HomeMy WebLinkAboutEXSY-03-2016-069747.TIF 4.v.A • CATAWBA COUNTY Case N EXSY-03-2016-069747
e Public Health Department Subdivision PEBBLE BAY PH 5
4 ' ;I: Environmental Health Division PIN# 460603240443
-'tl<- PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LO'r?t 233
1;42 s.
NAME ON PERMIT: JASON DINVAN, 7315 BAY COVE CT, DENVER NC 28037
Site Address: 7315 BAY COVE CT, DENVER NC 28037
Property Size: Square Feet:57,063.60 Acres:1.31
Directions: 16S, left Campground Rd / left Catawba Burris Rd/ right Bankhead Rd / right Salleybrook Ln/right Bay Cove
Ct/house on left
Owner/Authorized Representative Acknowledgement of Permit Receipt
I certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the
property described above.
ice" As the property owner or authorized representative, I have received the above referenced permit(s) as
requested in the application for service RBPR-02-2016-23247 by the following method(s):
/Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/ E-mail (Return receipt required)
0 D As the property owner or authorized representative I have reviewed and understand the specific conditions
O
of the permit issued, and further understand that all applicable regulatory requirements specified under the North
Carolina Laws and Rules for Sewage Treatment and Disposal Systems (15A NCAC 18A .1900), and/or
Well Construction Standards (15A NCAC 2C .0100), shall apply to the issuance of this permit and the
construction of the wastewater system and/or water supply well permitted.
Permit Issue Date: 03/04/2016 11
Owner/Authorized Representative Signature �� �/,ol'vii.� (C
Date
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by_ (name of person sending permit)
Signature Date/Time
Method: Fax Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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ehpermit 03/04/2016 08:12 Page 3 of 3
ty:A • CATAWBA COUNTY Case# RBPR-2-16-23247
�' Name Jason Dinvan
�� a Public Health Department Address 7315 Bay Cove Court Denver
d ; " R Environmental Health Division NC 28037
PO Box 389, 100A Southwest Blvd,Newton NC 28658
IS i, sM (828)465-8270 Fax (828)465-8276 TDD(828)465-8200
EXISTING SYSTEM INSPECTION REPORT
Type of Facility: House ® Mobile Home ❑ #Bedrooms 4
Business ❑ Mobile Home Park Re-connection ❑
Other ❑ Specify
Proposed Additions/Accessory Structure: 20'x43' pool plus 1300 a deck around pool at rear of hoome
Approved ❑ Not Approved ❑ Reason
Approval Not Required—Applicant Request Only
Evidence of System Malfunction: YES ❑ NO ® System Type/Description 75%red Gravity see WI S 7007-00714
Non Compliance Items Noted ' YES ❑ NO Z (Describe Below)
/ . 6 3 (ulI4
AUTHORIZED STATF AGENT DATE
J
Compliance Items and Notes
No signs of outbreak on existing system on 3/2/16. Pool is behind home and system is on road side of home. 15'
minimum setback met.
I
NOT FOR LOAN APPROVAL
EXISTING SYSTEM INSPECTION REPORT
Site/System Diagram
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