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HomeMy WebLinkAboutRBPR-03-2016-23355.TIF ¶1 ,Postal Etaactogp CERTIFIED MAIL,. RECEIPT ' 1 fit E , (Domestie( �gmQCovera•e Provided 2),;', ° (F,o;tleliveryjli ifformation;iis�itt (�ebsite atiww� llsps.coms MI mg O U F O C O A L U S E r Mark IPa tlge sEnv.Health NICKp� cedr:-. ! IVED i- ° Return Receipt Fee ! Z..° (Endorsement Required) ° Restricted DellWge IOU..N 1 ° (Endorsementt Required) -.1 fll RS COUNTY Y e � / 60 -•9% Total Pasc N mi FNVIRONM , - ' I.' •-0---'t •-23355 nO Sent To Mark-Tngle ° Ingle-Builders ° Sfreef.Apt.No.; r. or PO Box Na. City,State.ZIP.a 1-10-East--Main-St I,incolnton, C 28092 PS Form 3800.QEMECI13 0331;2123103m7CZOBSOM, Certified Mail Provides: o A mailing receipt o A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years • Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mello. o Certified Mae:ls-not available far any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables;pleease'uonsider Insured or Registered Mail. o For anadd�iy�pQd�al fee,a Return Receipt may be requt?sted to provide proof of delivery.ToYMain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811f loithe article and add applicable postage to cover the' fee.Endorse.mailpiece"Retdm Receipt Requested".To receive a fee waiver for' a duplibate return recut; 'LISPS®postmark on your Certified Mail receipt is required.`_'JP-rf o For an•additibnah feg;delivery may be restricted to the addressee or addressee'sauthdrized agent.Advise the clerk or mark the mailpiece with the endorsement"ResMcted Delivery". a If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT: Save this receipt and present it when making an Inquiry. PS Form 3600,August 2006(Reverse)PSN 7530-02-000-9047 vyY'A • THIS IS NOT A PERMIT Case # RBPR-03-2016-23355 ri Z CATAWBA COUNTY HEALTH DEPARTMENT o_'..�o"".lo V cut PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES I 1842 w Residential Building Plan Review - Building New o _ n•% IMPROVEMENT * l ' Contractor INGLE BUILDERS, INC (MARK INGLE), 3367 GUINLAN LN, LINCOLNTON NC 28092 B:704-735-9739 C:704-634-0849E:704-736-9686 JESSICA @INGLEBUILDERS.COM Owner CHATTERJEE LAKE INVESTMENTS LLC, 4933 SHADY MAPLE LN, WINSTON SALEM NC 271( B:336-922-9801 C:336-413-8709 NAME TO APPEAR ON PERMIT INGLE BUILDERS, INC (Mark Ingle) SITE ADDRESS: 8609 BAILEY DR, TERRELL NC 28682 PIN # 461602578155 NAME of SUBDIVISION: ELIZABETH SHERRILL PROP Lot# 3 Section/Block PROPERTY SIZE: Square Feet Acres 0.46 DIRECTIONS: 150 E/right Kiser Island Rd /left Bailey Dr/house at end on right PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: new dwelling 40 x 60/with basement"existing system on property/no permit w/exact sizing /***existing DW to be removed*** SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is"YES", then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure • STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF DW mobile home EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 28 x 60 NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 40 x 60 #OF NEW BEDROOMS:: 3 BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED?Yes Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: YES INNOVATIVE: ANY: Other described: existing B-ehapplicalion 03/08/2016 16:35 Page 1 of 1 ygA CATAWBA COUNTY Case# RBPR-03-2016-23355 x Public Health Department Subdivision ELIZABETH SHERRILL PROP �1^yC Environmental