HomeMy WebLinkAboutEXSY-11-2022-185324.TIF � C AwitA('Ot'N'11 caw r: LXSV•I I.2ti22.185314
1+K� Puhlrc lle:dth Ikpartrnent Nuhdo.i,si':
,e. . Environmental Health Division 1INI•' 269604509173
APO oar 389.2 Covcrnuient f)rnr.Newton.N(' 2$058 1.0'141
Site Address: 3284 PORTER CLINE RD.VALE NC 28168
Name on Permit: PD THREE FARMING INC
Property Size: Acres 100.32
Directions: W NC 10 Hwy,left Plateau Rd.approx 3 miles right on Porter Cline Rd, at end of road on tefi
Owner/Authorized Representative Acknowledgement of Permit Receipt
I certil'} that I am the owner or to thurired agent(o {ICE'S autlturizulitm required}representing the cm nor el'
the propcm described abuse.
As the property owner or authorized representative. I have received the above referenced
permit(s)as requested in the application firr service EHPR-11-2022-42818.by the following tnethod(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
1 Fleetronic Image transmittal'I.-mail (Return receipt required)
As the property owner or authorized representative I have reviewed and understand the specific conditions
ofthe permit issued, and further understand that all applicable regulatory requirements specified under the
North Carolina Laws and Rules for Sewage Treatment and Disposal Systems(I5A NCAC ISA.1900),
and/or Well Construction Standards(I5A NCAC 2C.0100), shall apply to the issuance of this permit and
the construction of the wastewater system anchor water supply well permitted.
Permit Issue Date: 11/30/2022
\
Owner/Authorized Representative SignatureLv�i' _ ip_1--''�Thss....._
---- Dale le7)/7 ) 9 D____
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (wane or person sending permit)
signature Date!Tintc lJ/iii)7Z
h Method: as 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 yoiPlease ttake a few momentts tto complette our custtomer service survey dtt
http://www.surveymonkey.com/s/E1-1CusttomerService
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[ Evaluation North Carolina Department of Environment and Natural Resources
[ I Re-evaluation Division of Environmental Health
(number) PREOCCUPANCY EVALUATION REPORT
OF DRINKING WATER SUPPLY AND
WASTEWATER FACILITIES FOR MIGRANT HOUSING
On 3 2 ,as required in G.S.95-225(c)and(d),an evaluation was conducted of the drinking water supply and
(d e)
wastewater system serving a migrant housing site composed of#of b Mobile home units,#c�of I House(s) and (�
Other type of housing/describe: located at 32 U LI PCc-ei Cline- PJ
p (� -(� dress or directions; use reverse if needed)
� , L 2g1 b`� and operated by 1 L) TAree, ra.YMI I' \ inL.
`` Ana e of persons]/c pony)
of 9 b� <�11DvJ �te�`L ��(Jl, 5-f6.1-eS\Jilt �j��
(mailing address)
*** PLEASE SUBMIT ONE REPORT FOR EACH SEPTIC SYSTEM ***
This report describes well/spring I and sewage system I . (Use reverse for a drawing,if needed.)
(number) (number)
The findings of this evaluation are as follows:
WATER SUPPLY
KbCommunity or non-transient-non-community water system under routine surveillance of Public Water Supply Section,
(yes/no) Division of Environmental Health
Private Water or Non-Community System Tr�l�,LIJC�( (. JG-(yles
/no) f
At the time of inspection,there Was Y1D't 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 SV�11Q ClTI to approval under 15A NCAC 18A.1900, "Laws and Rules for Sewage Treatment and Disposal
(subject$not subject)
Systems." Explain,if not subject to approval
pQOn-Site Septic Tank System [ ]Chemical Portable Toilets [ ]Others [ ]Privy(ies)
�"
At the time of inspection,there VIOLS n t t 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 wastewater syste ,to t st of my knowledge and belief, is sized to serve l people.
rximum number)
\et'e CakekM2ck l_fv'�
EnvJbnmen al Health Specialist Health Departm t
V2A lc4 6)( 3S1
ate Address
Forward copies to: Migrant Housing Operator e�M v 2-Zt5 l�
Department of Labor gi2-7()
Agriculture Safety& Health Bureau -� o /
Office Phone Number
DENR 3765(Revised 2/2011)
On-Site Wastewater Section(Review 12/2012)