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Home My WebLink AboutWELL-04-2023-193730.TIF d.1 : . CATAWBA COUNTY H �.li Public Health Department Subdivision 4Environmental Health Division PIN# 460904829830 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 9 Site Address: 2143 MOLLYS BACKBONE RD, SHERRILLS FORD NC 28673 Name on Permit: J. MICHAEL HOLCOMB Property Size: Acres 60.3 Directions: Turn left coming north on Mollys Backbone Rd, soon after passing Ridgeview Dr property on the right Owner/Authorized Representative Acknowledgement of Permit Receipt yI 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-02-2023-43539, by the following method(s): Received in Person Facsimile Transmittal (Return form with signature required) ,f 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 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: 04/17/2023 Owner/Authorized Representative Signature Date Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by cie (name of person 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 wantt tto hear from yod'lease ttake a few momentts tto complette our custtomer service survey att http://www.surveymonkey.com/s/EHCusttomerService iliteU 0511iNkj 61,3 A& .6/y) Li I 11 113 ehpctw I 04/18/2023 06:34 = • CATAWBACOUNTY Case# WELL-04-2023-193730 t 111 ,Z Public Health Department Subdivision < , c `5' Environmental Health Division PIN# 460904829830 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 9 /8, 1. sm Site Address: 2143 MOLLYS BACKBONE RD, SHERRILLS FORD NC 28673 Name on Permit: J. MICHAEL HOLCOMB Property Size: Acres 60.3 Directions: Turn left coming north on Mollys Backbone Rd, soon after passing Ridgeview Dr property on the right WELL ABANDONMENT PERMIT Well Type: Dug 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. ' ; ...--,,_, /:".—F....... 04/17/2023 Authorized State Agent Permit Issuance Date 4/17/2028 Permit Expiration Date ehjernut 04/19/2023 15:09