Flealth Division PIN# 461602578155 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 18.2, Sx NAME ON PERMIT: INGLE BUILDERS, INC (MARK INGLE), 3367 GUINLAN LN, LINCOLNTON NC 28092 INGLE BUILDERS, INC ( Mark Ingle) Site Address: 8609 BAILEY DR, TERRELL NC 28682 Property Size: Square Feet Acres 0.46 Directions: - 150 E/right Kiser Island Rd /left Bailey Dr/house at end on right Improvement Permits issued as a result of this information are valid for 5 years or may be non-expiring under certain specified conditions.An Authorization to Construct issued by this department is valid for(5)five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. I have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identificaqtion�nd abeling of all property lines and corners and making the site ible so that a co lete site evaluation can be performed. Date: 1-0-1,0 Signature of Applicant or Agent Acknii erireci An Environmental Health Specialist will contact you within 5 working days of application date. IF you need further information or assistance please call 828-466-7291 AREA1 FFENAME DATE` FEE AMOUNT Improvement Permit Fee 03/08/2016 $150.00 TOTAL FEES FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-ehapplication 03/08/2016 16:35 Page 2 of 4 CATA IA THIS IS NOT A PERMIT j COUNTY CATAWBA COUNTY HEALTH DEPARTMENT F«,„-�.a,,.. Application for Environmental Services Page 1 Improvement Permit D Authorization to Construct❑ Septic Repair❑ Septic Malfunction❑ Septic Expansion ❑ New Well Permit 1 Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility ❑ Property Address 8609 Bailey Dr Subdivision Elizabeth Sherrill Property Terrell, NC 28682 Lot it 3 Acres 0.46 Section/Block/Phase Driving Directions to Property 150 E,right on Kiser Island Rd.,left on Bailey Dr.,house at end on not NAME TO APPEAR ON PERMIT? ❑ Owner ❑ Applicant ® Contractor Applicant Contact Information NameMark Ingle Address110 East Main St. Lincolnton, NC 28092 Phone704-735-9739 I Cell Phone704-634-0849 Owner Contact Information NameChatterjee Lake Investment LLC (Raja Chatterjee) Address4g33 Shady Maple Ln. Phone336-922-9801 I CellPhonc336-413-8709 Contractor Contact Information I NameMark Ingle Address110 East Main St. Lincolnton, NC 28092 Phone704-735-9739 I Cell Phone704-634-0849 WHO WILL BE THE PRIMARY CONTACT? ❑ Owner U Applicant ❑ Contractor Description of Existing Structures on Site eoabmnae #of Bedrooms *f 3 Structure Dimensions 28x60 #of Occupants 2 Basement ❑ Yes [ No Basement Fixtures Q Yts SI No The Applicant shall notify the local health depattutent upon submittal of this application if any of the following apply to the property in question. If the answer to any question is"yes", applicant must attach supporting documentation. ® Yes f;}No Does the site contain any jurisdictional wetlands? d Yes CI No Does the site contain any existing wastewater systems? 0 Yes 0 No Is any wastewater going to be generated on the site other than domestic sewage? El Yes 0 No Is the site subject to approval by any other public agency? 