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CATAWBA COUNTY Case/i OP-08-2023-203476
I. Public Health Department Subdivision ALEXANDER WOODS
it ' Environmental Health Division PIN# 461602583289
PO Box 389,25 Government Drive,Newton,NC 28658 LOTI'' 6
Site Address: 4459 KISER ISLAND RD,TERRELL NC 28682
Name on Permit: DAVID HARRELL
Property Size: Acres 1.62
Directions: Hwy 16 to Hwy 150 E to Kiser Island Rd
Operation Permit
Permit Category: New Septic Wastewater Flow: 480 g.p.d.
Type of Facility: Primary Residence-House
Basement? No Basement Plumbing? No Bedrooms: 4
Water Supply: Private Well Maximum Occupants: 8
System Type: IIIG-OTHER NON-CONV TRENCH SYSTEMS
Description: 25% REDUCTION
System Code: IQ4PS System Code Description: Infiltrator Quick 4 Plus Standard
Types V and VI systems expire in 5 years.
Owner must contact Environmental Health 6 months prior to expiration for permit renewal.
System Installation Comments: Septic Tank:GST-1000 STB-160 4/11
Per owner, David Harrell,old septic tank was abandoned, filled with dirt.
PERMIT CONDITIONS:
1.All maintenance, monitoring, &performance requirements shall be in accordance with 15 A NCAC 18.1900, Rule.1961
2.Operation&Maintenance Specifics:
Subsurface system operator required? Yes No_X_
This system has been installed in compliance with applicable NC General Statutes,Rules for Sewage Treatment and Disposal.
GERRITT HOWARD 3938 08/25/2023
System Installer Installation Date
A.4.4.4—e-,-- Z--- 4:e....4__
08/25/2023
Authorized State Agent Permit Issuance Date
Form F
eh pens i i I(UO3/2(123 15:25
07, of-(L 4000. 315 3
Catawba County Environmental Health TAN_ Zo23 _�sb 9 c I
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