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CATAWBA COUNTY Case II WCOC-04-2022-169850
�(....).f. Public Health Department Subdivision DOUGLAS CORNERS
QEf) Environmental Health Division PIN# 268701254223
PO Box 389,25 Government Drive,Newton,NC 28658 LOT1t I I
/8. sr
Site Address: 6785 HANNAH CT,VALE NC 28168
Name on Permit `CLAYTON HOMES OF STATESVILLE/UNLICENSED GC
Property Size: Acres: 0.53
Directions: Ilwy 10 W,turn on Banoak Rd,turn on Ilannah Ct.
WELL CERTIFICATE OF COMPLETION
Permit Number: WELL-09-2021-158339
DATE COMPLETED INSPECTION TYPE STATUS INSPECTOR
02/08/2022 EH Well Grouting No EH Inspection I?ric Price
Driller self-certified
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 I 5A NCAC 02C
.0100.The completed Well Construction Record,as submitted by the licensed well contractor,will serve as
written certification of grout compliance
02/09/2022 EH Well Record Received Approved Eli Admin
03/30/2022 EH Well Head Approved Eric Price
Mid-South Well&Pump Company 02/08/2022
Well Driller Date Drilled
1.A.:„.. p .
03/30/2022
Authorized State Agent Issuance Date
rin+ellru. 06/15/2022 15:34 Page I oft