0 Yes a No Are there any easements or right of ways on this property? Describe Existing water supply in use U Individual Well LJ Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes 0 No If applying for an Improvement Permit or Authorization•to Construct,Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) ❑ Accepted ❑Alternative ❑ Conventional ❑ innovative ® Other existing 0 Any CATAVVBA TI-IIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT 7�s „c.; Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence 0 New Residence ❑ Addition to Residence #of New Bedrooms *13 Project Description tear down old house & build a new one Structure Dimensions 40x60 #of Occupants 2 Basement 0 Yes ❑ No Basement Fixtures Ci Yes ®No U Accessory Structure(s) Describe #of New Bedrooms *9' if applicable Structure Dimensions _ #of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing E Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence#Units #Bedrooms per Unit*t Total#Bedrooms *.f Structure Dimensions ❑ Food Service Specify Type #Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift #of Shifts Dining Area(Sq. Ft.) U Business Specific Type of Business Retail Floor Space #of Employees per Shift it of Shifts ❑ Other Facility Type Specify If Church#of Seats Kitchen ❑ Yes ❑No If Daycare Specify Occupancy _ Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes 9 N Describe Calculated Design Flow, Commercial t Additional information may be required to determine design flow from certain facilities. This value will be determined during consultation with on-site staff. Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as a bedroom and counted on all applications. The number of bedrooms will be confirmed by rooms identified on house plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system size increase in the future. f If structure is plumbed but no bedrooms,calculated design flow is required. **If No,a well permit must be issued with the Authorization to Construct. SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) Improvement Permits issued as.a result of this information are valid for 5 years or may he non-expiring under certain specified conditions.An Authorization to Construct issued by this department is valid for(5)five years from the date issued and is not transferable;Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. I have read this application and certify that the information provided herein is true,complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can he performed. Signature of Owner or Agent � Date 3' 3-16 ff�� Printed Name of Owner or Agent ✓°( ark Y,�� Catawba County. Environmental Health FY, : V 52.7 0 9593 10 71 39 25.74 J m o, o ^~i 'pLo 7 dim * • 69.4• a9 id e 48 \ o:.i9 r ci I iti..ta� r�S}b � 8 I, ZV4 ,k y ¢ LYre. r. {,{4 1 , F���^M 1 X 1ilig4h ,m C r 7x10,01 411tON it •irtrW& > } ,„ i '�;�4 $616 1 �� 1 ILL} 5 ,6 )14-•WARY a ak.t Tor e +� ��db ,g,Frr�ly-�WM.'y ?.Y°d�d ..54`ps(f��`'�A' '4+� A iu st: 1 A f "t A ,,A*alpl RkiF &;i ��14'Sy Wry• 1 1., Hsi l qth?Ty, fSi a.'y y„71r e n+t€ ag5-um g, :Ge:i 14: . ,, n rev .�} ..*- ii �,.} 6 �r�h '^ S+Y� K{'S` �''}' ' - i`YSUi,,° yy��G'i}h�£CS..'ay{,3�}�- ` >r1Y 2y ' �$0 Y°i�s +t 4� r}'`F 'tam, 1..e 9 i. T a1r,.i� �1r. Y - y...tii 4r s t 4''' �r At it x 0 1 wriTrS Y a � � 4 P;. ,1 1Va •7 30 �+'" r° ra � `�Y �� �Riy e��r u¢"j� p ^•.,t44 4 tt� � U f rh✓ � '.'} �"'", q����..'i IT r •. ? gyp h eY rai ps Y w r„ .c_5 t,#y'SAt 1 5j�7 Ntcs f4 ".E P > _p,0r is - �„fir 'Vi l��r s'4 irc- ' xi ? eA•"'.: r "1 �, tit`s a4 Ls 21 .ns.'£`e:,-.ryK" rv'trA,, x',t ,,..>s^� i ,. ss r'., xln a : I=a"rir peL'. [1�� .f,4:41. rJ ,c d F:t4IS4iStS si ! } f.' � c* ^j .+ ,„.. z""Te "f'mtL- Nq'j•K@` 1Y r "4"raryr�< 0: 'a7" „� 4f1G atL��, r atb r r ..z ",F r 0IP Kt'ss, lfi M.14 . ru --"A„ , akl�r-a+h.