HomeMy WebLinkAboutIMPV-02-2016-069482.TIF .?A..111.1-^$' , CATAWBA COUNTY Case N
Public Health Department Subdivision
< '=" "1 Environmental Health Division PIN# 377004805204
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PO Box 389. 100-A Southwest Blvd, Newton.NC 28658 LO"I'N 7
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NAME ON PERMIT: HAROLD FULLER, 23 PINECREST DR, FORESTDALE MA 02644
Site Address: 1219 SHILOH RD, CLAREMONT NC 28610
Property Size: Square Feet:435,600.00 Acres:10
Directions: 16 South/left onto Buffalo Shoals Rd/past Bandy's High School/left onto Shiloh/left on Right of Way past
house (brick on left) Lot on left
Owner/Authorized Representative Acknowledgement of Permit Receipt
T I certify that I 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-12-2015-22818 by the following method(s):
_ Received in Person
UFacsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/ E-mail (Return receipt required)
4, 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: 02/24/2016
� Owner/Authorized Representative Signature
Date
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted y •,r I t . - n\ (name of person sending permit)
Signature , �L�,MJ ;,1I /lL� Dater fime7_ Pelt iu OD
Method: Fax ,/Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
mi ES\ 'lCn@kei11a- n��il�° 4_�
We want to ear fr you. Please take a few mo ents to complete our customer service survey at:
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ehpennit 02/24/2016 08:34 Page 4 ui4
•g• CATAWBA El 7.1 . 0 Case# 1MPV-02-2016-069482
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iT Ilitilik Z Public Health Department r• ••.`••. e Subdivision
4 �1 •`r Environmental Health Division s '-c .• •r '1. PIN# 377004805204
w4- PO Box 389, 100-A Southwest Blvd,Newton. NC 28658 �
/842 ,• _ �k �-- itioA LOT# 7
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NAME ON PERMIT: HAROLD FULLER, 23 PINECREST DR, FORESTDALE MA 02644
Site Address: 1219 SHILOH RD, CLAREMONT NC 28610
Property Size: Square Feet:435,600.00 Acres:10
Directions: 16 South/left onto Buffalo Shoals Rd/past Bandy's High School/left onto Shiloh/left on Right of Way past
house (brick on left) Lot on left
Improvement Peinnt
Facility: Primary Residence
Permit Category: New Septic Bedrooms 3
WATER SUPPLY: Private Well
Basement? Yes Basement Plumbing? No
INITIAL SYSTEM SPECIFICATIONS
Permit Valid: Expires In Five Years: _X_ No Expiration:
Projected Daily Flow 360 g.p.d
Proposed Wastewater System: 25% REDUCTION
Type: IIIG - OTHER NON-CONY TRENCH SYSTEMS
Permit Conditions: See AC for permit conditions
REPAIR SYSTEM SPECIFICATIONS
Repair System Required? Required
Proposed Wastewater System: 25% REDUCTION
Type: IIIG -OTHER NON-CONY TRENCH SYSTEMS
Landscaping or other site alterations that potentially divert groundwater or surface water toward the septic system, or prevent proper
drainage away from the septic system, including the direction of gutter flows or foundation drains, is not approved, and may result in failure to
approve the initial system installation, or the suspension/revocation of existing permits,
The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of
the applicant/property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are met.
This Improvement Permit is subject to revocation if the site plan,plat or the intended use changes,or if site conditions are altered.
The Improvement Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the
provisions of the North Carolina 'Laws and Rules for Sewage Treatment and Disposal Systems' (15A NCAC 18A.1900). Neither
Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function
satisfactorily for any given period of time.
Jason Boyd 02/24/2016
AUTHORIZED STATE AGENT APPROVAL DATE
02/23/2021
Permit Expiration Date:
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
ehpermit 02/24/2016 08:35 Page I of 3
A Permit# RBPR-12-15-22818
CATAWBA COUNTY
G Name Harold Fuller
•
n 2 Public Health l Health Di Address 1219 Shiloh Rd Claremont NC
Environmental Health Division
PO Box 389, 100A Southwest Blvd, Newton NC 28658 PIN# 377004805204 _
842 sw (828)465-8270 Fax (828)465-8276 TDD(828)465-8200
Site Plan Authorization to Construct
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,.. PO Box 389.10u.A Southwest Blvd 'Centon. r 2s6ti Sect/Bt./Ph/Lot# 7
'- 165 51.;0 FAX 46- 3� t
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Applicant/Owner HAROLD R R KAREN L FULLER
Site Address: 1219 SHILOH RD CLAREMONT NC
Property Size: SF 10 ACMES
Directions: HW Y 165/LET ON BUFFALO SHOALS PD/GO PAST BANDYS CROSSROADS/ LFT ON SHILOI-V LFT ON RIGHT
OF WAY/NEW BRICK HOUSE ON LET/NEXT LOT ON LFT
Imorovement Permit
Permit Valid For: Five years No Expiration
Facility(Residential): House Q
House N Nubile Ilene Multi-Family_ Bedrooms 4 New? A_ Addition?
