HomeMy WebLinkAboutWCOC-03-2023-191162.tif CATAWBA COUNTY Case# WCOC-03-2023-191162
.I.I ,Z Public Health Department Subdivision
„ll<-1 '"I Environmental Health Division PIN# 366604834010
�J PO Box 389,25 Government Drive,Newton,NC 28658 LOTit 2
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Site Address: 4988 CALEB RD,MAIDEN NC 28650
Name on Permit *EUNICE VAN AARDE
Property Size: Acres: 1,16
Directions: South on N Springs RD, Right on W lst,Left on Northern Blvd 6.7 mi.Turn Left onto W Main
ST, 1.1 mi continue onto E Maiden RI),4.4 tni turn Right onto Caleb RD,destination 0.2 on Left
WELL CERTIFICATE OF COMPLETION
Permit Number: WELL-01-2020-127001
DATE COMPLETED INSPECTION TYPE STATUS INSPECTOR
05/07/2020 EH Well Grouting No EH Inspection Randy Ross
Variance Well.
Well was drilled without adhering to required conditions listed on the variance approval letter.Specifically,
the well was not grouted entire length of the casing.This grouting was also not inspected by Environmental
Health,it was certified by the well driller.
In order for the well to comply with the variance approval,the state stipulated that a liner be installed in the
well and grouted the entire length.Environmental Health verified liner grouting,but was not present for entire
grouting process.
Pursuant to I 5A 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
06/05/2020 Ell Well Head Approved Randy Ross
06/11/2020 EH Well Record Received Approved I:ll Admin
Robbie Ray 05/07/2020
Well Driller Date Drilled
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06/11/2020
Authorized State Agent Issuance Date
eIiwellcoe 03/13/2023 13:28 Page 1 of 1
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Parcel: 366604834010, 4988 CALEB RD 1 in=60ft
MAIDEN, 28650
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03/10/2023