HomeMy WebLinkAboutEXSY-10-2023-207225.TIF DigiSign Verified-d67flede-e380-4a86-bb8c-dbc700229d27
o y. CATAWBA COUNTY .___
�� Public Health Department Subdivision KISER SUNSET KEYS 1
S{., . ,s Environmental Health Division PINK 461604721757
�\/0 PO Box 389,25 Government Drive,Newton,NC 28658 LOTh 38
Site Address: 5006 KISER ISLAND RD,TERRELL NC 28682
Name on Permit: SAMUELAND KIMBERLY YOUNG
Property Size: Acres 0.48
Directions: Kiser Island Rd on Left past Harbor Cir
Owner/Authorized Representative Acknowledgement of Permit Receipt
VI certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
HYAs the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-08-2023-45234,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
1 Electronic Image Transmittal/E-mail (Return receipt required)
kyAs 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(I5A 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: 10/26/2023
Owner/Authorized Representative Signature__fuh,i
Date 11/13/2023
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature it Date/'Time ii/1/)3
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 complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerservice
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5006 KISER ISLAND RD, TERRELL NC_ CONDITIONS MUST BE INSTALLED BY A LICENSED
SECTION 1, LOT 38 KISER SUNSET KEYS SEPTIC INSTALLER. DRAINFIELD AREA MUST MAINTAIN
NATURAL CONTOURS& SLOPE. IMPROPER OR
EXISTING 3-BEDROOM GRAVITY CONVENTIONAL EXCESSIVE GRADING WILL VOID THIS DESIGN AND
LTAR- BOSS IS NOT LIABLE.
0%REDUCTION
1 BEDROOM TS1 PRETREATMENT DRIP REPAIR
800 SOFTLIU
LTAR 0.15
FOR GENERAL USE NOT A SURVEY 1
PRELIMINARY NOT FOR CONSTRUCTION
NOTES: p`k•NP
-SOIL NOTES PROVIDED BY MIRANDA STAMPEROt
INFORMATION FOR THE INSTALLER
-ONCE EXISTING WELL HAS BEEN PROPERLY
•
ABANDONED CRUSH AND FILL EXISTING SEPTIC TANK,
THEN REPLACE WITH NEW 1000 GAL SEPTIC TANK. — __----
TANK MUST BE 10' FROM PROPOSED HOUSE AND 15 j�
FROM PROPOSED POOL —
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ailiViINITIAL LINE it/
REPAIR LINE
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REMOVE LINE ft'
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PLO:38
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SCALE: •1.3 /
l" = 50 ft. KISER
LOT 38
BOSS blA d Outdmir frrMpss/i * 5006 KISER ISLAND,
MO�,., ,, „a I,,m�K,,,,, "Wiens* KIMBERLY YOUNG TERRELL,NC
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