HomeMy WebLinkAboutWCOC-09-2016-076542.TIF y,A a • CATAWBA COUNTY Case# WCOC-09-2016-076542
. "°' . Public Health Department Subdivision MAPLE GLEN
a Environmental Health Division PIN#
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PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT# 5
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Name on Permit BRANDON EDMONDSON, 3771 MAIN AVE DR NW, HICKORY NC 28601
Site Address: 1019 HEATHER GLEN DR,CATAWBA NC 28609 0 r.''O'4• CI
Property Size: Square Feet 40,075.20 Acres 0 92 eyF ,.
Directions: 10E/RT MURRAY'S MILL RD/LEFT SHERRILLS FORD RD/LEFT LONG ISLAND RD/RT
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MAPLE GLEN/RT HEATHER GLEN /PROPERTY ON RIGHT IN CUL-DE-SAC y ��,� A
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WELL CERTIFICATE OF COMPLETION
WATER SUPPLY: Well Type: Individual Well
WELL-08-2013-040767 INSPECTIONS
INSPECTION# COMP DATE INSPECTION TYPE STATUS INSPECTOR
EHINSP-335543 09/06/2016 EH GPS Data Collection Approved Jason Boyd
EHINSP-335541 09/06/2016 EH Well Head Approved Jason Boyd
EHINSP-333912 08/19/2016 EH Well Record Received Approved EH Admin
EHINSP-335542 08/18/2016 EH Well Grouting Approved Jason Boyd
Russell Well Drilling 08/18/2016
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 09/06/2016
AUTHORIZED STATE AGENT APPROVAL DATE
ehwellcoc 09/07/2016 09:54 Page 1 of I