The URL can be used to link to this page

169 Briar Cliff Ln (2) Davie County Environmental Health o..�O < 2Wjjek-1d- P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 Q r WELL PERMIT Account #: 990005785 Tax PIN/EH#: C00000012 Billed To: Kenneth Mason Subdivision Info: Address: 169 Briarcliff Lane Location/Address: 169 Briar Cliff Lane-27028 City: Mocksville Property Size: 9.44 Acres Reference Name: WELL REPAIR ProposActtiions�ot he employees of the Davie County EH Section shall in no way be taken as a guarantee that this well will produce water of any particular quantity or quality or for any amount of time. This permit is valid for a period of 5 years from the date of issuance. This permit may be revoked if it is determined that there has been a material change in any fact/circumstances upon which this permit was issued. . Permit Type: New❑ Repair E[ Abandonment ❑ Proposed Well Location Diagram Certificate of Completion Diagram v Comments: Driller: VQIJ-� Ifin 11�ite Certification#: r h Grout Inspected: Well Head Inspected- GPS Coo inat s: EHS: Date: EHS: �� Date: W.P.7-08 f/qS% _ Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 WELL PERMIT Account #: 990005785 Tax PIN/EH#: C00000012 Billed To: Kenneth Mason Subdivision Info: Address: 169 Briarcliff.Lane Location/Address: 169 Briar Cliff Lane-27028 City: Mocksville Property Size: 9.44 Acres Reference Name: WELL Abandonment Proposed Facility: Well Abandonment Actions of the employees of the Davie County EH Section shall in no way be taken as a guarantee that this well will produce water of any particular quantity or quality or for any amount of time. This permit is valid for a period of 5 years from the date of issuance. This permit may be revoked if it is determined that there has been a material change in any fact/circumstances upon which this permit was issued. Permit Type: New❑ Repair ❑ Abandonment ® . Proposed Well Location Diagram Certificate of Completion Diagram • Remove pump,piping and wiring from well • Excavate down to 3 feet below ground surface • Excavation should be at least 1 foot around the casing • Remove casing down to excavation level • Chlorinate well with 70%hypochlorite solution • Fill well with concrete to excavation level and 1 foot around the casing • Cover with soil • Owner/Agent,must call and schedule abandonment Comments: Driller: Certification#: Grout Inspected: Well Head Inspected: GPS Coordinates: EHS: Date: EHS: Date: W.P.7-08 GoMaps GIS Page 1 of 6 f 1 i m y O � Z � �I f^< 4$< O� f V t0o295ft / http://maps.co.davie.nc.us/GoMaps/map/map.cfm?CFID=4129&CFTOKEN=61640881 .11/21/2011