HomeMy WebLinkAboutWELL-04-2022-170288.TIF x -
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•�1(�, Public Health Department Subdivision —
ii • Environmental Health Division PINK 366703215422
PO Box 389,25 Government Drive,Newton,NC 28658 LOT#l:ilt
Sits Address: 4161 BUFFALO SHOALS RD, MAIDEN NC 28650
N.Iiia on Poratia :ANDREW PARKER
Property Size: Acres 4.19
Directions: Hwy 321 N bus/Maiden Hwy, Right Springs RD,Left onto Buffalo Shoals,lot on left
Owner/Authorized Representative Acknowledgement of Permit Receipt
lS frtify that I am the owner or authorized agent(owner's authorization required)representing the owner ofterty described above.s the property owner or authorized representative,I have received the above referenced
permit(s)as requested in the application for service RBPR-02-2022-40219,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
J Electronic Image Transmittal/E-mail (Return receipt required)
xAs the properly 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 systun and/or wstcr supply well pci,iiitti,d.
Permit Issue Date:04/27/2022 77
Owner/Authori Rep sentative Signature ;i/;D7�/ir U 4rx..-------
`'- i Date 7 3
------------------------
Documentation of Permit(s)Transmittal
(permit tr&tEs!iiI(icd ty ClictC4L:LC-or O.r.:i-L::;.'i`., •
Permit transmitted by (name of person sending permit)
Signature Cif ./ Date/Times/)f)
Method: Fax v Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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catawba county
public health
Memorandum
July 28, 2025
To: Andrew Parker
From: Megen McBride, Environmental Health Administrator
Re: Well Samples Required. Permit: WELL-04-2022-170288
Site Address: 4161 Buffalo Shoals Rd, Maiden NC 28650
The North Carolina Department of Health and Human Services requires all private drinking water wells
be sampled for bacteria, nitrate, nitrite, and a number of naturally occurring inorganic minerals.
Our office has made several attempts to contact you to schedule the water sample collection and
have been unable to reach you. Please contact our office so that we can schedule a time, at your
convenience,to collect the required samples.
The fees normally charged for these samples were included in the cost of your well permit, so there is
no additional charge for this service. The samples will be taken from an outside source.The sample test
results will be sent to you when they are received by our office. Typical process time is 6-8 weeks.
You may reach our office at (828)465-8270, or by e-mail at: ehadmin@catawbacountync.gov
catawbacountync.gov
Environmental Health
Catawba County Government Center
25 Government Drive 1 PO Box 389 1 Newton NC 28658 1 828.465.8270
MAKING. LIVING. BETTER.