HomeMy WebLinkAboutEXSY-11-2022-184495.TIF 44.► e CATAV'llA COUNTS' Case r EXSY-I I.2022-184495
t li t Public Health Department Sutxlvts;an
Environmental Ilealth Division PINS 266702660084
PO Box 389,25 Government Drive..Newton,NC 28658 t.(Yfs
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Site Address: 8389 COOKSVILLE RD,VALE NC 28168
Name on Permit: HISPANIC WOMEN FARMERS INC
Property Slut: Acres 61 62
Directions: W NC 10 Hwy, right Cooksville Rd,property on left
Owner/Authorized Representative Acknowledgement of Permit Receipt
f/1..V^ certify that I am the owner or authorized agent(owner's authuri•ration required)representing the owner of
the property described above.
/�C-- As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-10-2022-42525, by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
,G-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(I5A 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 {'f�
M a (-hut 6, r "
Date J `�
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (nave qf person sending permi()
Signature __ ....____. _._ .!✓...._._. . . .. _ . .._..... Date/'I'ilrte 0411 Z2
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Method: Fax 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 yosPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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EXISTING SEPTIC SYSTEM INSPECTION
NO'!' FOR LOAN APPROVAL
Case Number:EHPR-10-2022-42525 ❑ Reconnection to Existing System
Property Owner/Applicant: Hispanic Women Farmers Inc ❑ Mobile Home Park Reconnection
Site Address:8389 Cooksville Rd,Vale NC 28168 ® Applicant Request
Type of Facility: ❑ House ❑ Mobile Home Number of Bedrooms
❑ Business
® Other Migrant housing(900 GPD)
Proposed Addition/Accessory Structure:
® Approved ❑Not Approved Reason
❑Approval Not Required/System Location Only
Evidence of System Malfunction ❑ YES ® NO System Type/Description IIIB/25%reduction
Noncompliance hefts and Notes
-Do not drive,grade, cut, fill,or conduct farming activities over septic system area.
*NOTE:this inspection does not reflect on the lifespan or efficiency of the drainfield.*
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Authorized State Agent Cheyanne Morgan ' , ^Q- i/(41�- Date 11/15/2022
catawbacot tync.pv
Environmental Health
Catawba County Government Center
25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270
MAKING. LIVING. BETTER.
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(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 1 I 15 ,as required in G.S. 95-225(c)and(d),an evaluation was conducted of the drinking water supply and
(da e)
wastewater system serving a migrant housing site composed of#of d Mobile home units,it� 2#of
'i House(s) and
Ot er type of housing/describe: located at v✓ U l CooKs i l't ��(,1
\It��� r I C r ( ddress or di ctions;use reverse if need )An/y����
r l� 1u% and operated by �J�QI��1 � 0 riA ur ti1i5 _s1t. 1 vka0.hc
of 9 17 5 ct QKS V III. 1 t 7 ��1 k J �-' Zs 1 (o tame of persants[/company) Cat a O`l
(mailing address)
*** PLEASE SUBMIT ONE REPORT FOR EACH SEPTIC SYSTEM ***
This report describes well/spring b and sewage system l . (Use reverse for a drawing,if needed.)
(number) (number)
The findings of this evaluation are as follows:
WATERAA++ SUPPLY
1V 4 Community or non-Transient-non-community water system under routine surveillance of Public Water Supply Section,
(yes/no) Division of Environmental Health
NO
Private Water or Non-Community System p (t C w0 ev
(yes/no) D
At the time of inspection,there \l'405 ►jai- 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 u`h'1�Ck 'to approval under 15A NCAC 18A.1900,"Laws and Rules for Sewage Treatment and Disposal
(subjeclaot subject)
Systems." Explain,if not subject to approval
[(On-Site Septic Tank System [ I Chemical Portable Toilets ( I Others [ )Privy(ies)
At the time of inspection,there \1\.0.5 a bA- 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 11 astewater syste ,to the best my knowledge and belief,is sized to serve 5 people.
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v onmental Health Specialist Health Deppartment)
121i& Z2- Po �bx 3 1
Date Address
Forward copies to:Migrant Housing Operator VCAVv � / U 2_ ( 5 2
Department of Labor �/ I� 5 _ O�[
Agriculture Safety&Health Bureau t Z D YJ 7l/�\
Office Phone Number
DENR 3765(Revised 2/2011)
On-Site Wastewater Section(Review 12/2012)