Well CompletionHARNETT DEPARTMENT OF PUBLIC HEALTH PERMIT
TO CONSTRUCT A DRINKING WATER SUPPLY WELL
PIN #: 9553 -86- 9929.000 Parcel #: 099553 0017 02 Application #: 11 -5 -26286 Subdivision:
Applicant Name: Red Door Homes
Address: 4002 Fayetteville Rd. Raeford, NC 28376
Type of Facility Served by Well: SFD
Sewage System: 25 % Reduction
Permit Conditions: Well to be drilled in Well Area and not under power line
Lot #: 4
General Permit Conditions:
• Drinking water supply well construction must meet 15A NCAC 020.100 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
WELL CERTIFICATE OF COMPLETION
Date: 11/6/2013 Application #:11 -5 -26286 Well Contractor: Jackson Well Co.
Applicant Name: Red Door Homes
Address: 4002 Fayetteville Rd. Raeford, NC 28376
Directions to Site: 27 w to 24/27 turn left on Hillmon Grove Rd property on left about 5 -7 miles
Use of Well: sfd Date Drilled: 10/12/13 Total Depth: 485 ft Replacement Well? ❑ Yes ® No
Static Water Level: 66 ft Top of Casing is 12 in. above surface. Yield: 10 gpm at ft.
Disinfection: Type hth Amount 16 oz
Water Zone (depth) Casing Grout
From 430ft To 435ft From 0 To 148ft From 0 To 40 ft
From To Diameter: 6in Material: Svc Thickness: sr21 Material: sand/cement Method: pour
From To From To From To
Diameter: Material: Thickness: Material: Method: _
From To From To
Diameter: Material: Thickness: Material: Method:
Inspector: bm On Hold Date: Release Date: 11/6/2013
Remarks
Well Head Information
Casing Height: 1 ft (above finished grade) Access Port: Ys Vent Stack: yes
Well ID Tag: }�esPump ID Tag: des Sampling Tap: des Backflow Preventer:
Sample Taken? ❑ Yes ® No Well Head properly sealed: }_es
Remarks:
c 12-Authorized State Agent . C. �:... � /L Date /� �
See Attachment for completion sketch
Application #:11 -5 -26286 Applicant Name: Red Door Homes Subdivision: Lot #: 4
Well Construction Sketch
Power line �
Area for
Drain field
To Hillman
Barn
Grove Rd
Home
10
ft.
1
Well Area
path
Well Completion Sketch