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CATAWBA COUNTY 0 r,-el;*I. 0 Case# OP-03-2016-069930
(.3/' Public Health Department ;4 16e ..1]t Subdivision RUSSELL RIDGE PH 2
„"s, E l Hclh Dision ,'�.t• •r 173•.1 PINft 378004535189
O: Oi PO Box 389, 100-A Southwest Blvd,Newton. NC 28658 3 • } LOT# 10
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NAME ON PERMIT: *LAKE VISION DEVELOPMENT INC, 2242 LONGCOVE CT, SHERRILLS FORD
NC 28673
Site Address: 990 RUSSELL RIDGE DR, CATAWBA NC 28609
Property Size: Square Feet:22,215.60 Acres:0.51
Directions: Hwy 10 to Murrays Mill to left on Sherrills Ford RD to 1/2 mile- left on Russell Ridge
Catawba County Health Department Operation Permit
System Type: **** no system class assigned **** ()
(In accordance with Table Va)
Description: 25% REDUCTION
System Code: 104W System Code Description: Infiltrator Quick 4 Standard W
Types V and VI systems expire in 5 years.
Owner must contact health department 6 months prior to expiration for permit renewal.
System Installation Comments:
PERMIT CONDITIONS:
1. All maintenance, monitoring, and performance requirements shall be in accordance with
15A NCAC 18.1900, Rule .1961
2. Operation & Maintenance Specifics:
Subsurface system operator required? Yes_ No_X_
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage
Treatment and Disposal, and All conditions of the Improvement Permit and Construction Authorization.
Shannon Henderson#1091 03/09/2016
SYSTEM INSTALLER INSTALLATION DATE
Jason Boyd 03/10/2016
AUTHORIZED STATE AGENT DArE OF OPERATION PERMIT
Form F
ISSUANCE
ehpermii 03/10/2016 08:47 Page 1 of 3
J11 Permit# RBPR-11-15-22792
CATAWBA COUNTY
ti� �� Public Health Department Name Lake Vision Development
] Address 990 Russell Ridge Dr Catawba
Environmental Health Division
PO Box 389, IOOA Southwest Blvd, Newton NC 28658 NC
is 42 sM (828)465-8270 Fax (828)465-8276 TDD(828)465-8200 PIN# 378004535189
Lot 10
Site Plan Operation Permit
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