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HomeMy WebLinkAboutEXSY-06-2022-172997.TIF s f \� CATAWBA COUNTY Case# EXSY-06-2022-172997 fy .fl . Public Health Department Subdivision FAIRBROOK d Environmental Health Division PIN# 371120901603 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# PT 27-34 • . su Site Address: 1765 FRANKLIN DR, NEWTON NC 28658 Name on Permit: KHAMSAY PHOMSANE Property Size: ' Acres 0.54 Directions: Sandy Ford RD, Left Robinwood RD, Left Cochran ST, Runs into Franklin DR 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. fAs the property owner or authorized representative, I have received the above referenced permit(s)as requested in the application for service RBPR-04-2022-40731,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: 06/07/2022 Owner/Authorized Representative Signature "I Date Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name of person �sefnding permit) I I!Signature j Date/Time ift (1'. / 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/EHCusftomerService b4y111 ilybeK phettlunA a ii ie.Crrt_. efipesmo 06/07/2022 09:55 r (14 catawba county public health EXISTING SEPTIC SYSTEM INSPECTION NOT FOR LOAN APPROVAL Case Number:RBPR-04-2022-40731 ❑ Reconnection to Existing System Property Owner/Applicant:KHAMSAY PHOMSANE _ ❑ Mobile Home Park Reconnection Site Address: 1765 Franklin Dr, Newton _ ® Applicant Request Type of Facility: ❑ House ❑ Mobile Home Number of Bedrooms ❑ Business ®Other Proposed Addition/Accessory Structure: 12X16 STORAGE RUI!.DING ®Approved ❑Not Approved Reason ❑Approval Not Required/System Location Only Evidence of System Malfunction ❑YES ►7./ NO System Type/Description GRAVEL TRENCHES Noncompliance Items and Notes *DRAINFIELD was located and was not failing at time of site visit *No guarantee given to the septic systems longevity *Do Not cut, drive or Fill over septic system area Authorized State Agent Date 6/7/2022 catawbacountync.gov Environmental Health Cotowbo County Government Center 25 Government Drive PG Box 389 I Newton NC 28658 1828,465.8270 MAKING. LIVING. BETTER.