HomeMy WebLinkAboutAuthorization to construct new wellHARNETT DEPARTMENT OF PUBLIC HEALTH PERMIT
TO CONSTRUCT A DRINKING WATER SUPPLY WELL
PIN #: 0641-69-0024.000 Parcel#: 080641 0003
Applicant Name: Marty & Sherry Waddell
Address: 3971 River Road Fuquav-Varina, NC 27526
Type of Facility Served by Well: SFD
Sewage System: Conventional or 25% Reduction Sys.
Permit Conditions: Bradley Road (SR 143 1)
Application #: 18-5-43814 Subdivision: Lot #: 1
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 tycc% raf>Date
Grouting Inspection Witnessed Date _
❑ Grouting self -certified by driller GW -1 provided? ❑ Yes ❑ No
See attachment for construction sketch
Date: Application #:18-5-43814
WELL CERTIFICATE OF COMPLETION
Well Contractor:
Applicant Name: Marty & Sherry Waddell
Address: 3971 River Road Fuquav-Varina, NC 27526
Directions to Site: Bradley Road (SR 143 1)
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
(death)
Casing
Grout
From _
To
From
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From 0 To
_
From _
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Diameter:
_ Material: _
Thickness:
Material:
_ Method:
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Material:
Thickness:
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Method:
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Diameter:
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Inspector:
On Hold Date:
Release Date:
Remarks:
Well Head Information
Casing Height: (above finished grade) Access Port: Vent Stack:
Well ID Tag: Pump ID Tag: _ Sampling Tap: Backflow Preventer:
Sample Taken? ❑ Yes ❑ No Well Head properly sealed:
Remarks:
Authorized State
See Attachment for completion sketch
Application #:18-5-43814
Well Construction Sketch
/
Well Completion Sketch
Applicant Name: Marty & Sherry Waddell Subdivision: Lot #: 1
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