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HomeMy WebLinkAboutIMPV-05-2023-195144.tif �, =i CATAWBAl COUNTY Case# AtJTH-06-2023-197252 �. Public Health Deartment Subdivision CRESCENT LAND AND TIMBE • Environmental Health Division PIN# 462701058780 Akr. 1. PO Box 389,25 Government Drive,Newton,NC 28658 1.OTtt 42 Site Address: 3715 KINGFISHER LN,TERRELL NC 28682 Name on Permit *STROM CONSTRUCTION INC Property Size: Acres 0,76 Directions: E NC 150 Right Greenwood Rd Right Gordon Left Kingfisher 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. As the property owner or authorized representative,1 have received the above referenced permit(s)as requested in the application for service RBPR-05-2023-44220,by the following method(s): Received in Person Facsimile Transmittal (Return form with signature required) 7— 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:06/02/2023 Owner/Authorized Representative Signature Date Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by_ (name of person al sending permit) Signature Date/Time 123 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 yoiPlease ttake a few momentts tto complette our custtomer service survey att http://www.surveymonkey.com/s/EHCusttomerService Ch 5e slit Ale;Ask uefi.Ad;Ae. ehpennit 06/06/2023 10-21 '3 7/3- ifl•n1�,rht.t f^ ) County: Catawba IMPROVEMENI PERMIT FUR G.S.130A-33S(a2)/S12022-11 PIN/Lot Identifier Pin # 462701058780 Issued To. Kevin Goral Property location 3715 K_ingtisher Lane Terrell North Carolina 28682 Subdivision _ _ _-_-- --•-- :nt n 42 Block: Section 155 Report Provided: Yes IN No[j if yes name and license number of Lc!, Steven R. Cannon #1291 Now® Repair n Eapansrnn [, `,yawn R.Incanon Proposed Structure House Proposed Wastewater;vsrpm Type Vertical PPBPS ,i,nt,al) Vertical PPBPS (Repair, f ill System ❑Yes Nei II yes,specify [J New Existing (when adding more than 6 inches of fill to system area please provide a fill pianl Proposed Design Daily Flow 480 (WO Proposed I t rrt(Initial): .3 Proposed LIAR(Repair): .3____,, Design Wastewater Strength ®domestic 0 high strength ❑industrial process Number of bedrooms 4 Number or Occupants Other Pump Required. ®Yes ❑No ❑May be required based upon final Incahon and elevations of facilities Artificial Drainage Required Yes [MM. R yes,please Silerdy details type of Water Supply [g Private well (]Public well [_]Municipal Supply ❑Spring []Other ti Urainfield location rneets requirements of Rule 1945 Yes® No[] Drainfield location meets requirements of Ride 1960. Yes® No Permit valid for Five year.(site plan submitted pursuant to GS 130A•334(13a)) ❑No expiration(plat submitted pursuant to GS 130A-334(7a1) Permit conditions Licensed Soil Scientist Print Name Steven R. Cannon • Licensed Sod Scientist Signature �' fir_ �C1 1�1`'r "�- IT 4/3l2023 The US evaluation Is being submitted pursuant to and meets the requirements of G.S. 130A-33S(e2), 'See attached site sketch• 3715 Kingfisher Ln County: Catawba This Section for Local Health Department Use Only Initial submittal received: 5/1/23 by RP Date Initials Permit Number: (MPV-05-2023-195144 G.S. 130A-335(a4)states the following: 'If a local health department fails to act on an application for an improvement permit submitted pursuant to subsection(a3)of the section within 10 business days of receipt of a complete application, the local health department shall issue the improvement permit.' In accordance with G.5. 130A-335(a3)the improvement permit application is: ❑ Incomplete(If box is checked,information in this section is required.) The following items are missing: Copies of this were sent to the LSS and the Owner on Date State Authorized Agent: Date: ❑ Denied (See attached report.) Copies of this were sent to the LSS and the Owner on Date State Authorized Agent: Date: © Complete State Authorized Agent: Date of Issuance: 5/8/23 This Improvement Permit is issued pursuant to G.S. 130A-335(a2), (a3),and (a4)using the signed and sealed LSS/LG evaluation(s) attached here. The issuance of this permit by the Health Department in no way guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This site is subject to revocation if the site plan,plat,or the intended use changes,or if information submitted in the application was falsified, inaccurate or misleading. The Improvement Permit shall not be affected by a change in ownership of the site. This permit is subject to compliance with the provisions of the Laws and Rules for Sewage Treatment and Disposal and to conditions of this permit. The location and identification of all property lines,easements,water lines,and other appropriate utilities shall be the responsibility of the owner. The Department,the Department's authorized agents,and the local health departments shall be discharged and released from any liabilities,duties,and responsibilities imposed by statute or in common law from any claim arising out of or attributed to evaluations,submittals,or actions from a licensed soil scientist or licensed geologist pursuant to GS 130A-335(a2). Improvement Permit Expiration Date: 5/8/28 *See attached site sketch*