HomeMy WebLinkAboutIMPV-06-2023-198436.TIF I
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4.4e CATAWBA COUNTY
• f.a Public Health Department Subdivision
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ut , y Environmental Health Division PIN# 369702688080
PO Box 389,25 Government Drive,Newton,NC 28658 LOT#
Site Address: 6711 INGLESIDE DR, SHERRILLS FORD NC 28673
Name on Permit: SHELLY'WRIGHT
Property Size: Acres 4.46
Directions: Hwy 150 to Little Mountain Rd to Ingleside Dr
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, I have received the above referenced
permit(s)as requested in the application for service RBPR-03-2023-43745,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
4 Electronic Image Transmittal/E-mail (Return receipt required)
'i( _ As the property owner or authorized representative I have reviewed and understand the specific conditions
11�� 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:08/08/2023
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 Date/Time cl I 4 t 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 yotPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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Parcel: 369702688080, 6711 INGLESIDE DR 1in=100ft
SHERRILLS FORD, 28673
This maphepart product was prepared from the Catawba snityy,NC m,kro .�on Services. Catawba County has made substantial efforts
to ensue the amrreoy of tocaton and y irdorm lion col k ed on this map or dela on this report Catawba County promotes and recommends
the independent verliwtlon of any del dela oorhdned on this ma�►r tmep product by the user.The County of Catawba,itsemployees,agents,and
personnel,disdakn,end shall not be held table for any and a1 daee,loss or iabtity,whetter direct,I dired or consequential vihich arises or may
arise from this nhaphaport product or the use thereof by any person or may. 1
Copyright 2023 Catawba County NC
08108R023
.DEPARTMENT OF HEALTH AND HUMAN SERVICES greet L of-
DIVISION OF PUBLIC HEALTH,ENVIRONMENTAL HEALTH SECTION PROPERTY ID#:
ON-SITE WATER PROTECTION BRANCH ,/3 7/ COUNTY: Catawba
SOIL/SITE EVALUATION r ZJ
for ON-SITE WASTEWATER SYSTEM
(Complete all fields in full)
OWNER: ait Wets I`4 - APPLICATION DATE
ADDRESS: DATE EVALUATED: 3 'z.-3
PROPOSED FACILITY: 2 dr PROPOSED DESIGN FLOW(.1949): 2'fo PROPERTY SIZE:
LOCATION OF SITE: L 7t l l A3 1.s.:.1c Dr PROPERTY RECORDED:
WATER SUPPLY: ❑Private ❑Public ErWedl 0 Spring ❑Other
EVALUATION METHOD: ❑Auer Boring (}Pit 0 Cut TYPE OF WASTEWATER 0 ❑Inauatria Process ❑ k.
o SOIL MORPHOLOGY OTHER
it (.041) PROFILE FACTORS
1 J540
L s LArringempg HORIZON
PORTION/ 1lItR1B .1942 lROIR,E
k SLOPE ND (11‘) .041 .1541 SOIL .1943 .19t .1944 CLASS
STLRTJCRIR1rJ CONSISTENCE/ WETNESS) SOIL SAPEO RESTR <AR
TEX'IZJRE MINERALOGY COLOR DEPTH CLASS HOER
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4
DE9(7l nON INITIAL SYSTDA REPAIR SYSTEM OTHER FACTORS(1946):
SITE CLASSIFICATION(_1948): /�•
Available Space(.I945) P s 1s
Syaem T'pe(s) _ ' EVALUATED BY: � (�
OTHER(S)PRESENT:
Site LTAR p.2c a t r
COMMENTS:
Updated February 2014
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Parcel:369702688080, 6711 INGLESIDE DR tin=100ft
SHERRILLS FORD, 28673
This maplYepart product was prepared from the Catawba i dy,NC Information Services. Caleb'County has made substantial efforts
to ensure the accuracy of location and infonnjYon oorfairrod on this nap or dam on this report Catawba rmy promotes and recommends
the independent ve.Medion of fry dates=Mined en this mapirsport product by the user.The County of Catawba,is employes,nerds,and
per'aerm..&dim and alai not be hold Metes for any and el demapse,loss or isbity,whether eCror direct.indirect or consequential velloh arises or may
aria boon lie nnepltaport product or the use thereof by any person or entity.
Copyright 2023 Catawba County NC
06/20/2023