HomeMy WebLinkAboutWCOC-07-2016-074363.TIF A \ CATAWBA COUNTY Case# WCOC-07-20 1 6-074 3 63
.e nll'..:2, Public Health Department Subdivision DEERFIELD 4
<5.7-4 94 �/ Environmental Health Division PIN# 268902873749
PO Box 389, 100-A Southwest Blvd, Newton. NC 28658 LO'P# 74
842.- M
Name on Permit ELENA PRITCHARD, 2102 MOSTELLER ESTATE AV SE, HICKORY NC 28602 f
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Site Address: 6373 WILLOWDOTTOM RD, HICKORY NC 28602 0 i1� o , 11•
Property Size: Square Feet 42,688.80 Acres 0.98 '' _ a. 13 7- ,
Directions: 127 South/right into Deerfield Subdivision/at stop sign turn right/1st stop on the left 1 ��0 +y o•Willowbottom Rd/lot is on the right
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WELL CERTIFICATE OF COMPLETION
WATER SUPPLY: Well Type: Individual Well
WELL-12-2015-067314 INSPECTIONS
INSPECTION# COMP DATE INSPECTION TYPE STATUS INSPECTOR
EHINSP-330217 07/06/2016 EH GPS Data Collection Approved Steven Price
EI-HNSP-330216 07/06/2016 EH Well Head Approved Robbie Phelps
EHINSP-319428 03/09/2016 EH Well Record Received Approved EH Admin
EI-IINSP-319202 03/07/2016 EH Well Grouting Approved Robbie Phelps
Chris Russell 03/07/2016
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 07/11/2016
AUTHORIZED STATE AGENT APPROVAL DATE
ch"rcll coc 07/11/2016 09:32 Page I of I