HomeMy WebLinkAboutIMPV-05-2022-172309.TIF 8: CATAWBA COUNTY Case# IMPV-05-2022-172309
4/111110
NT(-� y Public Health Department Subdivision W GENE SIGMON
....." ,, : Environmental Health Division PIN# 369601357947
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 3-4
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Site Address: 6360 LOVE POINT RD, DENVER NC 28037
Name on Permit: JUSTIN BRITTAIN
Property Size: Acres 2.48
Directions: NC 150, right onto Grassy Creek Rd, left onto Love Rd, lot is on the left
Owner/Authorized Representative Acknowledgement of Permit Receipt
1 certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-04-2022-40766,by the following method(s):
Received in Person
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
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: 05/25/2022
Owner/Authorized Representative Signature
Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person
13i
nd ing permit)rmit)
Signature 4ed
Date/Time 6 I Z1/
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
jIn_ br; kih
@ NfriolvA. se Ao615.net
CBprmut 05/26/2022 13:14
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DEPARTMENT OF HEALTH AND HUMAN SERVICFS Sleet_. o! -.-..
DIVISION OF PUBLIC HEALTH,ENVIRONMENTAL HEALTH SECTION PROPERTY ID#:
ON-SITE WATER PROTECTION BRANCH COUNTY: Catawba
SOIL/SITE EVALUATION
for ON-SITE WASTEWATER SYSTEM
1 ((Complete all fields in full)
OWNER: -3 4tek /'t 0.. i✓t
APPLICATION DATE
ADDRESS: _DATE EVALUATED:3
PROPOSED FACILITY: PR SE D ION W(.1949): PROPERTY SIZE: /
LOCATION OF SITE: (, 5 6 )s' t?. PROPERTY RECORDED:
WATER SUPPLY: 0 Private 0 Public
CDWd[i 0 Sprin El Other �� �
EVALUATION METHOD: 0 Au er Boring Wit"0 Cut TYPE OF WASTEWATER: swage 0 Industrial Process 0 Mixed
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DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FA(;IURS(.1946):
Available Space(.1945) /Y., / SITE CLASSIFICATION(.1948): _
System Type(s) , 7e X7r:lenrei OTHER(S)PRE ENT:
Site LTAR —
5 13
COMMENTS:
Updated February 2014 _ ---
• Catawba County Environmental Health . .
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Parcel: 369601357947, DENVER, 28037
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',.,,4 '. IA•;o_p/regbrt product was prepared from the Catawba County,NC Geospatlal information Seneices. Catawba County has made substantial effc4s
..,,. ,ti ..,...: ..-L L a Ale accuracy of location and labeling Information contained on this map or data on this report,Catawba Countypromotes and
perNient verification of any data contained on this map/rmap/reportproduct by the user.The County of Catawba,Its employees agentsre,coannidnien's;
-r:, a..pnel,disclaim,and shall not be held liable for any and all damages,lose or liability,whether direct,indirect or consequential which arises or may,
.. it r''.from this map/report product or the use thereof by any person or entity.
Copyright 2021 Catawba County NC
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04/18/2622
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