HomeMy WebLinkAboutWELL-08-2023-201737.TIF Case 1 WEL,1:08-2023-201737
Subdivision VALLEY VIEW PARK SECTIOI
Y CATAIIOrICOUNTI' PI Nil 372114421641
't1 4 Public Health Depot-Omni 15
/ n I.U"I'N
if ���yw Environmental Health Qiviuln� .vton,NC' 28G39
l EV' PO Box 389,25 Government Drive•Nc
�GLV
Site Address:
1968 CRESTDALE LN,NEWTON NC 28658
Name on Permit: DONALD ROBINSON
Propem,she; Acres 0.47 Directions: StaRown,turn right on Valley View across from Trivlum, left on Crestdale, 2nd house on the right
ve Acknowledgement of Permit Receipt
Owner/Authorized Representati
��l''�I ce;tifY that 1 am the owner or authorized agent(owner's authorization required)representing the owner of
�( _
(� them pro rty described above.
F Ohe property owner or authorized representative, 1 have received the above referenced
permit(s)as requested in the application for service EHPR-06-2023-44574, by the following method(s):
_ Received in Person
Facsimile Transmittal (Return form with signature required)
1 Electronic Image Transmittal/E-mail (Return receipt required)
0 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 (I5A 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:OB/03/2023 — �_,
Owner/Authorized Representative Signature `" P _
.,----r Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
IC\e
Signature _ Date/Time_ 0 II S 1)3
Method: Fax Email US Muil 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/EHCusttomer5ervice
.k.Orid +i n .ct(aQof, Can .
(219
�1 hcr,,n O8/04202:1 08:45
8/17/23, 12:47 PM about:blank
WPDT Screening Report
O.„,
Area of Interest (AOI) Information
Area : 3,134,508.59 ft2
Aug 17 2023 12:47:06 Eastern Daylight Time
,----7 ..___..._______________ f--r-
,V-` .N..,,,.
\\ ----
r'
___. _
,, _______-_,
, ______ ____-\\
, ,, 1
I�
`
�� ! G r- -- 1I 1
r
„.,
,,,
_____,
+!
i r
r
, ,,
1 '-______./
___________
.-,-=----.-
„.. /.__„_ --- 5"s7- . ...'. \\:-.1.'''''' ''.
1-4,514
0 0 03 0 06 0 12 mi
Parcels(Polygons)- Parcels l 1 ti ti ti ti ti ', I,
r--i 0 0.06 0.1 0.2 km
L__J County Boundary
Non-System Roads
n NCrwam.DG7 G15 Unu..iwrcea.Ent A. .DS,USGS.NGA,NASA.CGiAA.N
— Non-System Stem Rar NC: NI EAS S(,N NIAA.Gondommryrawn.fey:aaoearnagl GSAy Go:N-d,FCIlA,rry ra,y:rW box GIS tar curlm-14,Csr.Cm.nwniN
Maa Ccna•buwn Stow d Nati Caaw DOT c. GCenStreeU,wp
— Secondary Route
about:blank 1/2
8/17/23, 12:47 PM about:blank
1968 Crestdale Ln
All North Carolina Department of Environmental Quality
(NCDEQ)GIS data Is expressly provided'AS IS'and'WITH ALL FAULTS".The NCDEQ
makes no warranty of any kind,express or implied,concerning this information,
including but not limited to any warranties of merchantability or witness for
any particular purpose.The NCDEQ assumes no responsibility or legal liability
concerning the Data's accuracy,reliability,completeness,timeliness,or
usefulness.The data Is not Intended to constitute advice nor Is it to be used
as a substitute for specific advice from a professional.Users should not act
(or refrain from acting)based upon information In the Data without
independently verifying the information and obtaining any necessary
professional advice.Users are solely responsible for ensuring the accuracy,
currency and other qualities of any products derived from or in connection with
the NCDEQ's Data.The Data is collected from various sources and may be
modified over time without notice to improve spatial and attribute accuracy.
The NCDEQ disclaims responsibility for the spatial accuracy and attribution of
GIS features and makes no warranty concerning same.
about:blank 2/2
A