HomeMy WebLinkAboutIMPV-05-2022-171522.TIF i.O* CA'TAWBA COUNTY
1 Subdivision NORTHVIEW HARBOUR PH
•— Public Health Department
Rr,.,,., . /t Environmental Health Division PI NW 461802797926
VIV../ PO Box 389,25 Government Drive,Newton,NC 28658 i()T N 292
im
SlbAddress: 8788 COLEBRIDGE CT,SHERRILLS FORD NC 28673
Nsmeon Permit: G.P.' KON CUSTOM BUILDERS, INC.
Property Size: Acres 1
Directions: Sherrrils Ford rd RT on Island Point Lft on 1st left capes cove
Owner/Authorized Representative Acknowledgement of Permit Receipt
X rertiry that I am the owner or authorized agent(owner's authorization required)representing the owner of
perty described above.
XAs the property owner or authorized representative, I have received the above referenced
i
permit(s)as requested in the application for service RBPR-03-2022-40423,by the following method(s):
Received in Person
1 Facsimile Transmittal(Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
As the property owner or authorized representative I have reviewed and understand the specific conditions
o t e permit issued, and further understand that all applicable regulatory requirements specified under the
North Carolina Laws and Rules for Sewage Treatment and Disposal Systems(I5A NCAC I8A.1900),
and/or Well Construction Standards(1SA NCAC 2C.0100), shall apply to the issuance of this permit and
the construction of the wastewater system and/or water supply well pennitted.
Permit Issue Date:05/16/2022
—�, t
Owner/Authorized Representative Signature 4 � f i
1Date 6- -dc,2,
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by_ _ _ _ (name of person sending permit)
Signature °K. Date/Time 51?7Jas
-f
Method: Fax 'Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from yoiPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
6041.notsfrinbii,I4US,&wl
PeLpon°i OS.IRR(122 II 28
R B -O3 a22- L—AOLio 0
A0T11- —X)02.,2 -1 I5,,z
0
J' (11 .
c.
a 9 /
i
S.
VY
LA ic KQM4 s "' , 6\ 4
/ ( ' #/e :'''''-l'‘
art ,iliii $
Rom
.4.,,,.,. 4 .., . : .. ,,..,...;.:. # ,.
/ ,i2
'14;y ..Vo �'71't:fie:•' �4P
Iti
6 -. ' t' ND cfi.yY
g at ail • N .* r)j� (4 ' g. 1 a
r
it pi
a
9. ' � '� ill "'"
.;
L�� 2GRE • '` 9°2
ss
ppVIPK}�. GRER :!:: . t 2A • raysob-
ci
N1C2ggi/i23J 0 4C �,
\ ,% t
. Os
4.
a 1*
c Q3
x .t ,i a� ,1,,. , fir.;, . .?. n-%A r, r *mt fpq..g,•g,,•., ;�.
DEPARTMENT OF HEALTH AND HUMAN SERVICES Sheet _of
DIVISION OF PUBLIC HEALTH,ENVIRONMENTAL HEALTH SECTION PROPERTY ID#:
ON-SITE WATER PROTECTION BRANCH COUNTY: Catawba
SOIL/SITE EVALUATION
for ON-SITE WASTEWATER SYSTEM
J�
(Complete all fields in full
OWNER: G 1 P� KOn -601 £C.l•t k'e1_s Z, KtizA,J ttrte'rAPPL)CATION DATE
ADDRESS.
DATE EVALUATED Pt12
°ROPOSED FACILITY: P OPO D DESI N FLOW I949): PROPERTY SIZE:
[,OCATION OF SITE: e /`I' 44 PROPERTY RECORDED:
WATER SUPPLY: 0 Private N-Kblic 0 Well Ll Spring Other
£VALUATION METHOD: ❑A er Boring ir3.Pit--D Cut TYPE OF WASTEWATER: swage 0 Industrial Process Cl Mixed
r
, 4r 4 S4 ti!S➢Ya%wty y A"`y�. }y ;• � zu 7 Y ,,,y 4'4;
�t�4 i' i i :Y,i'xY - h 4.5 i s {' N ! � vt i 3` vl4 iP I • .' r ,, � sse - .rt ' #,s y �Y,• ,� ',�v ,, •� 1 t ,� it g e
7 at .off .14 �t ' d' 3 v'7 l • S , f./•..4 -•0�; tSyr . lr`9 . f x �3z it :r
`{xsM C �t , ,7, r S i.n:, . '4 ; l�, '1 i fi$ i t3 .'14{ .l'r�`, .l'" ' i R;r:. ya x1 .•� \ +j4 ,�{•t •�, #
.. �5 Io';t , � ,t f v d ! 7 ,E Cs fit, v ,,,Y",,t t tir d � y.. t rv;: '1 i 1'� • S .. •t ,
;. fi�114 i 1' eN t i. "SF• �44 •#� 4t 4 9 4' . Y • ,,. ,. 7� ,i�,,I,V,' rr t fi�r k, F, s :,M
.��1�' ',,�J� �{� {dam-y t r� � '�° JE.3ii 1.. 8 � � r...; 7 �� � � M n�'�.J• � sit
if
, t ���L7�1.....i 1�,., ,y 3`„�1.4 Ai. ,44 :, ?,,. i N ,„i4 , • � fit,i4
,i r;_ ' i r -1, 4'5 ,? ,ill:VS i' �s 'k 6 r,' , ,;
? ' i7 J Y Pl` 4k
Y y e, r. ,�d..' i,1 t i`# ;�.� �" <:
+ ' IT' +m "��k h'N mYi G� �i`..' Alt t i�i�� ''"��1q ki5 �I}.c �'�.: '�F;CC�i 1� �Cr -iI
N, *,' .a?*„,,gl,a r L _ al �' . F f ��:;h 2 � +� 8!} a' tk i f r� .�` j `W .
1
><`
,50 c '3.---- 11(0 i,-'11: -Fr \., —
I )( 01-5 ' c ! &r i , L
&$ ; CL /X-P... � - xe
1 P1 r .S
i .2 .1L - K i' .�� 7f/r
/L.3..c° tpii— zi-, ;,La4A. Cr-- .--5.- -
n /p i/ c avR -F/- t1.
3 -5,2 h C LL ik i -- _,S5 5.} 5
/� `�
. , •
4 1101gitVAfr- Jf Lts /'
= 41
-f,-
DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946):
Available Space1945 SITE CLASSIFICATION(.1948):__ _ _
( )
System Type(s) % '(� 1,1_
� EVE-UAT ED BY:to ! L / OTHER(S)PRESENT:
Site LTAR -35 , 5
OMMENTS:
Jpdated February 2014