HomeMy WebLinkAboutEXSY-08-2022-176716.TIF From:Bradington-Young 7044354276 08/10/2022 14:09 #052 P.001
�,, Wig. CATAWBA COUNTY Case s EXSY-08.2022-176716
i•(.....). Public Health Department Subdivision
1 Environmental Health Division PINS 277004505770
PO Box 389,25 Government Drive,Newton,NC 28658 LOTS 4
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Slte Address: 1231 KIRKWOOD ST,HICKORY NC 28602
Naar on Permit: SHANNON VANHORN
Property Size: Acres 0.51
Directions: Old Shelby Rd right on virgina drive
Owner/Authorized Representative Acknowledgement of Permit Receipt
F certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
�AUAs the property owner or authorized representative,I have received the above referenced
permit(s)as requested in the application for service RBPR-03-2022-40559,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
1 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:08/01/2022 ` ,�`_
Owner/Authorized Representative Signature �t t..J�'�``
Date V-1v'2,UXa,,
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by .._. E
(name of personasending permit)
Signature .T_____.___. __Date/'I'ime p li 0/))
Method: Fax NI 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 yoLPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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public health
EXISTING SEPTIC SYSTEM INSPECTION
NOT FOR LOAN APPROVAL
Case Number:RBPR-03-2022-40559 ®Reconnection to Existing System
Property Owner/Applicant:Shannon Vanhorn ❑Mobile Home Park Reconnection
Site Address: 1231 Kirkwood St,Hickory NC 0 Applicant Request
Type of Facility: 0 House ® Mobile Home Number of Bedrooms 2
❑Business
❑Other
Proposed Addition/Accessory Structure:
®Approved ❑Not Approved Reason
0 Approval Not Required/System Location Only
Evidence of System Malfunction ❑YES ®NO System Type/Description HA/Gravel bed
Noncompliance Items and Notes
-Do not drive,grade,cut or fill over septic system area.
-New house location(including decks)MUST remain 5 feet from septic system area.
*NOTE:this inspection does not reflect on the lifespan or efficiency of the drainfield.*
•
Authorized State Agent Cheyanne Morgan C 9�'- Date 8/1//2022
catawbaco tync.•jv
Environmental Health
Catawba County Government Center
25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270
MAKING. LIVING. BETTER.
Catawba County Environmental Health
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HICKORY, 28602
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to ensure the accuracy of location and labeling Information contained on this map or data on this report.Catawba County promotes and recommends
the Independent verification of any data contained on this map/report product by the user,The County of Catawba.Its employees,agents,end
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arise from this map/report product or the use thereof by anyCperson or 1 entity. County NC
07/19/2022