HomeMy WebLinkAboutEXSY-11-2022-184497.TIF 4 i CATAWBA COUNTY Case# EXSY-l1-2022-184497
.f.IPublic Health Department Subdivision MOUNTAIN CREEK RIDGE
" Environmental Health Division PIN# 369803200723
libtatir. PO Box 389,25 Government Drive,Newton.NC 28658 LO'r# 4
Site Address: 3221 STONEMILL PATH, SHERRILLS FORD NC 28673
Name on Permit: 'TOSH POTTER
Property Size: Acres 1.01
Directions: 3221 Stone Path, Sherrills Ford
Owner/Authorized Representative Acknowledgement of Permit Receipt
XI certify that I am the owner or authorized agent(owner's authorization 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 RBPR-10-2022-42633,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: 11/15/2022
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)
(iiSignature Date/Time i s i3D/D 3
Method: Fax j 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 yo„Please take a few momentts to complete our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
Mhpo tkrabell l soi .r et
Pr
ehpennil 11/17/2022 14:41
G)
catawba county
public health
EXISTING SEPTIC SYSTEM INSPECTION
NOT FOR LOAN APPROVAL
Case Number: RBPR-11-2022-42633 ® Reconnection to Existing System
Property Owner/Applicant:Tosh Potter ❑ Mobile Home Park Reconnection
Site Address: 3221 Stonemill Path,Sherrills Ford ❑ Applicant Request
Type of Facility: ® House ❑ Mobile Home Number of Bedrooms 4
❑ Business
❑Other
Proposed Addition/Accessory Structure: 14x2R sicrresnry structure with retaining wall
❑Approved ®Not Approved Reason RETAINING WALL WITH FOUNDATION DRAIN TOO CLOSE TO DRAINFIELD.
0 Approval Not Required/System Location Only
Evidence of System Malfunction 0 YES ® NO System Type/Description 25%reduction 111G
Noncompliance Items and Notes
Authorized State Agent /lmR/.� V� Date 11/15/2022
catawbacountync.gov
Environmental Health
Cotowbo County Government Center
25 Government Drive ( PO Box 389 1 Newton NC 28658 1 828.465.8270
MAKING. LIVING. BETTER.