HomeMy WebLinkAboutEXSY-11-2022-183741.tif V,. CATAWBA COUNTY Case# EXSY-11-2022-183741
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;C(.......-'-I ,z Public Health Department Subdivision B L KISER
Q .-•,, 'aC Environmental Health Division PIN/ 461602553842
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 33
Site Address: 4713 KISER ISLAND RD,TERRELL NC 28682
Name on Permit: KEVIN WILKINSON
Property Size: Acres 0.5
Directions: Hwy 150 from Lincolnton to Kiser Island Rd in Terrell 4713
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.
As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-l0-2022-42606,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: 11/07/2022
Owner/Authorized Representative Signature
Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Date/Time
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 yoaPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomer5ervice
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catawba county
public health
EXISTING SEPTIC SYSTEM INSPECTION
NOT FOR LOAN APPROVAL
Case Number: RBPR-11-2022-42606 ® Reconnection to Existing System
Property Owner/Applicant: Kevin Wilkinson ❑ Mobile Home Park Reconnection
Site Address: 4713 Kiser Island Rd,Terrell NC 28682 ' ❑ Applicant Request
Type of Facility: ® House ❑ Mobile Home Number of Bedrooms 3
❑ Business
❑Other
Proposed Addition/Accessory Structure: 1t1Y1 icy 111 acrPccnry ctructure
®Approved ❑Not Approved Reason
❑Approval Not Required/System Location Only
Evidence of System Malfunction ❑YES ® NO System Type/Description 25%reduction IlIb
Noncompliance Items and Notes
• Maintain 5 feet minimum from home or decks.
• No guarantee to the longevity of system.
Authorized State Agent /ir —12,--_- Date 11/11/2022
catawbacountync.gov
Environmental Health
Catawba County Government Center
25 Government Drive I PO Box 389 1 Newton NC 28658 1828.465.8270
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Catawba County Environmental Health
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Parcel: 461602553842, 4713 KISER ISLAND RD 1 in=40ft
TERRELL, 28682
This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts
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,and
personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may
arise from this map/report product or the use thereof by any person or entity.
Copyright 2021 Catawba County NC
1 1/07/2022