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HomeMy WebLinkAboutIMPV-11-2022-185186.TIF s CATAWBA C01:NTV ' .f. fir 1,+�a Public IIcalth I)cpann)cnt 5uhdu usron s Nim •I Environmental Ilealth Division PIN I 377003018895 `� Po Box 389.25(iovennnent Ihi%e.Neuton.NC 28658 LUTt) 2 �f:I11 Site Address: 4071 TROUT POND RD, CLAREMONT NC 28610 Name on Permit: ERIC CHILDERS Property Size: Acres 2.36 Directions: NC 10 W,turn right onto Balls Creek Rd, right onto Trout Pond Road.grey 2 story house on the right hand side of drive Owner/Authorized Representative Acknowledgement of l'erm it Receipt x(77e1 cent I') that I am the owner or authorized agent(owner's authorization required)representing the owner of the property described above. CZ7C As the property owner or authorized representative. I have received the above referenced permit(s)as requested in the application for service Eli PR-08-2022-41928, by the I flowing method(s): Received in Person Facsimile Transmittal (Return form with signature required) fElectronic Image Transmittal/E-mail (Return receipt required) c'Ve 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 I 8A.1900). and/or Well Construction Standards(I5A NCAC 2C .01(10), shall apply to the issuance of this permit and the construction of the wastewater system and/or water supply well permitted. Permit Issue Date: 11/29/2022 Owner/Authorized Representative Signature r2te Z7 C/Ge ¢// - Date 12/08/2022 Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name of person sending permit) Signature Di e I)ate''fime /448ID7__ Method: Fax Email (1S 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 ed ek, td 10 I cloud. totn ,•h,,,„,„ I I:2).!II)' 118.11 1 P • DEPARTMENT OF I IEALTI1 AND I IUMAN SERVICES Shea l of Z DIVISION OF PUBLIC HEALTII,ENVIRONMENTAL I IEALTI I SECTION PROPERTY ID N:=e5rtr ON-SITE WATER PROTECTION BRANCI I COUNTY: SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM /f 1 (Compicte all fields in full) O OWNER: �rl C�11(I e I_S APPLICATION DATE O ��2 ADDRESS: (1/Q7/, - P4.ad DATE EVALUATED PROPOSED FACILITY: J`'D PROPOSED DESIGN FLOW(.1949): (QOo PROPERTY SIZE: 2.?b LOCATION OF SITE: SAm F PROPERTY RECORDED: — WATER SUPPLY. !Private ❑Public ffitVell 0 Spring 0 Other EVALUATION METHOD: ❑Auger Boring gl-Pit 0 Cut TYPE OF WASTEWATER: ZOSewage ❑Industrial Process ❑Mixed f s s • P R SOIL MORPHOLOGY OTHER 0 F (.1941) PROFILE FACTORS t .1940 E LANDSCAPE HORIZON POSITION! DEPTH 1942 PROFILE ii SLOPE% (IN-) .1941 .1941 SOIL -1943 .1956 .1944 CLASS STRUCTURE/ CONSISTENCE! WETNESS/ SOIL SA PRO RESTR &LTAR TEXTURE MINERALOGY COLOR DEPTH CLASS IIORIZ 0-8 1.04n( D 5S TiQ- z6 &a. c- - �7/z !/ 1 /31 Ic S cr s it)sa GL- rl- 3 z't / ,2.r • z 4 & ' 4 7(/z ( �sa8 . sd� L lr'� / zs' 2 13Z z�- sy r,Jb�� Lc- jr 30,/ / l I SS F-0- I -rill p5 A 1z-g• L 3 13 l�•36 s0-L Fr-- I `i / / 3 � l l3 a c. 36-SY os4/ G L R-, 01 A ©-7 S -C ,'s V 8L7- Z6 Sm. Fi - / / a4 G l z6- ki$ iiik 661- r-- r i DESCRIPTION INITIAL SYSTEM--- YSTL M/ REPAIRSYSTEM OTHER FACTORS(_19dG): --r— (1 /f ' SITE CLASSIFICATION(.1948): Ps Available Space(.1945) EVALUATED BY: p,Cron S SystemType(s) p,.S7''A'A SO L OTHER(S)PRESENT: Site LTAR [-U -3 COMMENTS: Updated February 2014