Projected Daily Flow Iygd g.p.d Water Supp'y Private Weil? x Public? Semi-Public?
Basement: Y Basement PIuinhiuu:__:;; :tooth,/Spo: N Special Futures(exphtinj.
Proposed Wastewater System: __COATI! -81_5.-. Type; ___c-/H
Proposed Repair
Permit Conditions:
Owner or Legal Representative Signature: Date:
Authorized State Agent: 'Z- S Date: �Jp(,l aODE
The iSSLIaUce of ibis permit by dm Ife:dth Dep/rinu:nt e!:.cs no:ip::c■uce the issuance N other permits. 11 is the responsibility of the applicant/property
owner to insure that;tit Catawba Counts'Planning/Yon::. :,ind It::tlding Inspections requirements are met_ This Improvement Permit is subject to
revocation if the site plan,plot or the intended use N:.nges. wt if site conditions are altered. 'The Improvement Permit is not affected by a
change in ownership of the property. This perulil • .�.iccw-d in rompliaince with the provisions or the North Carolina 'Laws and Rules fur
Sewage Treu7menr and Dispnsd jlyrmrts' '(15A _yCsv l: 1S,A .I'utti. Neither Canawba County nor the Environmental health Specialist warrants
that the septic rank system will cnntinuc to fuuctinu,.::nrfaci..r::y for any given period of time.
Authorization to Construct Wastewater System (Required for Building Permit)
" See site plan and additional nrnc/mteruv
Proposed Wastewater System: Type: Wastewater Flow g.p.d
New Repair Expansion Soil LTAR: g.p.d./ft2
Type of Facility:
Basement: •Y Ihn-einent ltiamuine: H Hon•WSp::: N _ Special Fixtures(e).plain):
Wirslowr System Requirements
Tank Size: Septic Tank gal Pump Tank _ gal Grease Trap gal
Drainfield: Total Area: _ sq ft Total L onrtl It Maximum Trench Depth in
Trench Width It Mttnh:..:rn Cover Minimum Trench Separation It
Distribution: Distribution Box Scri�117C•r Triulion Pressure Manifold LPP Other -
Additional Specifications:
Authorized State Agent: Date:
Permit Expiration Dale:
/have read e itd accept tilt.gtrcificmio!c and of! r.'r!: c r/this puma;GS indicated.
•
Owner or Legal Representative Signature: —I; �� .. Date: / (— /4: " c)t0 Farm 13
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E,'ircunrawl Ilualib li iori Subdivision
• PO Box"389.IOV-\S of Blvd.Neu'cu_ _ Seutq;tJPh/Lot#
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1.82S...165-S270 FAX- M)J 4 7n 1 D' .. ) I'1N' 377004805204
Applicant/Owner HAROLD R & KAR:ii: FUI_
Site Address: 1212 S'HILOH ND C :-P,, -'F NC
Property s SF
Directions: HWY 18S/LFT ON Eii. ji,Lo : ':DAL S ED/GO PAST BANDYS CROSSROADS/LFT ON SHILOH/LFT ON
RIGHT OF WAY/ NEV F CK 'USE ON LFT/ NEXT LOT ON LFT
Improvement Permit C t.+tiuu To Construct \\'ett Permit
SITE PLAN
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Scale
System components represent approximate cori:oi. :'nly, The contractor must flag the system prior to beginning the
installation to ensure that proper grade is main!aic; i'to not instali system under wet conditions. This permit is subject of
revocation if the site plan or site conditions art
Net tJ 8-,2°-off
Authorized Slate Agent Date
Form C
t cs a004- 0169/
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DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES Sheet I of/
DIVISION OF ENVIRONMFNCAL HEALTH PROPERTY ID
• ON-SITE WASTEWATER SECTION COUNTYf.c)wj,o
SOIL/SITE EVALUATION
for ON-SITE WASTEWATER SYSTEM
OWNER: K+9-2r) cm CL.62 APPLICATION DATE
ADDRESS: IQ1 9 Silt an/ cll. Gccs2£zoiW N.0 a-fl/D DATE EVALUATED: II-R-o6
PROPOSED FACILITY: Mo.c51 PROPOSED DESIGN FLOW(.1949): giro PROPERTY SIZE: ID.a° .9ceaTS
LOCATION OF SITE: 1?.!9 Ss, OM, 2bS4 PROPERTY RECORDED:
WATER SUPPLY: I Private U Public U Well 0 Spring 0 Other
EVALUATION METHOD: 0 Augcr goring ! Pit 0 Cut
TYPE OF WASTEWATER: ! Sewage 0 Industrial Process 0 Mixed
SOIL'MORPILOLOGY OTHER
P . ..:; .. (194pH....... PROFILE FACTORS
WM" HO121 j •1942 ...E : ..