-:.+. ,."�� -3°v a v - r,e c? a :g,.,i' 4sn.v 4d Parcel: 461602578155, 8609 BAILEY DR tin=5011 TERRELL, 28682 This map/report product vas prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made subalanlial ettorts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recom✓nends the independent vedlication of any data contained on this map/report product by the user,The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability.whether direct,indirect or consequential which arises or may arise from this map/report product or the use thoreot by any person or entity. Copyright 2014 Catawba County NC 03/03/2016 i/ Catawba County Environmental Health ive/A. ., ...04 . „ 52.7 • 7t39� 2574 Oo 69.44 v3 4k 11946 cep o p w 0 e,. te .9 r . x y a d — ; O .z o a' ; �t y CO T ., �m. F N _ ° t .a itcrtrafttligittc-stfrtl •-igt"4.a, -:ti. Fy n ,4' ,}y ' 1 �j��; t v ,Tp' g` ' ,t4±,,,, '` i �0 •8610 N jkgg g42,5-. ' 4# ate' " u gigAV v v# i AA, r Co Os, f x t x° P{' ,.- y:b l',�d%er � e {er„k,"`, 'i x'y to" ir`k ':+`��# - . • 30 rte °%'tSS .d'r $ S� % �' 4-'11/1 :"' ,.p '�-y, '''''''t,„7- `- -,-/0°,7,4010 .1.:'!:;. 5.,t 4" g a ctA,k ri 9rrtt §*t" a's «& '`4.^ - ' k !A ^.+,_ P m,5tr�FU�„ f? � .�5�+r.i ti4.� �x a 1 < t �.t* 3 v 'r 0, ¢ d # m b.; a e f' jjc ,.i' rt'�° vE d a btu `" 't " A` s�yt -+.. '- ''���' r L"S '� '` `�, � "%a� 'Ly �r +�..� . a4 yF` § 4 �4#4-°-rs � � +`#<#.#4#14a x .,, 4��` ds#,2a � - < "t 1,1-460-c-.P 5r+ •««4 4 Auq A V r , tit {,j.. .� sr v+.3.-w ag . ..ii ��+ S �s t +vs, xy ,4. ry co fin,. mesas .-.1 4,.3 i ,.,,.i q r s ,.-a, k '%5i `45 ' x4^°, 1'#4 Lt*# "w 'u# g., �. �i %� d 4 n. .„.3 B m"r*".170047".#Ae +w^y , ,,�,, . . �' � �8�`�E�... a p`.. , % ., x ` s% : � x i-{- d -°a r-i a ti + r - 'a -" i4 .v'`c a i-, y Parcel: 461602578155, 8609 BAILEY DR lin=50ft TERRELL, 28682 This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 03/03/2016 I Parcel Report Page 1 of 1 • Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 461602578155 Owner: CHATTERJEE LAKE INVESTMENTS Parcel Address: 8609 BAILEY DR LLC City: TERRELL, 28682 Owner2: LRK(REID): 14465 Address: 4933 SHADY MAPLE LN Deed Book/Page: 3260/0541 Address2: Subdivision: ELIZABETH SHERRILL PROP City: WINSTON SALEM Lots/Block: 3/ State/Zip: NC 27106-8704 Last Sale: $147,000 on 1994-03-01 'Plat Book/Page: 18/266 School Information: Legal: LOT 3 PLAT 18-266 School District: COUNTY a Elementary School: SHERRILLS FORD Calculated Acreage: .460 o- Tax Map: 013CX 04003 Middle School: MILL CREEK 0,^ Township: MOUNTAIN CREEK High School: BANDYS . v> State Road #: School Map —'39' . Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY n County Fire District: SHERRILLS FORD Zoningl: R-30 \Li Building(s) Value: $114,700 Zoning2: ` Land Value: $242,400 Zoning3: Assessed Total Value: $357,100 Zoning Overlay: CRC-O,WP-O,FPM-O Year Built/Remodeled: 1981/ Small Area: SHERRILLS FORD S—\b Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers \S`j ..