HomeMy WebLinkAboutWCOC-03-2016-070346.TIF �y,A \ CATAWBA COUNTY Case# WCOC-03-20 1 6-0703 46
04i11111 1111 1 Public Health Department Subdivision
E I` Environmental Health Division PIN#
'/Y 367804546571
PO Box 389, 100-A Southwest Blvd_Newton. NC 28658 LOT/1 C
842 :,
Name on Permit DEBRA GILBERT, 4596 S NC 16 HWY, MAIDEN NC 28650
Site Address: 4525 LITTLE MOUNTAIN RD, CATAWBA NC 28609 0 f 0
Property Size: 122,403.60 2.81 to �a
P Y Square Feet Acres .+j, . ;
Directions: Hwy 16 S to Drums Crossrods, Turn left onto Buffalo Shoals, 1/2 mile turn right onto Little `' ''3
Mountain Rd, Land is 1/2 mile on the right.
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WELL CERTIFICATE OF COMPLETION
WATER SUPPLY: Well Type:
WELL-07-2015-062435 INSPECTIONS
INSPECTION# COMP DATE INSPECTION TYPE STATUS INSPECTOR
EHINSP-320596 03/23/2016 EH Well Record Received Approved EH Admit)
EHINSP-319022 03/03/2016 El-I Well Head Approved Jason Boyd
EHINSP-319038 08/28/2015 EH GPS Data Collection Approved Jason Boyd
EHINSP-319039 08/28/2015 EI-1 Well Grouting Approved Jason Boyd
Junior Selzer 08/28/2015
WELL DRILLER DATE DRILLED
Well permits are valid for 5 years from the date of issuance and are subject to suspension and/or revocation from
non-compliance with appropriate state and local rules and regulations, or if false information was given in order to obtain a
permit. Wells shall be constructed in accordance with all state and local regulations and rules.
The Well Completion Report must be submitted to the Health Department within 30 days upon completion of a well.
Jason Boyd 03/23/2016
AUTHORIZED STATE AGENT APPROVAL DACE
elmellcae 03/23/2016 08:58 Page 1 of 1