HomeMy WebLinkAboutWCOC-03-2016-070521.TIF II>i CATARBACOUNTY Casetk WCOC-03-20 1 6-07052 1
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C ��,q Public Health Department Subdivision MOLLY WOODS
< /09 " Environmental Health Division PIM; 4609049 I 9438
PO Box 389. 100-A Southwest Blvd,Newton. NC 28658 LO-P# i 9
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Name on Permit TINA OSBORNE, PO BOX 262, SHERRILLS FORD NC 28673
Site Address: 7883 RIDGEVIEW DR, SHERRILLS FORD NC 28673 0 Ay , -•. r.:j 0
00 738. '��
Property Size: Square Feet 45, Acres 1.05 f�� �
Directions: SHERRILLS FORD RD TO MOLLYS BACKBONE RIGHT ON RIDGEVIEW. LOT ON RIGHT ` " `r it
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WELL CERTIFICATE OF COMPLETION
WATER SUPPLY: Well Type: Individual Well
WELL-01-2016-068535 INSPECTIONS
INSPECTION# COMP DATE INSPECTION TYPE STATUS INSPECTOR
EHINSP-320882 03/28/2016 EH Well Head Approved Robbie Phelps
EHINSP-320883 03/28/2016 EH GPS Data Collection Approved Robbie Phelps
EHINSP-320629 03/23/2016 EH Well Record Received Approved EH Admin
EHINSP-3201 IS 03/17/2016 EH Well Grouting Approved Robbie Phelps
Mid-south Well 03/17/2016
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.
Robbie Phelps 03/28/2016
AUTHORIZED STATE AGENT APPROVAL DATE
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