The URL can be used to link to this page

Home My WebLink AboutIMPV-11-2022-185134.TIF �� =� CATAWBA COUNTY . - . - t lam' Public Health Department Subdivision KISER SUNSET KEYS 1 s,'.R Environmental Health Division PINK 461604722722 �� PO Box 389,25 Government Drive,Newton,NC 28658 LOTS 37 &I, M Site Address: 5008 KISER ISLAND RD, TERRELL NC 28682 Name on Permit: EARL KISER Property Size: Acres 0.42 Directions: 5008 Kiser Island Rd, Terrell Owner/Authorized Representative Acknowledgement of Permit Receipt l 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-08-2022-42139, 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: 11/28/2022 Owner/Authorized Representative Signature ,�" "" —`� P g Date i2 f' (/2-O.z-)--- Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) 1j2 L L- Kt.f'L`�- Permit transmitted by c�-( //( &name of person sending permit) Signature i.�( J X — Date/Time /2 4/.22-- /D.1 Uf 4', i 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://+.vww.surveymonkey.com/s/EHCusttornerServIce ebperniii 11/282022 12:04 .sr . =; DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF PUBLIC HEALTH,ENVIRONMENTAL HEALTH SECTION Sheet_ of — t ON-SITE WATER PROTECTION BRANCH PROPERTY ID : • SOIIJSITE EVALUATION COUNTY: Catawba` for ON-SITE WASTEWATER SYSTEM (Compiete all fields in full) OWNER:_ 1-I K$c C g ADDRESS: APPLICATION DATE h9` PROPOSED FACILITY: PROPO ESI N W DATE EVALUATED: • tl LOCATION OF SITE: 49): PROPERTY SIZE: WATER SUPPLY: ❑Private C/r PROPERTY RECORDED: k- 0 Public 11 LI Spring rl er EVALUATION METHOD: 0 Au: r Boring I ❑Cut TYPE OF WASTEWATER: r gs� ��'', r - ❑Industrial Process ❑Mixed 1. 3 F nti f 6` _ ' .. ( L f ♦t y .'s1.1 ' ra e,6 1 A ,yfr " i i .< •�� f }F r , f �a ► !✓yi e. ct ,a. 1 ; .� y. ` - k 5'w i i;, i 'f _ t I. ". .. Q (.. nLtl l s ,,,,"..'i s �F..-e. .: '� i'..-'t �, .at,�' x : t Fes ,FI t J4,'�CV• ( d ty , .: i 1 Mrs 1I ' r t (r':. „ f+"y .S' � le. 3'' l,Ir , „< j R :,:. .ti 1'.; sh, a S Y �: 1 '� f , � .1 i i. is. i' > t },!',.,q'" Et , qn.` t d: ..:1.+ • Ii ,,,:...! .-, ( hr � r .i 1 , i i. , s e. t .�i%, l p a-.. x 'r.V i r;�,k-�, t `� t. Y n Z!'r i Y. ! f i ;1 }�Jk d k��Ji } r ,, 't S, �„e'7` ,„,,t y y .Mr.0 .}:c;'Iti-u:,..11 i ,, • I �i;•'S'!'i 1 1 aRt' .i: i) 4 °4A•'1! 'f`ri .-', }"4 fi,y 7� ..t� t 1. 1 sx '-,!All ;b t).1Y 31 rt..y�SAte, 1L rdIEMIUMMII I IMS9 t - MI .a (,' 'a - 1 2 � � Z� r ! 7!fj �� lINIKV 3 " _ (Lid , S. _� a-Li (' tW 4 -f7- ,_"7-40 1 1 1 4 DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FA(:IURS(.1946): Available Space(.1945) II) SITE CLASSIFICATION(.1948): "l— System Type(s) TV EVALUATED BY: -__ V OTHER(S)PRESENT: Site LIAR COMMENTS. Updated February 2014 -- ,.c;,�+ ?f' *u��fin i;��, } 3 r rvi," t I 1 i•.-- / A! / / e4t # Fr f ot �' �• • •• 6+ \ 4 GI M�4• r • ai _.ftE A x •-' (7 )1,\ (40 M.41 ' 4.'d .• . * ' - ; t gb • e 1 ` t : `; ,... R ti J 1 i 1 far ® h � t. hD % a I L et y s _et Q Qi a ., ; ; : . ® Y ,i4 r, 0. • i tit' • •fir•' ,� /�Qi� y h trI I. , •• .+Y ( ,. .Utz A. ? • CDj' © a• • i ,a d i ® t • �� +.,•err .Y P. e ;t. a. h ri• v :"- •a w S ti C.c. • • ( y. 5 Ora q) '. li „. 0 4 s, yr I. • 1 } • 1 1I c, 4� tiL. ! ' CarY, i tR �`� Cot° c �- * 4.) -. • r`. - 1- _.