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Home My WebLink AboutIP-02-2016-069507.TIF 13 CATAWBA COUNTY Case# IMPV-02-2016-069507 .C' n G Public Health Department Subdivision Jimmy L Moore and wife Sh ; �!g¢ su Environmental Health Division PIN# 374309150460 -y PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 LOF# 1 NAME ON PERMIT: JIMMY L. & SHIRLEY C. MOORE, 36 SULLIVAN POINT LN, TAYLORSVILLE NC 28681 Site Address: 4288 JAYOUNT FARM RD, CONOVER NC 28613 Property Size: Square Feet: 153,156.96 Acres:3.516 Directions: County Home Rd, County Home Dairy Rd, right Spring Hill Dr, left JA Yount Farm Rd, property in curve on right Owner/Authorized Representative Acknowledgement of Permit Receipt certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the /property described above. `F reques s the property owner or authorized representative, I have received the above referenced permit(s) as requested in the application for service EHPR-02-2016-23137 by the following method(s): JReceived in Person Facsimile Transmittal (Return form with signature required) Electronic Image Transmittal/ E-mail (Return receipt required) '{____ � the s the property owner or authorized representative I have reviewed and understand the specific conditions of 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 Al 2 (!,27.--e Date c/...125:./ )6 Documentation of Permit(s) Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name of person sending permit) Signature Date/Time Method: Fax Email US Mail Other Owner's request to send by the above indicated method of transmittal in lieu of signature We want to hear from you. Please take a few moments to complete our customer service survey at: http://www.surveymonkey.com/s/EHCustomerService ehpermit 02/24/2016 16:50 Page 3 of 3 s \ CATAWBA COUNTY 0 ; ti r 5 0 Casc# 1MPV-02-2016-069507 .fi�t Public Health Department kF r 131' Subdivision Jimmy L Moore and wife Sh 9 -.} PINK 374309150460 < ""`y "I Environmental Health Division �r 714'12. PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 'r - - } "' 41• -..n > LOT# 1 }ice A D I- ' ° . °'. NAME ON PERMIT: JIMMY L. & SHIRLEY C. MOORE, 36 SULLIVAN POINT LN, TAYLORSVILLE NC 28681 Site Address: 4288 JAYOUNT FARM RD, CONOVER NC 28613 Property Size: Square Feet: 153,156.96 Acres:3.515 Directions: County Home Rd, County Home Dairy Rd, right Spring Hill Dr, left JA Yount Farm Rd, property in curve on right Improvement Permit Facility: Primary Residence - house Permit Category: New Septic Bedrooms 5 WATER SUPPLY: Private Well Basement? Yes Basement Plumbing? Yes INITIAL SYSTEM SPECIFICATIONS Permit Valid: Expires In Five Years: _X_ No Expiration: Projected Daily Flow 600 g.p.d Proposed Wastewater System: 25% REDUCTION Type: 1IIG- OTHER NON-CONY TRENCH SYSTEMS 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. Steven Price 02/24/2016 AUTHORIZED STATE AGENT APPROVAL DATE Permit Expiration Date: 02/23/2021 No grading or construction activity is a//owed in areas designated for system and repair without approval of the Health Department. ehpermit 02/24/2016 16:50 Page 1 of 3 {,. g.r enR., �,w y'u�. •r ,-.4,is l.�a. ° .. . ar �.,n #..f 3FN:.�'w'FrL'S #15:1 .g:A`6 ' i"ta Q ' 1 t FHA( - e2- 2o14— 23137 '` 1 y2}18 1-A yer..4 'F..,. 104 e...c,.,,. '!R D• il• } Sea ae ' (..,.11 4. I , or cUU;vc OJ.- Sciatic SK.( 4 Pr• . sca J 1 Q SM�d.J:Sew , Li- IinCl S' Itia wn .n prof.3+-� °�a1 Ere "Ago. :n }it t• • •+ r.••4 4' be rcc.rcea pr:.,r it I rs.•■.n CC e c AC. Met C 91:1;t14:30' a . rip V 0 N �ti 3�5 tS 14t 8� ell f /r L sce1:c pr kr... Intk.. I.(t.141" t . ° 3 2S'!. 06.4. ` 6.16000\ .t PV L.FZ Yl4' f,P66 et ISo& 544°w Drrit... A .. P2 22.1S'Q Se2'u /�. " ` P3 2r5le 56S"W ` " 4 P4 zAil e S `16.1" „ I = S°i DEPARTMENT OF HEALTH AND HUMAN SERVICES (Qi2 o2-2olt.- 23!37 Sheet ! of ! DIVISION OF PUBLIC HEALTH,ENVIRONMENTAL HEALTH SECTION PROPERTY ID 1!: 130 f is°'No ON-SITE WATER PROTECTION BRANCH COUNTY: Co 4'4%1 SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM Ji� wt (Complete all fields is full) OWNER: _ APPLICATION DATE ADDRESS: DATE EVALUATED: PROPOSED FACILITY: 5 Or PROPOSED DESIGN FLOW(.1949): too PROPERTY SJ7.F: 3S nc LOCATION OF SITE: PROPERTY RECORDED: WATER SUPPLY: 0 Private ❑Public ,�{W.` ell ❑ Spring ❑Other ^ l� EVALUATION METHOD: ❑Auger Boring Pit ❑Cut TYPE OF WASTEWATER: XSewage ❑Industrial Process ❑Mixed • • . • • P R SOIL MORPHOLOGY OTHER . F (.1941) PROFILE FACTORS I .1940 LANDSCAPE HORIZON POSITION/ DEPTH .1942 PROFILE it SLOPE V. ON .1941 .1941 SOIL .1943 .1936 .1944 CLASS STRUCTURE! CONSISTENCE/ WETNESS/ SOIL SAPRO RESTR &LTAR TEXTURE MINERALOGY COLOR DEPTH CLASS HORIZ o - 7 ''Sgk/ a fit Sr Ps L5 7-3/ 56fc/ c F4 sir silk_ yL 4 "VA • 1 py.. 3f-4z "s6(!/ et ft se- _ 0`3 •b -S `ISO/ cc FL Se tv 4- 1S L.5 1-iv 5&( c ( t s6 wit 9 y 4,4- 2 39- Hy s'su-/ c Ff - B 0-4, L../ t.c L)e-t,14 FI 3e- Pr S 3 pt (2.,-.32 -'.3Z c6 C — Ft sr 0`3 32- 42. "s6(c C fi • e • o- 7 usEkc/ CI- FL 16- L5 7-zl SSE/ c fe 56 Al A- q2 ev+ ,✓,}- 975 i 4 (0% zJ-LI z tIssfc/ tL. uiisp AL se 0 ,3 DESCRIPTION ' INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): Available Space(.1945) 71 p� SITE CLASSIFICATION(.1948): P5 �l / EVALUATED BY:System Type(s) _ Zj°Z I 2S�b ta O'I'11LR(S PRE ENT: s `2 Site LTAR 0,3 0,3 COMMENTS: