HomeMy WebLinkAboutWCOC-05-2016-072652.TIF t\xA CATAWBA COUNTY Case/I WCOC-05-2016-072652
, ffillaL.,i Public Health Department Subdivision ROXBURY FIELDS
--=•-•�} Environmental Health Division PIN# 375501351758
,, , PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 LOT4 2
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Name on Permit LAVINE SCROGER, 383 N THOMAS LN, STONY POINT NC 28678
Site Address: 6245 ROCKY RD, CLAREMONT NC 28610 0 4 ` • ?l I7
Property Size: 21,780.00 0.5 T:
P Y Square Feet Acres
Directions: Hwy 16 toward Taylorsville, Right onto Riverbend Rd, Left onto Rocky Rd, Property is on the ,1 , "
Left. O f:o fro
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5ac6292f-5121-401c-8366-7826a12bd017
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WELL CERTIFICATE OF COMPLETION
WATER SUPPLY: Well Type: Individual Well
WELL-04-2016-071129 INSPECTIONS
INSPECTION# COMP DATE INSPECTION TYPE STATUS INSPECTOR
EHINSP-325703 05/18/2016 EH Well Head Approved Steven Price
EHINSP-325704 05/18/2016 EH GPS Data Collection Approved Steven Price
EHINSP-323089 04/22/2016 EH Well Record Received Approved EH Admin
EHINSP-323757 04/20/2016 EH Well Grouting Approved Steven Price
Russell Well Drilling 04/20/2016
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.
Steven Price 05/18/2016
AUTHORIZED STATE AGENT APPROVAL DATE
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