HomeMy WebLinkAboutWELL-01-2023-188174.tif ,, % CATAWBA COUNTY Case# WELL-0I-2023-188174
�, -t111 I Public Health Department Subdivision
11s Environmental Health Division PIN# 367704723850
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PO Box 389,25 Government Drive,Newton,NC 28658 Lar#
She Address: 4044 ANDERSON MOUNTAIN RD, MAIDEN NC 28650
Name on Permit: CHRISTOPHER RICHARD/TARA ANNE STANCIL
Property Size: Acres 4.54
Directions: S NC 16,right Anderson Mountain Rd, on left
Owner/Authorized Representative Acknowledgement of Permit Receipt
•
Xr I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
•
X62- As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-01-2023-43224,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
J Electronic Image Transmittal/E-mail (Return receipt required)
il$ 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: 01/26/2023 /��
Owner/Authorized Representative Signature ZA---i'
Date 7 9,0 _
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature 4i, Date/Time 1/ 71a3
Method: Fax Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from yoiPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymcinkey.com/s/EHCusttomerService
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Matt WPDT Report
Area of Interest (AOI) Information
Area : 3,134,508.61 ft2
Jan 26 2023 15:07:11 Eastern Standard Time
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- Federal Route - Secondary Route
Non-System Pinar/Roads
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NC Route
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4044 ANDERSON MOUNTAIN RD MAIDEN 28650
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