HomeMy WebLinkAboutWCOC-08-2016-075167.TIF 4,42k • CATAWBA COUNTY Case# WCOC-08-2016-075167
.F- 111y Public Health Department Subdivision CHARLES WILSON AND WI
G "lir 2s.914 Environmental Health Division PIN# 460701366801
� PO Box 389. 100-A Southwest BlvdL Newton.NC 28658 LOLOP/ 9
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Name on Permit *MATT BECKHAM, 144 ARBOR RIDGE RD, MOUNT HOLLY NC 28120
Site Address: 3612 DOCKSIDE LN, SI-1ERRILLS FORD NC 28673 Q-• I ;o•' �0
Property Size: q 23,522.40 0.54
p rtY square Feet Acres --
Directions: frottl Charlotte/Hwy 16N1 right 150E I left Mt Pleasant Rd/right Dockside Ln/ property on leftfl' :Th
(old red&white mobile home on left 4 n}7 1:le
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WELL CERTIFICATE OF COMPLETION
WATER SUPPLY: Well Type: Individual Well
WELL-10-2015-066108 INSPECTIONS
INSPECTION# COMP DATE INSPECTION TYPE STATUS INSPECTOR
EHINSP-332082 07/29/2016 EH Well Head Approved Jason Boyd
EHINSP-332081 07/29/2016 EH GPS Data Collection Approved Jason Boyd
EHINSP-310591 03/15/2016 EH Well Record Received Approved EH Admin
EHINSP-310803 11/10/2015 EH Well Grouting Approved Jason Boyd
B and K(Robert Teague) 11/10/2015
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 08/01/2016
AUTHORIZED STATE AGENT APPROVAL DATE
ehocllo c 08/01/2016 10'.46 Page I of I