HomeMy WebLinkAboutWCOC-08-2016-075183.TIF CATAWBA COUNTY Case#
0WCOC-08-2016-075183
G Public Health Department Subdivision
L
Environmental Health Division PIN# 364807579865
PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 LOT# I
Name on Permit JACOB KILLIAN, 1513 PRISON CAMP RD, NEWTON NC 28658
Site Address: 1513 PRISON CAMP RD, NEWTON NC 28658 ❑� • ro rX 1• ❑�
40 108.
Property Size: Square Feet 104, Acres 2.39
Directions: Hwy 321 - Prison Camp Rd g past the 4th house on the right- paved road by a cow pasture 43
• 0 r re 12 r
0' o IN 17 r low
WELL CERTIFICATE OF COMPLETION
WATER SUPPLY: Well Type: Individual Well
WELL-05-2016-072349 INSPECTIONS
INSPECTION# COMP DATE INSPECTION TYPE STATUS INSPECTOR
EHINSP-332098 08/01/2016 EH Well Record Received Approved EH Admin
EHINSP-331882 07/28/2016 EH Well Head Approved Jason Boyd
EHINSP-332126 07/28/2016 EH GPS Data Collection Approved Jason Boyd
GPS Complete per Jason Boyd 8/1/16
EHINSP-331471 07/25/2016 EH Well Grouting Approved Jason Boyd
Chris Russell 07/25/2016
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 08/01/2016
AUTHORIZED STATE AGENT APPROVAL DATE
ehucllcuc 08/01/2016 14:15 Page I of I