HomeMy WebLinkAboutIMPV-11-2022-184375.TIF �.1:1fy. CATAWBA COUNTY
:�.Wit Public Health Department Subdivision THE SUMMIT AT LAKE NORM
46,--, _ is Environmental Health Division PINS 470002981138
41/4../11, PO Box NW,25 Government Drive,Newton,NC 28658 LOTH 94
Us Address: 7087 ERIC CRANE DR,CATAWBA NC 28609
Name on Permit: BRIAN&ALLISON NOCHER
Property Sine: Acres 1.37
Directions: NC Hwy 18 Left onto Balls Creek Right W Bandys Cross RD Left Buffalo Shoals RD Right Sherrills Ford Rd,
Left onto Long Island RD,Right Kaniker LN,Left Eric Crane DR,lot on Right
Owner/Authorized Representative Acknowledgement of Permit Receipt
0;11 I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
06'As the property owner or authorized representative,( have received the above referenced
permit(s)as requested in the application for service RBPR-05-2022-41025,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
T Electronic image Transmittal/E-mail (Return receipt required)
Vi‘e 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(1SA 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: 11/14l2022 .
Owner/Authorize Representative Signature /
�' !?ate 8 � �-
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of personsending permit)1
Date/Time I r )%iZZ
Signature
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
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This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial effort
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 maplreport 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.
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11/11/2022
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This map/report product was prepared from the Catawba County,NC Geospat
ial 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
11/11/2022
DEPARTMENT OF HEALTH AND HUMAN SERVICES Sheet=/ of
DIVISION OF PUBLIC HEALTH,ENVIRONMENTAL HEALTH SECTION PROPERTY ID : 4.
ON-SITE WATER PROTECTION BRANCH •
COUNTY; 1
SOILISITE EVALUATION YI��
for ON-SITE WASTEWATER SYSTEM
(Complete all fields in full)
OWNER: is b A t' a c L( APPLICATION DATE
ADDRESS: DATE EVALUATED: 7•r.01
PROPOSED FACILITY: ''IQr PROPOSED DESIGN FLOW(.1949): t('o PROPERTY SIZE:
LOCATION OF SITE: 7961 Ec t Gf et...t 1Di- PROPERTY RECORDED;
WATER SUPPLY: ❑Private 0 Public [ ell 0 Spring ❑Other s
EVALUATION METHOD: ❑Au:er Boring Pit ❑Cut TYPE OF WASTEWATER: ❑Sewage ❑IndustttI EPioce,ss i]Mix�e(d
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DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): g' f
f SITE CLASSIFICATION(.1948):
Available Space(-1945) Pf
2 -i3 - EVALUATED BY:
System s).l, J j an OTHER(S)PRESENT: 1 e.,-. .
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Updated February 2014
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DEPARTMENT OF HEA.LTH AND HUMAN SERVICES PROPERTY ID#: -: ''.::•iii:' i -
DIVISION OF PUBLIC HEALTH DATE OF EVALUATION: '.7,AVej: •
ENVIRONMENTAL HEALTH SECTION 1 6a-A COUNTY:
ON-SITE WATER PROTECTION BRANCH .
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