HomeMy WebLinkAboutWELL-1-10-4382.TIF
G CATAWBA COUNTY Case # EHPR-1-10-3278
Public Health Department
Subdivision
Environmental Health Division
PO Box 389, 100A Southwest Blvd, Newton NC Section/Bl/Ph/Lot#
42 sn+ (828) 465-8270 Fax (828) 465-8276 TDD (828) 465-8200 PIN# 370011560560
Applicant/Owner Rick Coffey
Site Address: 1683 Springfield Rd Hickory
Property Size: 2.93
Directions:
WELL ABANDONMENT PERMIT
WELL TYPE: DRILLED, BORED, DUG, ETC dug
1-15-10
ISSUED BY: PERMIT ISSUANCE DATE
OWNER OR LEGAL REPRESENTATIVE DATE
WELL ABANDONMENT INSPECTION
TOP 3' OF CASING MATERIAL REMOVED (BORED WELLS) YES NO ❑
WELL DISINFECTED: NOV4(4W DATE INITIALS
WELL FILLED WITH APPROVED MATERIAL
(BORED OR DUG WELL ONLY) DATE 2 to INITIALS ~&M
WELL GROUTED TO SURFACE (DRILLED WELLS ONLY DATE INITIALS
WELL CAPPED WITH CONCRETE DATE INITIALS
WELL ABANDONMENT REPORT RECEIVED DATE INITIALS
PERSON ABANDONING WELL Wetl VZ6 AeA 4-I(( A rvid
OWNER DATE it w LZe" Ve7 Sl a'011 4aj
(aid Ir ,may vea6 a16=
CONTRACTOR l Uo W (V ^ ~1 DATE Z 11 16 k 4 r oh we ~t5~~fW-
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Wells shall be abandoned in accordance with all state and local regulations and rules. The Well Abandonment Report must be
submi ed to the Health Departn nt within 30 days upon completion of a well.
4125110
AUTHOR D STATE AGENT COMPLETION DATE
C:\Documents and Settings\jenglish\Local Settings\Temporary Internet Files\Content.Outlook\PP83 W9G6\WELL, ABANDONMENT
PERMIT.docx
CDP File Number. 37890 County File Number: E"PR-''o s27s
Drawing Type: Construction Authorization Date: 0 1/ 1 a/ a 0 1 0
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