HomeMy WebLinkAboutWCOC-07-2016-074360.TIF pA • CATAWBA COUNTY Case4 WCOC-07-2 0 1 6-0743 60
I G Public Health Department Subdivision C BALLARD AND M SHERP
< r'--•- , I� Environmental Health Division PIN# 461704712967
�� PO Box 389, 100-A Southwest Blvd.Newton.NC 28658 LO DI PT 11 &PT 12
1842 :.
Name on Permit JOHN ALLISON, 810 W KETCHIE ST, CHINA GROVE NC 28023
Site Address: 8844 PENINSULA DR, TERRELL NC 28682 0 pzeggs 0
Property Size: 20,908.80 0.48 SEe �, � �
P Y Square Feet Acres �.7...Directions: _Jiffy 16 South, Left on Hwy 150 East, Right on Kiser Island Rd, Left on Penninsula Dr, Lot is 7' ` •�
0- 'O O r:
on the Left 35111 _ It +
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WELL CERTIFICATE OF COMPLETION
WATER SUPPLY: Well Type: Individual Well
WELL-12-2015-067554 INSPECTIONS
INSPECTION# COMP DATE INSPECTION TYPE STATUS INSPECTOR
EHINSP-330212 07/08/2016 EH Well Head Approved Robbie Phelps
EHINSP-330213 07/08/2016 EH GPS Data Collection Approved Robbie Phelps
EHINSP-327896 06/13/2016 EH Well Record Received Approved EH Admin
EHINSP-327462 06/07/2016 EI-I Well Grouting Approved Robbie Phelps
B&K Well 06/07/2016
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 07/08/2016
AUTHORIZED STATE AGENT APPROVAL-DATE
cti ellcoc 07/11/2016 09 14 Page 1 or'