HomeMy WebLinkAboutIMPV-01-2023-188169.TIF rye CATAWBA COUNTY
F.(....t. ,Z Public Health Department Subdivision LORENE B SPEAGLE PROP
d `I Environmental Health Division PIN# 267804912236
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 3
. . $M
Site Address: 2013 LYNN MOUNTAIN RD,VALE NC 28168
Name on Permit: JOSEPH&STEPHANIE ROWE
Property Size: Acres 15.85
Directions: NC 10, Right onto Lynn Mountain Rd, Property on the left
Owner/Authorized Representative Acknowledgement of Permit Receipt
X. 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 RBPR-01-2023-43139, by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
4 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: 01/26/2023
Owner/Authorized Representative Signature
. Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature °1/ Date/Time ON)3
Method: Fax 1/ 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 stake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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gefe- 0- 023. 4313i Catawba County Environmental Health
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Parcel: 267804912236, 2013 LYNN MOUNTAIN 1in=50ft
RD VALE, 28168
This map/report product was prepared from tho Catawba County,NC Ooos rntlal Infonnrttlon Son/Ices. Catawba County has made substantial efforts
to ensure the accuracy of location and Iaboling Information contninnd on thin map or data on this report.Catawba County promotes and recommends
the Independent vorifcaUon of any dole contninod on thin ntn h/roporl product by Iho usur.Thu County of Catawba,Its employees,agents,and
personnel,disclaim,and shall not be hold liable for any and all dnnuijos,toss or liability,whether direct,Indirect or consequential which arises or may
arise from this mop/report product or the use thoroof by any person or entity.
Copyright 2021 Cntnwbn County NC
01/25/2023
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES Sheet i of
DIVISION OF ENVIRONMENTAL HEALTH PROPERTY ID T: }6 g bu 11113 6
ON-SITE WASTEWATER SECTION COUNTY: t b?
SOIL/SITE EVALUATION
for ON-SITE WASTEWATER SYSTEM •
OWNER: J O.fcph 54,/hake /how 4 APPLICATION DATE 1 !ti l z f 3
ADDRESS: 1013 L\jnA MoNn•6;e1 RI. Vultl. I/C 16k DATE EVALUATED: 1. x3
PROPOSED FACILITY: / g2 Add;?:an PROPOSED DESIGN FLOW(.1949): 1-1 g0 Gil) PROPERTY SIZE: /S S 5
LOCATION OF SITE: c r et1 P PROPERTY RECORDED: I !`I g
WATER SUPPLY: 0 Private 9 Public Well 0 Spring 0 Other
EVALUATION METHOD: 0 Auger Baring VP it 0 Cut •
TYPE OF WASTEWATER [VSevage 0 Industrial Process 0 Mixed
..................
(i1941)•:: P? �31Tv `:tAC'L(3FfSct's € ; €'s
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Ir scuPnoN INITIAL SYSTEM REPAIR SYSTEM •OTHER FACTORS(.1946):
Available Space(.1945) s' s' SITE CLASSIFICATION(.1//9948): /
e EVALUATED BY: ►Sl(\L ' _t erk,r?c
-System Type(s) G cfm e 1
1 So r OTHER(S)PRESENT:
. Site LTAR O, 5,S 0, 7 2 S
COMMENTS: