HomeMy WebLinkAboutEXSY-03-2023-191471.TIF • A
CATAWIBA COUNTY Case N LXSY-03-2023.191471
Public Health Department Subdivision
t,. ' Environmental Health Division I'INN 460715639286
PO Box 389,25 Government Drive,Newton,NC 28658 unit 204
site Address: 4027 CHEVLOT HILLS RD, SHERRILLS FORD NC 28673
Name on Permit: MARK REECE
Property Size: Acres 0.86
Directions: E NC 10 HWY left on Cheviot Hills Rd on Left
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.
)(, //'I€-As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-01-2023-43194,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
7 Electronic Image Transmittal/E-mail (Return receipt required)
1, 111' -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: 03/16/2023
Owner/Authorized Representative Signature
6R.
Date 3--31-2.0 2_3
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by _ _ (name of person sending permit)
OliSignature ] Date/Time__31 3 C1 j a 3
Method: Fax J 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 yoaetease ttake a few momentts tto complette our custtomer service survey aft
http://www.surveymonkey.com/s/EHCusttomerservice
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catawba county
public health
EXISTING SEPTIC SYSTEM INSPECTION
NOT FOR LOAN APPROVAL
Case Number: RBPR-1-2023-43194 ® Reconnection to Existing System
Property Owner/Applicant: Mark Reece ❑ Mobile Home Park Reconnection
Site Address: ❑Applicant Request
Type of Facility: ® House El Mobile Home Number of Bedrooms 2
❑Business
El Other
Proposed Addition/Accessory Structure: New 411'Y4n' 2 RR Home
❑Approved El Not Approved Reason
® Approval Not Required/System Location Only
Evidence of System Malfunction ❑ YES ®NO System Type/Description Gravel Trenches See Permit 401572
Noncompliance Items and Notes
The existing system is located inside the 50 foot lake buffer. Because of OP#01572,dated 12/15/1986,reconnection to existing system is
allowed.
Owner has been advised that any relocation of system,expansion,or failure of system would require evaluation of soil and a new permit.
Authorized State Agent Date 3/16/2023
Existing System Ins tions expir 1 year from approval date
catawbacountync.gov
Environmental Health
Catawba County Government Center
25 Government Drive PO Box 389 Newton NC 28658 828.465.8270
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Parcel: 460715639286, 4027 CHEVLOT HILLS 1in=50ft
RD SHERRILLS FORD, 28673
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Copyright 2023 Catawba County NC
03/24/2023