HomeMy WebLinkAboutWCOC-07-2016-074186.TIF 3,A CATAWBA COUNTY Case# WCOC-07-2016-074186
.iliPublic Health Department Subdivision MRS EMMA L KILLIAN ES'I
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4 ���I , , Environmental Health Division PIN# 363914236941
1 ,,,,/ PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 LOT# 37-40
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Name on Permit *CLAYTON HOMES OF STATESVILLE, 2026 NORTHSIDE DR, STATESVILLE NC 28625
Site Address: 1853 DISNEY LN,NEWTON NC 28658 0 • , r•"f 0
Property Size: Square 14,810.40 0.34 14,71/4.-'11/2974'.6• • {y.
P Y S uare Feet Acres _
Directions: 121 Business South, Right on Hwy 10 West, Left onto Lutz DR, Left on Disney RD lot on left ' `r
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WELL CERTIFICATE OF COMPLETION
WATER SUPPLY: Well Type: Individual Well
WELL-04-2016-070769 INSPECTIONS
INSPECTION# COMP DATE INSPECTION TYPE STATUS INSPECTOR
EHINSP-329823 07/05/2016 EH GPS Data Collection Approved Jason Boyd
EHINSP-329822 07/05/2016 EH Well Head Approved Jason Boyd
EHINSP-328420 06/17/2016 EH Well Record Received Approved EH Admin
EHINSP-327965 06/13/2016 EH Well Grouting Approved Jason Boyd
Chris Russell 06/13/2016
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.
Jason Boyd 07/05/2016
AUTHORIZED STATE AGENT APPROVAL DATE
eharellcuc 07/05/2016 10:51 Page 1 of I