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CATAWBA COUNTY Case# WCOC-05-2022-172504
4 .f Public Health Department Subdivision STORYBROOK PHI
Q ,�O Environmental Health Division PIN# 369701193494
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 2
/8.2 sw
Site Address: 3458 STORYBROOK LN,SHERRILLS FORD NC 28673
Name on Permit *D&E PROPERTIES, LLC
Property Size: Acres: 0.92
Directions: S Hwy 16 Left on BUS 16,Left Mt Beulah,Right on Little Mtn RD 1/4 mile on Right,2nd lot on
left
WELL CERTIFICATE OF COMPLETION
Permit Number: WELL-11-2021-161598
DATE COMPLETED INSPECTION TYPE STATUS INSPECTOR
04/15/2022 EH Well Grouting No EH Inspection Jason Boyd
Pursuant to 15A NCAC 02C .0305(b) This well grouting was certified by the licensed
well contractor who is therefore liable and responsible for its compliance with the rules of 15A NCAC 02C
.0100. 1'he completed Well Construction Record,as submitted by the licensed well contractor,will serve as
written certification of grout compliance
04/19/2022 1?H Well Head Approved Jason Boyd
05/31/2022 1/H Well Record Received Approved EH Admin
Chris Russell 04/15/2022
Well Driller Date Drilled
d— 11
05/31/2022
Authorized State Agent Issuance Date
elmell.nc 06/15/2022 14:14 Page I of I
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