HomeMy WebLinkAboutWELL-11-09-2355.TIF
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G CATAWBA COUNTY Case # EHPR-10-09-2180
h~ Public Health Department Subdivision
G~ EnvirdnmentaI Health Division Section/BUPh/Lot#
PO Box 389, 100A Southwest Blvd, Newton NC
PIN# 3 -81-1442
184 2 sM (828) 465-8270 Fax (828) 465-8276 TDD (828) 465-8200 ELL-
WELL- 11 ~3SS
Applicant/Owner Catawba County / Rand Grindstaff
Site Address: 6801 Lineberger Rd. Denver, NC 28037
Pro a Size: 1.17 acres
Directions:
WELL ABANDONMENT PERMIT P9S0
WELL TYPE: DRILLED, BORED, D ,ETC drilled
10/27/2009
Nor,,- ISSUED B PERMIT ISSUANCE DATE
OWNER OR LEGAL REPRESENTATIVE DAT
WELL ABANDONMENT INSPECTION
TOP 3' OF CASING MATERIAL REMOVED (BORED WELLS) YES NO ❑
WELL DISINFECTED: DATE io INITIALS
WELL FILLED WITH APPROVED MATERIAL
(BORED OR DUG WELL ONLY) DATE 117 /C INITIALS 9!---
WELL GROUTED TO SURFACE (DRILLED WELLS ONLY DATE 11-711,) INITIALS 4"-g
WELL CAPPED WITH CONCRETE DATE /v INITIALS
WELL ABANDONMENT REPORT RECEIVED DATE INITIALS
PERSON ABANDON G WEL
OWNER DATE
177
CONTRACTOR DATE Z
Wells shall be abandoned in accordance with all state and local regulations and rules. The Well Abandonment Report must be
submitted to the Health Department within 30 days upon completion of a well.
/b
AUTHORIZED STATE AGENT COMPLETION DATE
C:\Documents and Settings\jenglish\Local Settings\Temporary Intemet FileS\Content.Outlook\C9H5VVQQ\EHPR-10-09-
2180_wellabandonment. docx