HomeMy WebLinkAboutWELL-05-2023-194741.TIF r•
• CATAWBA COUNTY Case# WELL-05-2023-194741
IPublic Health Department Subdivision
"fit , Environmental Health Division P1N# 367802756110
1414 PO Box 389,25 Government Drive,Newton,NC 28658 LOT#
411111riai
Site Address: 4718 LITTLE MOUNTAIN RD. CATAWBA NC 28609
Name on Permit: TYLER BLACK
Property Size: Acres 1.23
Directions: Hwy 16 S.left Buffalo Shoals Rd, right Little Mountain Rd. 11th house on left
Owner/Authorized Representative Acknowledgement of Permit Receipt
-73 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-04-2023-44031, by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
7 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 I8A.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: 05/02/2023
Owner/Authorized Representative Signature / `--
Date 514
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (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 yoaPlease hake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
ehpennii 05/02/2023 13:34
catawba county
public health
Memorandum
November 25, 2024
To: Tyler Black
From: Megen McBride, Environmental Health Administrator
Re: Well Samples Required. Permit: WELL-05-2023-194741
Site Address: 4718 Little Mountain Rd, Catawba NC 28609
Since July 1st, 2008,the North Carolina Department of Health and Human Services requires all private
drinking water wells be sampled for bacteria, nitrate, nitrite, pH, 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@CatawbaCountvNC.gov
catawbacountync.gov
Environmental Health
Catawba County Government Center
25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270
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