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CONSTRUCTION For Office Use Only
AUTHORIZATION *CDP File Number 3 5 a l l
Catawba County Public Health Department County ID Number: WLS2009-00694
Environmental Health Division
Evaluated For: REPAI%-f
P.O Box 389, 100-A Southwest Blvd
PERMIT VALID UNTIL: ~,SUZ
Newton NC 28658 1 1/ 0 1/.1 0 1 4
Phone: (828)-465-8270 Fax: (828) 465-8276
Applicant: JACK DEVLIN Property Owner: CHRISTINE DEVLIN (i
Address: PO BOX 158 Address: 3936 E NC 10 HWY
City: CLAREMONT City: CLAREMONT
Statefzip: NC 28610 State/Zip: NC 28610-7430
Phone Phone
Property Location & Site Information
Address/Road Subdivision: Phase: Lot:
3936ENC10HWY
CLAREMONT NC Directions
Structure: SINGLE FAMILY HWY 10 E - 1 MILE ON LEFT AFTER WITHERSPOON
CROSSROADS - AT WHITE BLOCK BUILDING ON
# of Bedrooms: 3 LEFT IT IS THE BRICK HOUSE ADJACENT TO
# of People: 1 BUILDING
*Water Supply: PUBLIC
stem eci ica ions
Minimum Trench Depth:
Inches
*Site Classification: PS Minimum Soil Cover:
Inches
Design Flow: Maximum Trench Depth:
Inches
Soil Application Rate: Maximum Soil Cover:
u Inches
*System Classification/Description: *Distribution Type: GRAVITY
TYPE III G. OTHER NON-CONY. TRENCH SYSTEMS
Septic Tank: 1 0 0 0 Gallons
*Proposed System: OTHER 1-Piece: OYes /No
Nitrification Field Pump Required: 0Yes ONo O May Be Required
Sq. ft. Pump Tank: Gallons
No. Drain Lines
1-Piece:OYes ONo
Total Trench Length:
ft. GPM--vs-- ft. TDH
Trench Spacing: Inches O.C.
- OFeet O.C. Dosing Volume: _ Gallons
Trench Width: Olnches
O Feet
Aggregate Depth: Grease Trap: Gallons
inches Pre-Treatment: O NSF OTS-I OTS-II
Septic Tank Installer Grade Level Required: 01 011 0111 ON
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CDP File Number 35211 WLS2009-00694
County ID Number:
❑ Open Pump System Sheet
Repair System Required:OYes /No ONo, but has Available Space
Repair System
Trench Spacing: 0Inches O.C.
(Design Site Classification: - O Feet O.C.
Flow**** 15A N CAC 18Ah w1thI945 8Fe tes
Soil Application Rate: Aggregate Depth inches
u Minimum
TreJl74[~ ~n itch Depth: Inches
*System ClassifcationlDescriplKtie;l~ pa ir Area ~till~J p~ Inches
Maximum Trench Depth:
*Proposed System: Inches
Maximum Soil Cover:
Nitrification Field Inches
N Sq. ft.
No. Drain Lines *Distribution Type:
Total Trench Length: ft Pump Required: OYes ONo OMay Be Required
.
Pre-Treatment: O NSF OTS-I OTS-11
*Site Modifications
No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department.
*Permit Conditions
The issuance of this permit by the Health Department in no way guarantees the issuance of other permits. The permit holder
is responsible for checking with appropriate governing bodies in meeting their requirements.
Permit is to replace septic tank only.
Replace septic tank and plumb into existing drain field. When work is complete an inspection is required by Environmental Health.
This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit, not
to exceed five years, and maybe issued at the same time the Improvement Permit issued (NCGS 130A-336(b)). If the installation has not been
completed during the period of validity of the Construction Permit, the Information submitted in the application for a permit or Construction
Authorization is found to have been incorrect, falsified or changed, orthe site is altered, the permit or Construction Authorization shall become
invalid, and may be suspended or revoked (.1937(8)). The person owning or controlling the system shall be responsible for assuring compliance
with the laws, rules, and permit conditions regarding system location, installation, operation, maintenance, monitoring, reporting and repair
(1938(b)).
Applicant/Legal Reps. Signature Required? OYes ONO
Applicant/Legal Reps. Signature. ~r Date:
*Issued By: 1896 - Lucas sear Date of Issue: 1 1 0 1 a 0 0 9
Authorized State Agent: Malfunction Log OYes
t•
OHand Drawing *Import Drawing TotalTime:(HH:MM)
**Site Plan/Drawing attached.** 0
Hours Minutes
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CDP File Number: 35211 County File Number: WLS2009-00694
Drawing Type: Construction Authorization Date:
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