burris, Right on Bankhead, left on Trestle Ln, left on driveway
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
Robbie Phelps 09/06/2016
ISSUED BY PERMIT ISSUANCE DATE
chpermit 09107/2016 10:48
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