HomeMy WebLinkAboutEXSY-11-2022-184289.TIF f"., CATAWBA COUNTY Cases EXSY-l1-2022-184289
,.(t I Public Health Department Subdivision
Environmental Health Division PINI 460604723133
�� PO Box 389,25 Government Drive,Newton,NC 28658 LOU a PT 7&ADJ
i:IllSite Address: 5102 SLANTING BRIDGE RD, DENVER NC 28037
Name on Permit: 'LYFE MARINE INC
Property Siva: Acres 2.59
Dlrectlons: Hwy 150 E, right Slanting Bridge Rd,on left past Keistlers Store Rd
Owner/Authorizedorauthori Repzedresentativeowner'sauthor Acknowledgement of Permit Receipt
_I certify that 1 am the owner agent( ization required)representing the owner of
the property described above.
X As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service CBPR-09-2022-42330,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 I8A.1900),
and/or Well Construction Standards(I5A 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: 11/11/2022
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_ !iiice b Z
Method: Fax NiEmail 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/EHCusttomerServIce
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catawba county
public health
EXISTING SEPTIC SYSTEM INSPECTION
NOT FOR LOAN APPROVAL
Case Number:CBPR-09-2022-42330 ® Reconnection to Existing System
Property Owner/Applicant:LYFE MARINE INC(RANDOLPH JORDAN) ❑ Mobile Home Park Reconnection
Site Address: 5102 SLANTING BRIDGE RD,DENVER NC 28037 _ ❑ Applicant Request
Type of Facility: ❑!louse ❑ Mobile Home Number of Bedrooms
Business CONSTRUCTION STORAGF 4 EMPLOYFFS
0 Other
Proposed Addition/Accessory Structure:
❑Approved ®Not Approved Reason ROAD AND DRAINAGE THROUGH REPAIR AREA.
❑Approval Not Required/System Location Only
Evidence of System Malfunction ❑YES ® NO System Type/Description 1IIG 25%REDUCTION
Noncompliance Items and Notes
• ROAD AND DRAINAGE THROUGH REPAIR AREA.
Authorized State Agent ()/ v\J2-4 U`--- ut>-C9 - Date 09/21/2022
s•
catawbacountync.gov
Environmental Health
Catawba (aunty Government (enter
25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270
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