HomeMy WebLinkAboutWELL-10-10-12309.TIF „ CATAWBA COUNTY Case # WELL -10 -10 -12309
i f m o m Public Health Department Subdivision
-i Environmental Health Division Lot # 3
v 0 'S' PO Box 389, 100 -A Southwest Blvd, Newton, NC 28658
ig 2 sM PIN# 362812766647
Applicant/Owner JODY FULBRIGHT
Site Address: 2665 APPLE ACRES LN, NEWTON, NC
Property Size: SF 2 ACRES
Directions: 10W/ LEFT STARTOWN RD/ GO PAST AME CHURCH/ 4TH DRIVE ON RIGHT
WELL CERTIFICATE OF COMPLETION
WATER SUPPLY: Well Type:
INSPECTIONS
INSPECTION# COMPLETED INSPECTION TYPE STATUS INSPECTOR
INSP -96867 02/23/2011 EH Well Grouting Approved Megen McBride
INSP -96868 03/02/2011 EH Well Head Approved Megen McBride
INSP -96870 03/02/2011 EH Well Certificate of Completion Approved Megen McBride
INSP -96871 03/01/2011 EH Well Record Received Approved EH Admin
Terry Scronce 02/18/2011
WELL DRILLER DATE DRILLED
Well permits are valid for 5 years from the date of issuance and are subject to suspension and/or revocation fro non - compliance with
appropriate state and local rules and regulations, or if false information was given in order to obtain a permit. Wells shall be constructed
in accordance with all state and local regulations and rules. The Well Completion Report must be submitted to the Health Department
within 30 days upon completion of a well.
Megen McBride 3/2/2011
AUTHORIZED STATE AGENT APPROVAL DATE
03/03/2011 10:43
L;; ' ' , ; :, , ;: E&TL 4L WEL CON QCf'tOWPKCORD
}C '' ; `Ji n D t�badNaeaal Reamnces- D'riuion of WetsQmlhay
... /. , 2.` y - A
WELL CONTRACTOR CB YGTEON It -
1.M.L{0NRR/1CT0 9. WATER ZONES °teeth):
j i' T 630 Bnn 6 S Top Boleor�!_._-
� v'r er. C. A C �
SC' Name 1 �' Pk�„ Top S Bottom q 0 Tap Bottom
i .)C (Ad I t1 lJfil'i;, � Tom Worn TaP
3 / .SS Lt,\ 8 h-. J 7. CANN& Depth Dletneter Watold M)
A A d d r e s s Tap I r see m5 S Ft, > 64 /Q (.1v .s-<-
lv e,w`f"a:N N; .G • Z`° CSg Top Bottom Ft ..
City otTarrn Stets 7Jp Code Tpp _ Ft. ...
f623) .324-57
Area code Phone number O. GROUT: Depth Material j 11 / _ t Method
T. WELL INFORMATION: l � Top n Bottom 1-O Ft 5a / /C:"1 r Pc' Kr
. WELL CONSTRUCTION PERMITS Ce �: b p �, �� �
. I � . To p Bottoi l„�,_ FL
OTHER ASSOCIATED PERMITWtappnoea) Tap_____ Bottom . R ' -
SITE WE I.ID WIepp1 ?5).. 9. SCREEtt Depth DlantalaT Dotes Mated&
3. MU. uSE (OtedrAppriCabta Boast Residential' Water Sempt* ❑ Top --- Fl._- -0n. In.
DATE DRILLED / I' ' / / / T OP-- eon FL -._._ b . in. ._
TUa COMPLETED / I: O 0 AM ❑ PNAI Tap Mom R. in in. ..
0. WEIR LOCATION: 10. SAND/GRAVEL PACK:
t! Depth She Medal
CITY: IV i-W � /\ " " Tap Botlem Ft.
26 b S A L _ AL('cs L N . 22- 56 Tap eottoo __,_FI.
. t t fin. La we.. POtt�l cede) , Top Bo tom Ft, .
Nk411 GRAF1 eC / LAND SETTVNl1c etneceepatopttreseal
11. DRILLING LOG -MP a . S •'r _ s xao ilagEn CO t -8W" 'se .1 ../ ra v °alO
1 opt I 5 & a pus aRAuoottop000c m Ze) r _ 7 SL t o 1 A ,
latRudanor�,desctraee: S DTNNIIIaWtl map
y 0 1 S 0
&caw aloe wet &edema at aUSGStopo map e redto ,S 0 15S .B1I.. Rm. S4 -Rlucjc
9ds/tem toot ages GM 1 GJt be 4. 13Rc� k R K
sv�tt Q, 1bZ0 3)t, -t - R1 .,c Pnr_IC
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a, c I flp Ac.rc L.tvh • _
Sheet 1
1e..-t, h1,G. Z LSS 1 -
City ar Toon State Zip Dods 1
Area code Phone meter 12. REMARKS:
6. WELL DETAIL6: _
a. TOTAL Wilt 2-4
b. DOES ttIE1 L REPLACE ExL4fDltti YMF11t� j YES f7 X 1 DO I EBY �TWY THAT THIS WELL WAS COASTRUCTE D tat
. WATER LEYELt WTop ofCamt9: - 7 5 FT. ACCORDANCE VIA h18ANCAD2O.NEU.CONSTRUCTION
(Use*" : STANDARDS, AND ittar A COPY OF TH HAS BEEN
PROVIDED TOTES WELL OWNER.
a TOP of D FT.Ahove Sl smoke ` 'macW y 3�
area area erro+6rat a d Mbr below toad tsalhxmq �+a�
T nig
a memo in accordance veal MAC AC 2C .011& SIGNATURE CERTIFIED 11481. CONTRACTOR DATE
a. YIELD (gp n): q , memo craw 13. : I + n 1 t vY i` (t L 10 .w. 5 G • Y - c:-r�
t DISINFECTION: Type 'r/ 1 t'1 Amount l C. () PRINTED NAVE OF PERSON CONSTRUCTING THE WELL
. subutitTheiniatnit to the ' within Sit War . Phonalft. ($i�) (Ws. f0 A. RRev. 11 O
1
. �...._:.. RECEIVED
MAR 0 1 2011
CATAWBA COUNTY
ENVIRONMENTAL HEALTH