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Home My WebLink AboutWELL-04-2023-194452.TIF g CATAWBA COUNTYrAci -NN) Case# WELL-04-2023-194452 Public Health Department " ` Subdivision d 'a '4, Environmental Health Division 1723 NC, 112 PIN# 374207680515 PO Box 389,25 Government Drive, 58 LOT# 1842 :M Site Address: CONOVER NC 28613 Name on Permit: WK DICKSON Property Size: Acres 39.290 Directions: N NC 16 Hwy on left before St Johns Church Rd NE Owner/Authorized Representative Acknowledgement of Permit Receipt I 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-04-2023-44025, 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 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: 04/27/2023 Owner/Authorized Representative Signature Date Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name of person sending permit) Signature Date/Time .5 Is J)'3 Method: Fax .1 Email US Mail Other Owner's request to send by the above indicated method of transmittal in lieu of signature i - We wantt tto hear from yoLPlease ttake a few momentts tto complette our custtomer service survey att http://www.surveymonkey.com/s/EHCusttomerService 5 to )456 lu iccit (S , l�> r ehpernit 05/02/2023 13:29 ) 19 h t 1 Coin ey Q d��]! Case# 2 CATAWBACOUNT}� Qp�;�S�G� tQ, WELL-04-2023-19445_ �Q t � Public Health Department r�V N 1, i W Subdivision k „ ® "-1 Environmental Health Division 17 Z3 1•, (J PIN# 374207680515 Irs ' PO Box 389,25 Govemmen rive,Newton,NC 28658 LOT# \842 9, Site Address: 9-id-N1-6- -H+W-CONOVER NC 286 Syr/ � A •�{,�� Name on Permit: WK DICKSON Property Size: Acres 39.290 Directions: N NC 16 Hwy on left before St Johns Church Rd NE WELL ABANDONMENT PERMIT Well Type: Drilled 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. PERMIT CONDITIONS "Well must be abandoned by a licensed well driller. 04/27/2023 Authorized State Agent Permit Issuance Date 4/27/2028 Pennit Expiration Date ehpermit 05/05/2023 1 4:47 /6 � CATAWBA COUNT) Case.4 W ELI,04-2023-194452 d es' Public Health Department Subdivision t 'i Environmental Iiealth Division PIN# 374207680515 // PO no 389,25 Government Drive,Nessuon,NC 28658 L'42/ LO'1'd Site Address: 1521 N NC 16 HWY, CONOVER NC 28613 Name on Permit: WK DICKSON Property Size: Acres 39.290 Directions: N NC 16 Hwy on left before St Johns Church Rd NE Owner/Authorized Representative Acknowledgement of Permit Receipt I certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the property described above. fAs the property owner or authorized representative, I have received the above referenced permit(s)as requested in the application for service EHI'R-04-2023-44025, by the following method(s): _ Received in Person Facsimile Transmittal (Return form with signature required) 1 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 ISA.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: 04/27/2023 Owner/Authorized Representative Signature -, Date Documentation of Permit(s) Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name of person sending permit) Signature qC, Date/Time 5151)3 Method: Fax J 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 yosPlease ttake a few momentts tto complette our custtomer service survey att http://www.surveymonkey.com/s/E1-1CusttomerService S wa 1 Ws Q tv (-d l ckset. lam r ehpemut 05/D2/2023 13:29 4,413• • CATAWBA COII\'I'\' Case# WELL-04-2023-194452 `Q'�� , Public Health Depanment Subdivision 6 '1 Environmental Health Division PIN# 1 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 374207680515 Site Address: 1521 N NC 16 HWY, CONOVER NC 28613 Name on Permit: WK DICKSON Property Size: Acres 39.290 Directions: N NC 16 Hwy on left before St Johns Church Rd NE WELL ABANDONMENT PERMIT Well Type: Drilled 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. PERMIT CONDITIONS `Well must be abandoned by a licensed well driller. e i�� ,r 5,40+s 04/27/2023 Authorized State Agent Permit Issuance Date 4/27/2028 Permit Expiration Date ehperntit 05'05/2023 IJ:17