SCAPE 7AM1 1911. :: 1941 SOIL 194] 1956 1944.
a {O�!. DF-PTH STLtUC.TURF.) CONSIST ET.CFJ'' WETNESSI SOtf. SAPRO PROFILE;
POSIT RE$TR
-- :::SLOPE:/S lw)' TEXTURE°; MINERALOGY._ COLOR DEPTH CLASS
_ ... .. .. ........ .. . ........... .... - GLASS HORI9
0- g PC1 ti/c 41
1 32-vF 5647s ciSao Ix" /star N/A- Lice„ Wt
-570 siirme Aktsas SAP
- J
-7- D S P�ow`tir
2 / &1k Sao/S't G Fey/sy S
3.1---wt �? t/c4 4p Pei �s' • .AJ/A 48` N/A
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3 / 3 S`(75; (Ai) ' . e-Xr N/A- 48” S r]//.r <
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DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946):
SITE CLASSIFICATION(.1948): .t4 /Tn-OW
Available Space(.1945) s
System Types) EVALUATED BY: 6r— 4 oo
eS
Cou' C.0.VV. OTHER(S)PRESENT:
Site LTAR 3 .�
COMMENTS:
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LEGEND
use the following standard abbreviations
SOIL CONVENTIONAL LPP MINERALOGY/
) LANDSCAPE POSITION GROUP TEXTURE .1955 LTAR• .I9S1 LTAR• CONSISTENCE, STRUCTURE
CC(Concave Slope) I S(Sand) 1.2-0.8 0.6-0.4 NEC?(Nn-es7 vssive) G(Single Grain)
CV(Canvas Slope) IS(l namy Sand) SEXP(Slightly Expansive) M(Massive)
D(Drainage Way) EXP(Expansive) CR(Carob)
DS(Debris Slump) II SL(Sandy Loam) 0.8-0.6 0.4-0.3 GR(Granular)
FP(Flood Plain) L(Loam) . SRK(Subangu)ar Blowy)
FS(Foot Slope) ARK(Angular Blocky)
H(Had Slope) IA . SCE-(Sandy Clay Loam) 0.6-03 03-0A5 PL(Platy)
L(Lied=Slope) SW(Silt Loam) • PR(Prismatic)
N(Nose Slope) CL(Clay Loam)
R(Ridge) SiCL(Silly CLy Love) MOIST WET
S(Shoulder Slope) Si(Sill)
T(Tense) VFR Way FriableI NS(Norpoickyl
TV SC(Sandy Clay) 0,4-0.1 0.2.0.05 PA(FtiaUel SS IStiahly Sdc*y)
SiC(Silty Clay) Fl(Finn) S(Sticky)
C(Clay) VET IV cry Firm v.Very Stick y) VS NaySCkky)
0(Organic) Norm EFT(Extremely Fore) NP(Naopl®k)
SP(Slialuly Plank)
•Ad)ust LTAR doe to depth,consistence,st meta rc,Soil wet ant,landscape,position.wastewater flow and quality. P(Plastic)
NOTES VP(Very Plot)
HORIZON DEPTH In inches below natural soil surface
DEPTH OF FILL In inches from had surface
RESTRICTIVE HORIZON Thickness and depth from land surface
S(PROLITE S(suitablc)at U(unsuitable)
SOY.WETNESS Lncdss from hand surface to 0¢water or inches from land surface to soil colors with aroma 2 or loss-record MutscB color chip designation
CLASSIFICATION S(Suitable),PS(Provisionally Suitable),or U(Unsuitable)
Evaluation of sepiolte sha0 be b pits.
Long-term Acceptance Rate(L P •):gal/day/Rs
Show pro Ede locations sad other site features(dimensions,reference or benchmark.and North).
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DENR(4444/01)
Review(444441)