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4-f. Public lic:dth I)cp:emu-I l subcht Issin AUTUMNWOODS PH 2
I,vin I•.nwonntental Iicalth Da,Niun PI`tr 460901083203
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Site Address: 1523 MARSHBROOKE LN, CATAWBA NC 2..609
Name on Permit: LINDO EVERALD
Property Size: Acres 0 62
Directions: 150,left on Sherrills Ford, right on Long Island Rd, right on Eulaha Lr,,onto Marshbrooke Ln,lot on corner of
Marshbrooke Ln&Conestoga Crossing
Owner/Authorized Representative Acknowledgement of Permit Receipt
XI certify that I am the owner or authorized agent hits authoriratiun required)representinc the ins ncr or
the proper))described ahove.
1( As the property owner or authorized representative. I have received the above referenced
permit(s)as requested in the application for service 1111I'R-I0-2020-359f12. by the Billowing nmthod(s):
Received in Person
Facsimile transmittal (Return form with signature required)
I Electronic Image Transmittal/ I:-mail (Return receipt required)
As the property owner or authorised representative I have reviewed and understand the specific conditions
of the permit issued, and further understand that all applicable regulators' requirements specified under the
North Carolina Laws and Rules for Sewage Treatment and Disposal Systems(I5A NCAC IAA.1900),
and/or Well Construction Standards (1SA NCAC 2(7 .0100), shall apple to the issuance ofthis permit and
the construction of the wastewater system and/or water supply well permitted.
Permit Issue Date:03/23/2023
OwncriAuthorized Representative Siunature ------...„
))ate J 3 al3
IP.ekly
Documentation of Perntit(s)'I•ransmittal
(permit transmitted by electronic or other means)
Permit transmitted by (,' mania(?pe�rswz.reueling permit)
Signature 4tom- I)ate%'1•ime 5/3/2 3
Method: I••a% J Email LIS Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from yoa'lease hake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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—. CATAWBA COUNTY Case# IMPV-03-2023-192033
FT .f.la1. Public Health Department Subdivision AUTUMNWOODS PH 2
d „ 1�.�� —1 Environmental health Division PIN# 460901083203
PO Box 389,25 Government Drive.Newton,NC 28658 LOT# 4
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Site Address: 1523 MARSHBROOKE LN, CATAWBA NC 28609
Name on Permit: LINDO EVERALD
Property Size: Acres 0.62
Directions: 150,left on Sherrills Ford, right on Long Island Rd, right on Eulalia Ln, onto Marshbrooke Ln,lot on corner of
Marshbrooke Ln&Conestoga Crossing
Improvement Permit
AN AUTHORIZATION TO CONSTRUCT MUST BE ISSUED PRIOR TO BUILDING PERMITS
THIS PERMIT IS NOT FOR SEPTIC INSTALLATION
Permit Category: New Septic Wastewater Flow 360 d
9.p.
Type of Facility: Primary Residence
Basement? No Basement Plumbing? No Bedrooms: 3
Water Supply: Private Well Maximum Occupants: 6
INITIAL SYSTEM SPECIFICATIONS
Proposed Wastewater System: DRIP IRRIGATION
System Classification: VA-SAND FILTER PRETREATMENT
Pump Required ***** Operator Required
REPAIR SYSTEM SPECIFICATIONS
Repair System Required? Required
Proposed Wastewater System: DRIP IRRIGATION
System Classification: VA-SAND FILTER PRETREATMENT
Pump Required ***** Operator Required
Permit Conditions: All parts of future system or repair must be minimum: 50'from any individual well, 10'from
property lines, 15'from ditch line at road, 10'from any water or utility lines, 10'from home
with a foundation drain, 5'from any decks or porches.
System will require a design submittal from a Professional Engineer prior to issuance of an
Authorization to Construct.
Any grading, driving, or filling of lot beyond light clearing of shrubs, small brush, and trees
over system or repair area will result in revocation of Improvement Permit.
;hprrwn 04127/2023 14.40