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HomeMy WebLinkAboutWell CompletionHARNETT DEPARTMENT OF PUBLIC HEALTH PERMIT TO C( TRUCT A DRINKING WATER SUPPLY :LL PIN #: Parcel #: Application #:17-5-42685 Subdivision: Fred Turlineton Lot #:6 Applicant Name: Greenfield Housing Address: 2117 Hwy70E Gamer NC 27529 Type of Facility Served by Well: Modular (76'x30') Sewage System:25% Reduction System Permit Conditions: 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 A rt--- fig! Date Grouting Inspection Wi sed Date ❑ Grouting self -certified by driller GW -I provided? ❑Yes ❑ No See attachment for construction sketch WELL CERTIFICATE OF COMPLETION Date: O*Jifl 1 Application #: I1-5-492 Well Contractor: Odin 3r Applicant Name: LLnL,-,c<>1 M Address: 9735 9,Ao"-4-- Ghurr-K I" ez'r_ 053334- Directions to Site: YU ( M I Use of Well: Date Drilled: Total Depth: Replacement Well? ❑ Yes ❑ No Static Water Level: _ Top of Casing is _ in. above surface. Yield: _ gpm at _ ft. Disinfection: Type _ Amount Water Zone (depth) From To From _ To _ From _ To Inspector: _ Remarks: Casing From _ Diameter: _ From Diameter: From Diameter: On Hold Date To Material: _ Thickness: To Material: _ To Material: Release Date: Thickness: Thickness: Grout From 0 To _ Material: _ Method: _ From To Material: Method: From To _ Material: Method: Well Head Information Casing Height: --9-11(above_frnished grade) access Port: Vent Stack: Well ID Tag: ump ID Tag: _✓ Sampling Tap: _ / Backflow Preventers Sample Taken? Yes ❑ No Well Head properly sealed: Remarks: Authorized State See Attachment for completion sketch Application #:17-5-42685 Applicant N-me:Greenfield Housing Subdivision: Fred Turlineton Lot #: 6 Well Construction Sketch Well Completion Sketch r I f s Ee'a �c 1 5y�5T £M I i T 1 70- P2oseEG � I P2o5n�LT C�V� v< is cool ua:ol FAX 2522990955 BOYETTE WELL John H, BoyaW Jr. Weu CJ"*,J 2505 NC wau Gomm omlBa.� Numb. BOYS WON & Septk Inc zwmlQa.Q.m..rmyfx . fbd/yp0ad4.Naedhe6be0pmQ. ft.. M -0--W —mc vm6.ea of i W.p IIs (wekwax ®)r OM ("-boplCOW tW 39'NY) Gndea" W: °wWD1.Y ( ) VM10pd [IR -W tW W 1,2,b' (.hmod) Awa OOewmdmriv Ramdimi Pond Loop) I. Door Wdkj) cm,pk dl P�WlO'IO.mr ��u V Pdilq lDy(if p) �7�♦r PM�</).olF Nlwi#Ii f `Y �'Th� cc.vLPrlkw. ad4 5. Ladiwe odD ei or dad1Wdel Waft) t" PbP.a..o.J ar LiT'•.p.nry / ob•o••d d, /cuff oft T. L uM..q.dr... m.e: Gym mr 1.�+`• ei ab,G.a „M.b• e.yy a.. d..dp, ,. rwm.) .ed.mv 4.aa.ar.,,v �b rertb a aq old baropl s„b.W.,�v'w gym, 1 .3ddM 02C,MWW W.0c _ '°a6'd.W eld. 8. Aw G"p.boOO f w Ck"'-p CeoLL6rmd Wd6 hffvM ma aamtc Y , wd aeh9� dril 0Y 1 OW -1 M needed. ,dkma TOTAL NUMORR ofYAO. muodm deldlo, You mV PW m Pmi'1do.ddi0...1 wdl d0a deMGa a ma mY oMo aMxk pq. 8.saa.my. F9. Teed well dma yym lud mrb .e Z" T '�A W-!6d..papaer#61...f �7om•ma>�oo1 V-) xd. B.r AN Wd1.: 9.Imb tl- Tem -kbm 30 d of 16 Sttic 11W lead bola. ap.ttrFsy; off° m me faib.•i�; Ya oempletioo oe roll /I+ma Md 4 a6m.oabZ v �� W) DdrbM..f W"w R..mus.Jahno ye,R rmml,, V,,L ii. Bwwl.dd,, 6.250L)l&1?MaS .lMc-IW.MWOr MC 2709,.M7 IL won 2db. r.r L1 M addl000 To lm&n3 dm 8.m m dc oao-hl ak-p.* �ry .booty 4bo m>dmb ®mP9 of mL fie vim, 30 •dd. f ?W �'�. teb: m6b. dYapm6, me) topi>m m ma i4A of aomplethn oC wall n'oR WATIGR RUPrI.Y W6J.LS OWL -h DMMM..f W.6er R..� V� I.}oaxi.. CW tM I Of M.9 Sardco (k.er� RAdo6 WC zM9,16td 13.. YWd (Qr)-- Meaw.re.6t J,� x�lli la...._..�- - , eddit,. m 136. [1)W/eeym qpa: "" @) X, •Im • aa. aapy of mu dmn ® as tocol m wbux �ympd*til m m6 ou..y helm dV.q� of tho ,ow myf lam as -1 Nem Oeol<a Dq�po�ep^-.• .Q.,,.s_Di.'slmatwmrPoos R -i -d 2Q2 -M16 li� 0 01 priitl Form. F" ae 0,jr Q I .. larAwwrig imp, ©�� 4