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4. CATAWBACOUNTY Cased WCOC-06-2023-197793
• .f.I Public Health Department Subdivision
• .� Environmental Health Division PIN# 461902553712
PO Box 389,25 Government Drive,Newton,NC 28658 LOT/+
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Site Address: 8511 DOG LEG RD,SIIERRILLS FORD NC 28673
Name on Permit *TODD GALLOWAY CONSTRUCTION INC.
Property Size: Acres: 2.705
Directions: Molly Back Bone,Right on Azalea Left on Dog Leg
WELL CERTIFICATE OF COMPLETION
Permit Number:WELL-02-2023-189145
DATE COMPLETED INSPECTION TYPE STATUS INSPECTOR
04/11/2023 Ell Well Grouting No EH Inspection Randy Ross
Pursuant to I5A 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 Construction Record,as submitted by the licensed well contractor,will serve as
written certification of grout compliance
04/25/2023 EH Well Record Received Approved Eli Admin
06/08/2023 EH Well Ilcad Approved Randy Ross
ROWAN WELT. 04/11/2023
Well Driller Date Drilled
#4c.s — /- /, _-__
06/12/2023
Authorized State Agent Issuance Date
;hirellcur 07/07/2023 11:05 Page I of
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