HomeMy WebLinkAboutEXSY-08-2023-202602.TIF AM IN.. CATAWBA COUNTY Case a EXSY-08-2023.202602
q..>_ Public Health Department Subdivision B L KISER
,� • Environmental Health Division PINX 4E31602553842
\ PO Box 389,25 Government Drive,Newton,NC 28658 LOT/ 33
Site Address: 4713 KISER ISLAND RD,TERRELL NC 28682
Name on Permit: KEVIN WILKINSON
Property Size: Acres 0.5
Directions: Hwy 150 from Lincointon to Kiser Island Rd in Terrell 4713
Owner/Authorized Representative Acknowledgement of Permit Receipt
ifi( t_ I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
1" the property described above.
,(,, ii_49 As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-10-2022-42606,by the following method(s):
_ Received in Person
_ Facsimile Transmittal(Return form with signature required)
LElectronic Image Transmittal/E-mail (Return receipt required)
dAs the property owner or authorized representative I have reviewed and understand the specific conditions
y,
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(1 SA 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:08/15/2023
4
Owner/Authorized Re U7 Representative Signature /�^
c( J p g
Date &I/ 3
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by -._. (name of person sending permit)
SignatureCl 'iE , Date/Time 5131/2 3
Method: Fax V Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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ehpenmi 011'23,2023 09:26
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catawba county
public health
EXISTING SEPTIC SYSTEM INSPECTION
NOT FOR LOAN APPROVAL
Case Number: RBPR-10-2022-42606 0 Reconnection to Existing System
Property Owner/Applicant: KEVIN WILKINSON ❑ Mobile Home Park Reconnection
Site Address: 4713 KISER ISLAND RD,TERRELL NC 28682 ' ® Applicant Request
Type of Facility: ® House ❑ Mobile Home Number of Bedrooms 3
❑ Business
❑Other
Proposed Addition/Accessory Structure: 1(1'X16'X1(1'
®Approved ❑Not Approved Reason
❑Approval Not Required/System Location Only
Evidence of System Malfunction ❑ YES ® NO System Type/Description IIIB 25%REDUCTION
Noncompliance Items and Notes
• Maintain 5 feet min.from any part of septic system with additions.
• No guarantee to the longevity of the existing system.
8/15/2023
Authorized State Agent46--/-64-"Date
catawbacountync.gov
Environmental Health
Catawba County Government Center
25 Government Drive 1 PO Box 389 1 Newton NC 28658 1 828.465.8270
MAKING. LIVING. BETTER.