WellHARNETT DEPARTMENT OF PUBLIC HEALTH PERMIT
TO CONSTRUCT A DRINKING WATER SUPPLY WELL
PIN 0636-5-4101 Parcel
Application 09-5-22648 Subdivision: Little Tree Lot 2
Applicant Name: Marcus & Susan Alkire
Address: 161 Talbert Drive Holly Springs NC 27540
Type of Facility Served by Well: SFD
Sewage System: Conventional
Permit Conditions: Well to be 100 ft from any part of septic system
General Permit Conditions:
• Drinking water supply well construction must meet 15A NCAC 02C.100 rules
• The permitted drinking water supply well shall be located in accordance with the SITE PLAN
• ANY ALTERATION of the site of the site (including location of structures and appurtenance) or modification in use of the well, may
subject this Permit to revocation
Authorized State Agent.
Date
Grouting Inspection Witnessed Date _
❑ Grouting self-certified by driller GW-1 provided? ❑ Yes ❑ No
See attachment for construction sketch
Date: 3/26/2010 Application #:09-5-22648
WELL CERTIFICATE OF COMPLETION
Well Contractor: Jackson Well Company
Applicant Name: Marcus Alkire
Address: 2268 Wade Stephenson Rd. Holly Springs NC 27540
Directions to Site: 401 to Christian Light Rd turn left go the Hwy 42 turn left go to Wade Stephenson Rd turn right
Use of Well: sfd Date Drilled: 3/18/2010 Total Depth: 260 ft Replacement Well? ❑ Yes ® No
Static Water Level: 70 ft Top of Casing is 12 in. above surface. Yield: 15 gpm at ft.
Disinfection: Type hth Amount 12 oz
Water Zone (depth) Casing Grout
From 135 To 138 From 0 To 85 From 0 To 25
From 236 To 238 Diameter: 6.25 Material: Pvc Thickness: sr21 Material: sand cement Method: pouring
From To From 85 To 106 From To
Diameter: 6.25 Material: gale Thickness: . 188 Material: Method:
From To From To
Diameter: Material: Thickness: Material: Method:
Inspector: On Hold Date: Release Date:
Remarks:
Well Head Information
Casing Height: 12 in (above finished grade) Access Port: yes Vent Stack: yes
Well ID Tag: yesPump ID Tag: yes Sampling Tap: yes Backflow Preventer: yes
Sample Taken? ❑ Yes ® No Well Head properly sealed: c1'
Remarks:
Authorized State Agen k Date
See Attachment for completion sketch