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HomeMy WebLinkAboutEXSY-10-2023-206139.TIF • CATAWBA COUNTY Case# EXSY-10-2023-206139 Public Health Department Subdivision ISLAND FORD PARK Environmental Health Division PIN 377303342673 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 5 w Site Address: 4141 PIPER CUB DR, CLAREMONT NC 28610 Name on Permit: *REPRISE CONSTRUCTION SERVICES LLC Property Size: Acres 0.79 Directions: Northwest Blvd, US 70 E/Conover Blvd/Rock Barn Rd NE/left Centennial Blvd in Claremont/continue on State Rd 1716 to Marvin St/Bart Lee St/Piper Cub Dr/on corner Owner/Authorized Representative Acknowledgement of Permit Receipt I certify that 1 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-09-2023-45533,by the following method(s): Received in Person �7 Facsimile Transmittal (Return form with signature required) J Electronic Image Transmittal/E-mail (Return receipt required) f 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: 10/06/2023 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 __ Clie Date/Time 101 4 Method: Fax j 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 complete our custtomer service survey att http://www.surveymonkey.com/s/EHCusttomerService 5Dr)fti riti za k e 6 ntiii.P. fcm Chpemut 10/06/2023 15:02 MV\ (r. ) catawba county public health EXISTING SEPTIC SYSTEM INSPECTION NOT FOR LOAN APPROVAL Case Number:RBPR-09-2023-45533 N Reconnection to Existing System Property Owner/Applicant:CHESTER KURZAK ❑ Mobile Home Park Reconnection Site Address: 4141 PIPER CUB DR,CLAREMONT ❑Applicant Request Type of Facility: ❑ House N Mobile Home Number of Bedrooms 3 ❑ Business ❑Other Proposed Addition/Accessory Structure: N Approved ❑Not Approved Reason ❑Approval Not Required/System Location Only Evidence of System Malfunction ❑YES N NO System Type/Description GRAVEL BED 15FT X 72FT Noncompliance items and Notes *ANY FOUNDATION INCLUDING DECK MUST BE 5FT MIN FROM ANY PART OF SEPTIC *SYSTEM WAS NOT FAILING AT TIME OF INSPECTION *DO NOT GRADE, DRIVE OR FILL OVER SYSTEM AREA Authorized State Agent DEAN EVANS Date 10/6/2023 Existing System Inspections expire 1 year from approval date catawbacountync.gov Environmental Health Catawba County Government Center 25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270 MAKING. LIVING. BETTER. • Catawba County Environmental Health ----PIZ-PR"' { - ©1ti - LIsl3 25 FXSY aDa • BART LEE ST 170.23 36. 6 Y3' so ■ N a4141691 � a Verne S < l) C afs' o rc-1 Dr;vc- ■ 200 e// Parcel: 377303342673,4141 PIPER CUB DR 1 in=40ft CLAREMONT,28610 This mapiieport product was prepared tarn to Catawba •-NC Geoepalial Information Services. Catawba County has made substantial efforts b ensure the= aw of louden and HOrMidion aort~Yrod an CYs map or data on this report Catawba County promotes and recommends the Independent verification of wry dad mAalflad an this maigroport prods t by the user.The County of Catawba,its employees,agents,and Personnel.dlsdekn.end Shill not be held Blibilikir rile/ d damages. bir or Dety,whether direct,Indirect or consequential which anses or may arise from thh map/report product or the use Owed by Copyright 2023 Catawba County NC 10/06/2023