HomeMy WebLinkAboutWELL-11-2023-208242.TIF 4,i% e CATAWBACOUNTY
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//.tII, Public Health Department Subdivision DEERFIELD SUED
Environmental Health Division PINK 269905089900
411 PO Box 389,25 Government Drive,Newton,NC 28658 I O'I'# 80
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Site Address: 5950 WOODHALL, HICKORY NC 28602
Name on Permit: GARY BLAIR
Property Size: Acres 1.04
Directions: NC 127, left onto Deerfield Ln, road name changes to Fawn Trail, left onto Shierbourn, right onto Brandywine,
left onto Woodhall,property ont he left
Owner/Authorized Representative Acknowledgement of Permit Receipt
)( g certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
4 gAs the property owner or authorized representative, I have received the above referenced
if
permit(s)as requested in the application for service EHPR-11-2023-45978,by the following method(s):
Received in Person
I Facsimile Transmittal (Return form with signature required)
11 Electronic Image Transmittal/E-mail (Return receipt required)
Stl5As 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: 11/10/2023
Owner/Authorized Representative Signature y 7_ g
ia,:,
Date 11/26/23
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Date/Time_ NM )3
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 yoePlease ttake a few momentts tto complette our custtomer service survey aft
http://www.surveymonkey.com/s/EHCusttomerService
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fig: \ CATAWBA COUNTY Case# WELL-11-2023-208242
!~� .{�{. y Public Health Department Subdivision DEERFIELD SUBD
d Environmental Health Division PIN# 269905089900
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 80
1:42 s+
Site Address: 5950 WOODHALL, HICKORY NC 28602
Name on Permit: GARY BLAIR
Property Size: Acres 1.04 •
Directions: NC 127, left onto Deerfield Ln, road name changes to Fawn Trail, left onto Shierboum, right onto Brandywine,
left onto Woodhall, property ont he left
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.
,,&. 4..101cite +;k;43) 11/10/2023
Authorized State Agent Permit Issuance Date
11/10/2028
Permit Expiration Date
ehpennit 11/10/2023 15:07
Catawba County Environmental Health
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Parcel: 269905089900, 5950 WOODHALL 1 in=60ft
HICKORY, 28602
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Copyright 2023 Catawba County NC
11/09/2023