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�l • CATAWBA COUNTY Case# EXSY-11-2022-185332
�q' .t.ii ,� Public Health Department Subdivision
' . c Environmental Health Division PIN# 360804518035
• PO Box 589,25 Government Drive,Newton,NC 28658
/842 w LOT# 2
Site Address: 4426 GRACE CHURCH RD, NEWTON NC 28658
Name on Permit: LFR FARMS
Property Size: Acres 0.57
Directions: W NC 10 Hwy, left Blackburn School rd, right Grace Church Rd, .10 mile property is cream colored mobile
home on right
Owner/Authorized Representative Acknowledgement of Permit Receipt
?( _I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
iAs the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-1l-2022-42814,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
J 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: 11/30/2022
Owner/Authorized Representative Signature
"-.7 Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Date/Time I in/ ,)3__
Method: Fax i 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 yoLPlease ttake a few momentts tto complette our custtomer service survey aft
http://www.surveymonkey.com/s/EHCusttomerService
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ehpennit 11/30/2022 16:25 10\
•
Catawba county
public health
EXISTING SEPTIC SYSTEM INSPECTION
NOT FOR LOAN APPROVAL
Case Number:EHPR-11-2022-42814 ❑ Reconnection to Existing System
Property Owner/Applicant:Agri-Land West LLC/LFR Farms&Greenhouses ❑ Mobile Home Park Reconnection
Site Address:4426 Grace Church Rd,Newton NC 28658 ® Applicant Request
Type of Facility: ❑ House ® Mobile Home Number of Bedrooms 3
❑ Business
® Other-Migrant housing
Proposed Addition/Accessory Structure:
®Approved ❑Not Approved Reason
❑Approval Not Required/System Location Only
Evidence of System Malfunction ❑YES ® NO System Type/Description IIIG-25%reduction
Noncompliance Items and Notes
• Existing system inspection for continued use of home for migrant housing. Mobile home has 3 bedrooms and can have a maximum of
6 occupants.
• Permit on file is for 3 bedrooms(see WLS2001-01648).
• Do not drive,grade,cut,or fill over septic system area.
• No guarantee can be given as to the lifespan of the septic system.
Authorized State Agent Cheyanne Morgan ;�9Aj9^^' Of\1,r Date 11/30/2022
catawbaco'tmtync.gdv
Environmental Health
Catawba County Government Center
25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270
MAKING. LIVING. BETTER.
DQ 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 11,30 1 2.02 - ,as required in G.S.95-225(c)and(d),an evaluation was conducted of the drinking water supply and
(date)
wastewater system serving a migrant housing site composed of#of ! Mobile home units,#of 0 House(s) and
Other type of housing/describe:�7 located at 4I q 26 Grace Church► R4.
NeWkoP r IV G [-Ot�S g perated by LUCQS RI C• KQ( r t dRirecran� S reverse if needed)
+ �1 L and o
of 4 t 5 E V t c or 10. CT Sit p i &(aani[• Ik N G(namae7f p�5 o s]/Company)
(mailing address)
*** PLEASE SUBMIT ONE REPORTII FOR EACH SEPTIC SYSTEM ***
This report describes well/spring I and sewage system 4 . (Use reverse for a drawing, if needed.)
(number) (number)
The findings of this evaluation are as follows:
WATER SUPPLY
No Community or non-transient-non-community water system under routine surveillance of Public Water Supply Section,
(yes/no) Division of Environmental Health SS
e Private Water or Non-Community System Tndt J1 ava`, P( ija4r well
I
( s/no)
At the time of inspection,there W as r1 b'- 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 Ub�Ldr to approval under 15A NCAC 18A.1900, "Laws and Rules for Sewage Treatment and Disposal
(subjec not subject)
Systems." Explain, if not subject to approval
VOn-Site Septic Tank System [ ]Chemical Portable Toilets [ ]Others [ ]Privy(ies)
At the time of inspection,there V406 POT 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 ,astewater sy ern, to e bes f my knowledge and belief, is sized to serve people.
f/ ► a A Uahawba Co axu rn number)
r vironmental Health Specialist Health Depa�ment
I if a 112,2,3 Pb eAX 3S I
ate Address(� /
Forward copies to: Migrant Housing Operator JJ . J4VV1 • N C' 2.Q6 58
Department of Labor in
�� /�
Agriculture Safety&Health Bureau i1 - rrV 5- V2.7 0
Office Phone Number
DENR 3765(Revised 2/2011)
On-Site Wastewater Section(Review 12/2012)