HomeMy WebLinkAboutEXSY-03-2023-190315.TIF ,
5 CATAWtBA COUNTY Case# EXSY-03-2023-190315
h .t.,111,z Public Health Department Subdivision
d ,- Environmental Health Division PIN# 374006381197
PO Box 389,25 Government Drive,Newton,NC 28658 LOP/ B
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Site Address: 1320 BENSON LN, NEWTON NC 28658
Name on Permit: JOHN HOUSNER
Property Size: Acres 0.57
Directions: Mt.Olive Church RD, Right Thomas DR, Right E. 18th ST,changes to Benson LN , property on the Right
Owner/Authorized Representative Acknowledgement of Permit Receipt
XI certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
Ithe p operty described above.
xAs the property owner or authorized representative, I have received the above referenced
ermit(s)as requested in the application for service RBPR-02-2023-43407,by the following method(s):
Received in Person
_ Facsimile Transmittal(Return form with signature required)
I Electronic Image Transmittal/E-mail (Return receipt required)
1 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: 03/01/2023
Owner/Authoriz d Representative Signature e 1,` 67.
Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by_ (name of person sending permit)
Signature Date/Time
Method: Fax Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature ,
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public health
EXISTING SEPTIC SYSTEM INSPECTION
NOT FOR LOAN APPROVAL
Case Number: RBPR-02-2023-43407 ❑ Reconnection to Existing System
Property Owner/Applicant:JOHN HOUSNER _ ❑ Mobile Home Park Reconnection
Site Address: 1320 BENSON LN,NEWTON
® Applicant Request
Type of Facility: (2 House ❑ Mobile Home Number of Bedrooms 3
❑ Business
❑Other
Proposed Addition/Accessory Structure:B1I,1,AR1) ROOM 77FT X {9FT
®Approved ❑Not Approved Reason
❑Approval Not Required/System Location Only
Evidence of System Malfunction ❑YES ®NO System Type/Description GRAVEL TRENCHES
Noncompliance Items and Notes
SEPTIC TANK AND DRAINFIELD LOCATED
NOT FAILING AT TIME OF INSPECTION
NO GUARANTEE GIVEN TO SYSTEM LONGEVITY
NEW ADDITION IS 39FT BY 22FT
ANY FOUNDATION,PORCH DECK,ETC.. MUST BE MIN 5FT FROM ANY PART OF SEPTIC SYSTEM
Authorized State Agent Dean Evans Date 3/1/2023
Existing System Inspections expire 1 year from approval date
catawbacountync.gov
Environmental Health
Catawba County Government Center
25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270
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Catawba County Environmental Health
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Parcel:374006381197, 1320 BENSON LN 1 in=50ft
NEWTON, 28658
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Copyright 2021 Catawba County NC
02/28/2023