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HomeMy WebLinkAboutWELL-5-11-17914.TIF � CATAWBA COUNTY Case # WELL-5-11-17914 y - G Public Health Department " �? Environmental Health Division Subdivision CATAWBA COUNTRY CLU J"°'"' �°? `< p0 Box 389, 100-A Southwest Blvd, Newton, NC 28658 Lot # 3 Ig 2 s� PIN# 371019523436 Applicant/owner KIM CLARKE ' � ����R 5 �Ii �vg� g Site Address: 3441 BRIDGEFORD LN, Newton, NC Property Size: SF 0.469 ACRES Directions: ON SANDY FORD RD 1/2 MILE WEST O!' ROBINSON RD INTERSECTION ENTRANCE TO CATAWBA COUNTRY CLUB IS ON LGFT. PROPERTY IS STH HOUSG ON LEFT AFTER COUNTRY CLUB. HOUSE FACES SANDY FORD BUT ADDRESS IS S[DE STREGT BRIDGEFORD LN WELL ABANDONMENT PERMIT Wells shall be�abandoned in accordance with state regulations: Article 15A North Carolina Administrative Code Subsection 2C The Well Abandonment'Report must be submitted to the Catawba County Environmental Health within 30 : ����days upon completion of a well abandonmen�t. � Well contractor must sch'eciule well abandonment inspection with Cata�vba County Environmental Health. } �.. � f _.�., � ��, ^a � � �; �� � . �.C°" c: � . , � �_ ; :'1WELL TYP� I;r . - ,., � . ��--`� Drilled �_a�� �. w---� � � � "`,�,., � � '', ,�� y��r ,:,ti � � � �� � V �� . ,.,r- " � ��"`_Y � � � � �' �, .�����" �� � ��` Megen�.McBride � � OS/ l/2011 � ISSUED BY ' PERMIT 1SSUANCE DATE �z �� OS/12/I I 09:15 I � CATAWBA COUNT,,Y: Casc 1. �14CLL 5'I I 17919 � � � � 3Public',ficalth�DcpanmenN , ,,� „p�,,, �: Subdivisiom ��ATA1Vf3A COUNTRY CI;U� C�vuonmental Hc�Ith,Drviswn , . . _ . 1 '" ��`f'0 Box 389 100-A Soulh«�csl�Dlvd Nealon;!NC 28658 Lol+y' 3 .�., ... �. � , ,, ._ . .:,. , ., _. �' '�,-, , f'INl1: ;37LQ1953343G � _ . .. , I � Applic`andOwner KIM'� A=RKE�� ' I Site:�Addiess;' 3441r`I3RIDGEFORD��LN;:Ne�v�6n;;,NC: Froperry�Size,� SF' Q:469 nCRES - Di er ctions �{ � ON�SA�NI�Y FORD�RD?I%2"M1Lf �WES'I OI' R013fNSON RQ+INTFftSI'CTION CNTRANCE lO;CATn�VBA COUNTftY i y � C[;UE3,IS ON LCIT'�PROPCRTY'.IS 5Tf-1 HOUSC QN LLf'T;!Af GER COUNTRYaCLUB: HOUSE I'ACCS � :: �. � .�� . . � v .. _ . . .. E3UT A`DDRCSS�IS�SIDE STRCET E3RIDGC('ORD I:N� .� -. .f-•. ... �,>-�., F - � . .�. . � _ . . . � ,, ; . � � , i � . , � .. _w. -: - ,.. . O�wnerlAu�th`qrized Represe"ntat►ve',Ackn�owlecigement of �Permit Receipt � '� � �� �ccrnfy�that ['ain the.o�vner:or'�authorized;agcnt (owner;s�authorizafion.required),'r.epre"seiifii�g thc'�ownec'�:oGtl�ei + r ,property,descr�bed abo,.v,e.. � �' ' � ... _ ) �� ��s the^ ro e owner or,a`Cilhor�zcd re resentative I 11a:ve iece��ed.the abo�c referenced ermit s as re, applicatign�for;seiv�ce p � ` p O V � r , .P�, P �.rtY � _ q E•HPR-S.=;l:1-108�1•9 , by the follow�ng _ Receiued�>»'Person' � � ,„.I'acs�nirle Transniilt'al (R'eturn forin �v�th�signature required�) s � �Clectron�c, Image Transmittal/ � ,rna�l (Rc,tum rece�pt _requtred)� ' 1 I , , ,. _.. . , I �As,the property owner or authorized representat�,ve I I�a��e rev�ew,ed and understand-thc sp.ecific. I „`coridri►ons,of�the Perrnri-'issuecl;. and�fuether,understari�i that;all applicable�regulal�ry requ�rerrients speci�fiedrundcr the�Nurtla�Car,olina�°La,w�s a�i� Rules�for Seivage Treatmen`t an�l`Dis��,osal Systems,f(r15uA�. { r ��,�. � '?:`= � }'= �NCAC 1�A�� 1900j; and/,oi �Ve11�Constt.uct�on St��nilards (ISA NCAC 2C 010'0), s}iall apply to the� ,issuance,of�ftiis permit�,and�the=construct�on of:the wastewater systcm and/or wat"ec supply,�well;permrtted:, .�,, . u .,. . �; � ,Perin�t Issue Date`� OS%'�] �l /20:1��:�1 � � � , i � . ° _ >;- � �" 'Owiier/Autlior�zed�Repi,esentat'iv,e Signati�re ` Dafe S'' �Z' �/% , �, ,. , I , . __ _.. __ , . . _ .. . _. _ . , �• ------ -- . ------------------------------------------------------------------------- --------------------. � , , ' i .Documentation�of.P.,..e� m�t{s) Tran"smi:ttal . , ' (�er"mit transmitfed b,y�clectroriic or,�;Eher mcans) • � �. . r � , r � >�Permit transmi:tted vy.,�: _ ��ud..�' a ` (nuh�e of,;�erson;'seiulrngl�e�niii): i � ., � , � � . _: ; S�griatu�e -" .. ; Date/Time '���1! ' , � - - - ' Nlctl�od: . Fax �Cma`il US:M�iI; .Othc.r° . � . , . � O��nc�;s request to�send,by the abovc induated method,of transmittal in I�cu;of sig»aturc. � i ?"acicno��tedges the,conditions a.n�l statements_abo�e: ; , . �S P,��Cl�arjtr h��� ' I . OS/12Z11 09s1,5�. ' �, . ` , { . ___ -. . ,.