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HomeMy WebLinkAboutEXSY-11-2022-184498.TIF c1r`� CATAWBACOUNI'Y ' Cased EXSY-l1-2022-184498 .�. Public Health Department Subdivision R'� Environmental Health Division PINS 267703037478 \,40P PO Box 389,25 Government Drive,Newton,NC 28658 LOTt :It sm Site Address: 8739 W NC 10 HWY,VALE NC 28168 Name on Permit HISPANIC WOMEN FARMERS INC Property Size: Acres 38.29 Directions: W NC 10 on left before Cooksville Rd (honer/Authorized Representative Acknowledgement of Permit Receipt YI certify that I am the owner or authorized agent(owner's authorization required)representing the owner of r` the property described above. }( ; As the property owner or authorized representative,I have received the above referenced f permit(s)as requested in the application for service EHPR-10-2022-42528,by the following method(s): Received in Person _ Facsimile Transmittal(Return form with signature required) idiE- 11 Electronic Image Transmittal/E-mail (Return receipt required) V�"-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: 11/15/2022 Owner/Authorized Representative Signature _ilLi -CA' V 4\-et � _ --C wA '.7 Date ! Z-5 =12- Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name of person sending permit) Signature Date/Time 1)1-OD Method: Fax V 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 yotPlease ttake a few momentts tto complette our custtomer service survey att http://www.surveymonkey.com/s/EHCusttomerService cmuc 11/17/2022 14.25 Df Evaluation North Carolina Department of Environment and Natural Resources [ )Re-evaluation Division of Environmental Health (number) PREOCCUPANCY EVALUATION REPORT OF DRINKING WATER SUPPLY AND WASTEWATER FACILITIES FOR MIGRANT HOUSING On I 2 :as required in G.S.95-225(c)and(d),an evaluation was conducted of the drinking water supply and (d le) wastewater system serving a migrant housing site composed ofp#of 0 ,Mobile home units,e #of 0 House(s) and� Other type of housing/describe:PtCCQSS©(i Vied QI IIfl ) I[)IO 6Idt located at 03 31 W I V C- 1 Q It(w y e\iAI NI C. .2g I r ; (a¢�reis r directions:use reverse if needed) and operated by l O ftf C () [ °+Iaen of 9 -7 5 C o oks ilk ; \hate NC, n( 16 D (name of person[sycompany) (mailing address) *** PLEASE SUBMIT ONE REPORT FOR EACH SEPTIC SYSTEM *** This report describes wellspring 0 and sewage system I .(Use reverse for a drawing,if needed.) (number) (number) The findings of this evaluation are as follows: • WATER SUPPLY Y1b Community or non-Transient-non-community water system under routine[Cri'f urveillance of Public Water Supply Section. (yes/no) Division of Environmental Health V�� _ i_X_ 0.6 Private Water or Non-Community System t,c p4C V 0` r I �� (yes/no) _ At the time of inspection,there ,W S GI' visual evidence of non-compliance with the"Protection of Water Supplies" (was/was not) 15A NCAC 18A.1700(attach copy of bacteriological sample).List deficiencies which were identified: (Use reverse if necessary) WASTEWATER FACILITIES System S U 0\�& 'to approval under 15A NCAC 18A.1900,"Laws and Rules for Sewage Treatment and Disposal (subje not subject) Systems." Explain,if not subject to approval (On-Site Septic Tank System [`,)Chemical Portable Toilets ( )Others [ )Privy(ies) V"At the time of inspection,there �N Y\O visual evidence of non-compliance with 15A NCAC 18A.1900(including (was/was not) .1962)"Laws and Rules for Sewage Treatment and Disposal System." List deficiencies which were identified: (Use reverse if necessary) The stewater s m,to be of my knowledge and belief,is sized to serve Un people. /IAI�7.C. t IUGL(m rwironmen al ealth Specialist Health Department I 2:2— f P)Ox Dat n Address C �[/ Forward copies to:Migrant Housing Operator y QvAt N 2( r` / � n(5 Q Department of Labor S2 ' Li/ C ^ Q �� Agriculture Safety&Health Bureau p (fi+J U Office Phone Number DENR 3765(Revised 2/2011) On-Site Wastewater Section(Review 12/2012)