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CATAWBA COUNTY Case# WCOC-09-2022-180895
�.7 .J.` ,�, Public Health Department Subdivision
d -4 Environmental Ilealth Division PIN# 366904835348
PO Box 389,25 Government Drive.Newton,NC 28658 LOTI 1
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Site Address: 4070 MT OLIVE CHURCH RD,NEWTON NC 28658
Name on Permit ROBERT LEE
Property Size: Acres: 7.12
Directions: Hwy 16 to Balls Creek Rd,turn left go approx 2 miles to Mt Olive Church Rd,Turn left,go 500
ft,Lot on Right
WELL CERTIFICATE OF COMPLETION
Permit Number: WELL-10-2019-123603
DATE COMPLETED INSPECTION TYPE STATUS INSPECTOR
04/09/2020 Ell 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 15 A NCAC 02C
.0100. The completed Well Construction Record,as submitted by the licensed well contractor,will serve as
written certification of grout compliance
10/19/2021 EII Well Head Approved Jason Boyd
11/01/2021 Ell Well Record Received Approved EH Admin
Donald Russell 04/09/2020
Well Driller Date Drilled
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11/01/2021
Authorized State Agent Issuance Date
ehw.Ileoc 10/17/2022 11:42 Page 1 of 1