HomeMy WebLinkAboutWELL-07-2022-176101.TIF � % CAT,W4 A,3 CO( 11
if , Public Health Iktvrtmcnl Ni hl, . .
' lot deEn.nonmtnral Ilralth t)(+ru°" 1'Iti. 462705089018
* PO Boy 114.25 Go+ernment Dn+t.Nt+.lon,NC tar t t r t r
5rto Addruis: 3505 FAMILY CIR, TERRELL NC 28682
Name on Pormlt: 'RAYMOND OTTESEN
Property Sim Acres 0 44
Directions: no directions written
Owner/Authorized Representative Acknowledgement of Permit Receipt
I ccrtifs that I am the unner or authorize)agent((wner's authorization required,representing the owner of
thF propert) descrihcd aboveXr .
`- As the property owner or authorized representative. I have received the above referenced
permit(s)as requested in the application fur service RNI'It-12-2021-393R2, by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
7 Electronic image Transmittal' F-mail (Return receipt required)
As the property owner or authorized represcntati%c 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(I SA NCAC IRA.1900),
and/or Well Construction Standards (15A NCAC 2C .0100), shall apply to the issuance alibis permit and
the construction of the wastewater system and/or water supply well permitted.
Permit Issue Date: 0712012022
Owner/Authorized Representative Signature �l
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Date 7-2 -
Documentation of Pcrmit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted h, (rrrmle of person.+,wrlirrg permit)
Signature g Date/'time 7hlfij)
Method: Fax 1 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 Case# WELL-07-2022-176101
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Public Health Department Subdivision
Environmental Health Division PIN# 462705089018
PO Box 389,25 Government Drive,Newton,NC 28658 LOT#
Site Address: 3505 FAMILY CIR,TERRELL NC 28682
Name on Permit: *RAYMOND OTTESEN
Property Size: Acres 0.44
Directions: no directions written
WELL ABANDONMENT PERMIT
Well Type:
Wells shall be abandoned in accordance with state regulations:
Article 15A North Carolina Administrative Code Subchapter 2C
The Well Abandonment Report must be submitted to the Catawba County Environmental Health within
30 days upon completion of a well abandonment.
Well contractor must schedule well abandonment inspection with Catawba County Environmental Health.
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07/20/2022
Authorized State Agent Permit Issuance Date
7/20/2027
Permit Expiration Date
chpermit 07/20/2022 16:03
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Parcel: 462705089018, 3505 FAMILY CIR 1 in=40ft
TERRELL, 28682
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07/18/2022