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CATAWBA COUNTY Case# WCOC-07-2022-176343
Public Health Department Subdivision STORYBROOK PH 1
ri, , Environmental Health Division PIN,/ 369701190164
111114.1.140 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 14
Site Address: 3473 STORYBROOK LN,SHERRILLS FORD NC 28673
Name on Permit *D&E PROPERTIES, LLC
Property Size: Acres: 1.19
Directions: Hwy 16 South Left BUS 16 Left Mt Beulah Right Little Mtn,Right Storybrook 3 lot on left
WELL CERTIFICATE OF COMPLETION
Permit Number: WELL-03-2022-167730
DATE COMPLETED INSPECTION TYPE STATUS INSPECTOR
06/14/2022 EH Well Grouting No EH Inspection Dean Evans
Verified well location.
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.The completed Well Constriction Record,as submitted by the licensed well contractor,will serve as
written certification of grout compliance
07/20/2022 EH Well Record Received Approved EH Admin
07/21/2022 EH Well Head Approved Steven Pricc
Chris Russell 06/14/2022
Well Driller Date Drilled
i ----.._ /57
07/21/2022
Authorized State Agent Issuance Date
08102/2022 12:03 Page I of I