Loading...
HomeMy WebLinkAboutHawksridge Farms 1 26 10.tif LK Evaluation North Carolina Department of Environment and Natural Resources ❑ Re- evaluation Division of Environmental Health (number) PREOCCUPANCY EVALUATION REPORT OF DRINKING WATER SUPPLY AND WASTEWATER FACILITIES FOR MIGRANT HOUSING On Scahu ar .2,6, - as required in G.S. 95- 225(c) and (d), an evaluation was conducted of the drinking water supply and ( wastewater system serving a migrant housing facility at it 29-3 S ka. / 7/t y (address or directions; t.M.6 reverse if needed) 7,x'6 and operated by A9' er© ote ` (name of person[sJ /company) of a e Fa (At T�i .gx 33 `x 9 '�l�ar , . a3 (mailing address) The housing is composed of units, served by / _ wells/springs and a_ sewage systems. (number) (number) (number) This report describes well /spring O _ and sewage system / . (Use reverse for a drawing, if needed.) (number) (number) The findings of this evaluation are as follows: WATER SUPPLY es Community or non- transient - non - community water system under routine surveillance of Public Water Supply ( es /no) Section, Division of Environmental Health /gyp Private Water or Non - Community System (yes /no) At the time of inspection, there W4_5 48,/ visual evidence of non - compliance with the "Protection of Water Supplies" (was /was not) 15A NCAC 18A .1700 (attach copy of bacteriological sample). List deficiencies which were identified: (Use reverse if necessary) WASTEWATER FACILITIES System 5 ii / e to approval under 15A NCAC 18A .1900, "Laws and Rules for Sewage Treatment and Disposal ( subject /not subject) Systems." Explain, if not subject to approval On -Site Septic Tank System ❑ Chemical Portable Toilets ❑ Others ❑ Privy(ies) At the time of inspection, there Wac3 visual evidence of non - compliance with 15A NCAC 18A .1900 (including (was /was not) .1962) "Laws and Rules for Sewage Treatment and Disposal System." List deficiencies which were identified: (Use reverse if necessary) The wastewater system, to the best of my knowledge and belief, is sized to serve G people. / // /� l / (maximum number) / ber // /� /`J '�{1a�/!�. (.ash ki/�s '� �l�Gt aQun / dc._1 Environmental ealth •ecialist Heelth Department 3/i/ J 38 9 1 , o Date `�^ / �' Address Forward copies to: Migrant Housing Operator fre� J�, C - Department of Labor, Bureau of Migrant Housing 1/-6 — �� .? L 6') v DENR 3765 (Revised 3/98) Office Phone Number On -Site Wastewater Section (Review 12/98) Purpose: General Statute 95 -225 requires the Commission for Health Services to adopt rules establishing the standards for sanitation and quality of water for migrant housing. It further requires that the collection, treatment, and disposal of sewage is to be in accordance with Article 11 of Chapter 130A of the North Carolina General Statutes and 15A NCAC 18A .1900, "Laws and Rules for Sewage Treatment and Disposal Systems." This form is developed to be used in making evaluations of water supplies and sewage disposal systems for migrant housing operators. Preparation: Local environmental health specialists shall complete the form each time they conduct an evaluation. Prepare an original and two copies for: 1. Original to be left with the responsible person. 2. Copy for the local health department. 3. Copy for the N.C. Department of Labor, Bureau of Migrant Housing. Disposition: This form may be destroyed in accordance with Standard 7, Inspection Records, of the Records Disposition Schedule published by the N.C. Division of Archives and History. Additional forms may be ordered from: On -Site Wastewater Section Division of Environmental Health P. O. Box 29594 Raleigh, NC 27626 -0594 (Courier 52- 01 -00) DENR 3765 (Revised 3198) On -Site Wastewater Section (Review 12/98) i Evaluation North Carolina Department of Environment and Natural Resources ❑ Re- evaluation Division of Environmental Health (number) PREOCCUPANCY EVALUATION REPORT OF DRINKING WATER SUPPLY AND WASTEWATER FACILITIES FOR MIGRANT HOUSING Onnpa./ a6 / �eia , as required in G.S. 95- 225(c) and (d), an evaluation was conducted of the drinking water supply and P ate) wastewater system serving a migrant housing facility at Li-.2L1-3 57 ,4f /z7 17/1.J 7 (address or direction (name se ,r4verse if needed) l7 pry ike 28"6 oz. and operated by , 'c h e of persons] /company) of fr .. '�. s - a s 0 00 d 33 - - d r /!i (m a iling address) The housing is composed of e units, served by 0 _ wells /springs and 2 sewage systems. (number) (number) (number) This report describes well /spring 7S _ and sewage system . . (Use reverse for a drawing, if needed.) (number) (number) The findings of this evaluation are as follows: WATER SUPPLY PS Community or non- transient- non - community water system under routine surveillance of Public Water Supply es /no) Section, Division of Environmental Health /yo Private Water or Non - Community System (yes /no) At the time of inspection, there G/Q.S /219 visual evidence of non - compliance with the "Protection of Water Supplies" (was /was not) 15A NCAC 18A .1700 (attach copy of bacteriological sample). List deficiencies which were identified: (Use reverse if necessary) WASTEWATER F ACILITIES System —CI eG/ to approval under 15A NCAC 18A .1900, "Laws and Rules for Sewage Treatment and Disposal (subje'bt /not subject) Systems." Explain, if not subject to approval y On -Site Septic Tank System ❑ Chemical Portable Toilets ❑ Others ❑ Privy(ies) At the time of inspection, there Was ila 7 visual evidence of non - compliance with 15A NCAC 18A .1900 (including (was /was not) .1962) "Laws and Rules for Sewage Treatment and Disposal System." List deficiencies which were identified: (Use reverse if necessary) The wastewater system, to the hest of my knowledge and belief, is sized to serve people. (maximum number) dehdA.-dr‘gee Ar'_ ; ear (44Yer4d4, Environmental Health pecialist H th Department 3////0 ? fi 6 `3f7 Date Address � Forward copies to: Migrant Housing Operator /(� � 4174JJ j /!� C v d Department of Labor, Bureau of Migrant Housing 6� G j r DENR 3765 (Revised 3/98) O/` b Office Phone Number On -Site Wastewater Section (Review 12/98) Purpose: General Statute 95 -225 requires the Commission for Health Services to adopt rules establishing the standards for sanitation and quality of water for migrant housing. It further requires that the collection, treatment, and disposal of sewage is to be in accordance with Article 11 of Chapter 130A of the North Carolina General Statutes and 15A NCAC 18A .1900, "Laws and Rules for Sewage Treatment and Disposal Systems." This form is developed to be used in making evaluations of water supplies and sewage disposal systems for migrant housing operators. Preparation: Local environmental health specialists shall complete the form each time they conduct an evaluation. Prepare an original and two copies for: 1. Original to be left with the responsible person. 2. Copy for the local health department. 3. Copy for the N.C. Department of Labor, Bureau of Migrant Housing. Disposition: This form may be destroyed in accordance with Standard 7, Inspection Records, of the Records Disposition Schedule published by the N.C. Division of Archives and History. Additional forms may be ordered from: On -Site Wastewater Section Division of Environmental Health P. O. Box 29594 Raleigh, NC 27626 -0594 (Courier 52- 01 -00) DENR 3765 (Revised 3/98) On -Site Wastewater Section (Review 12/98)