\ %c� Miscellaneous: Firm Panel Date: 2008-03-18 - 2 6 \\15(*� ` Building Permits for this parcel. Firm Panel #: 3710461600L ��\?J Building Details 2010 Census Block: 5022 ���. WaterShed: WS-IV Critical Area 2010 Census Tract: 011504 \ U' r Voter Precinct: P41 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report A This map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be hold liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. ©2015, Catawba County Government, North Carolina. All rights reserved. • http://gis.catawbacountync.gov/nomap/parcel_report.php?key=461602578155&typ=P 3/3/2016 NI CATAWBA.CCUNTIL HEALTH DEPARTMENT itg-61-- 1 Lot Evaluation Improvement Permit Repair Permit-Canpletion Permit N-29- gent I) ,, eC Y Phone Address 0-1607 it5A, (_.1 5 jZ Subdivision - _ ,/ ,, ��, �_ - _; Section/Block Lot # Lot Size Directions: /SD ( (1,.4y eA71-0 /.ACED 7S /2j) 1 F.FT d,("7 /G 4' x-57'' )1,d,tS i a Facility: House Mobile HOmei --Business_ Other: Zoning Approval yes/no # Multi-family Other ; 100% Repair Area yes/no Bedroans .. hs Seats Employees ; GPD Flow Application Rate Garbage •' •• - :•- _ F' s ; REPAIR NDIZC E: REPAIRS muss BE WITHIN 30 Basement _ ,�•. -s/no ; DAYS OR DAYS F!}[ DATE OF PEWIT. Private Pub is t****************itt ►+:mm* ****** s* Type of System: Trench Bed System r Or (Specify) Tank Size: Septic Tank • , // - /A" ^ J Pump Tank N i t r i f i c a t i o n Field: Total Square Feet O F D) ` _ Depth of Stone ).„1 " Bed Size t Q 'I 1 ' Trench Width--------- Total Length of All Trenches Number of Trenches Individual Trench Length--/ / / / Feet on Center Maximum Trench Depth Distance to Nearest Well Lot Evaluation: Approved '/Disapproved ********************* Sketch of Lot Evaluation Site - System Design • )b'tI !i"- T) • • TR LoSs ?s ° Zn a pie I c-44 <14t> 1006( �I �s 1-6-6,51Xe C__ ?� NvT /eoo1 ***********************,**********#******************************************** ***4***** Permit Date (Lot Evaluat ion and Improvement Permit void after 36 months) Owner/Agent Sanitarian Installed By ;,..,c Date k t ;r'! Sanitarian � �., (Note any changes/information in red or by sketch on back) Topo S PS U Drainage S PS U Depth S PS U Restrictive Hoz. S PS U Space S PS U Soil S PS U III Loam: Sandy Clay, Silt, Clay, Silty Clay .6-.4 IVa Clays: Sandy, Silty, Clay .4-.2 WHITE•OFFICE COPY YELLOW-OWNER/AGENT COPY 1 t, 4 CATAWBA COUNTY HEALTH DEPARTMENT P. -,:th E "1 Telephone (828)465-8270 TDD (828)465-8200 WLS #aeO'ev2.41 lmprovethent Permit AC Repair Permit. Operation Permit. System Type Well Permit.Replacement Well Owner/Agent �� le„s t� -,r Phone Address Qcy -6P..l t,-e/ Rd Subdivision e ti-c NC.. Se 'on/Block/Phase Lot# Lot Size .1/b Directions /G�[0 O "�� S OP '� a, o�t.•� 2�Go� Property Address k6e) .5,-.4 ,)/ Facility House, lc Mobile Home Business Multi-family Other. Pin Number 96/6^eb?-5-7.. $/55 Other Zoning Approval# #Bedrooms 3 #Seats #Employees Application Rate , ,35 GPD Flow 36c7 Hot Tub or Spa yes/no Special Fixtures Basement yes4415) 100% Repair AreaE/no Basement Plumbing yes/no Water Supply. Private Well Public Semi-Public ************************************************************************************************************************ Type of System: Trench Bed Pump Pump/Panel Panel LPP Other Septic Tank Size Pump Tank Size Nitrification Field: Total Square Feet Depth of Stone Bed Size Trench Width Total Length of All Trenches Number of Trenches Trench Length I l / / l Feet on Center Maximum Trench Depth Distance of Nearest Well *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* *************************************************************************************************************************** Topo % Slope Texture Cyr^de -5( Structure Clay Min. -)(Y)- i`J Soil Wetness "11 Soil Depth Restric Hoz. at " Available space yes/no 4.f Overall Class S PS U _ t ,,.. Comments - - I 131-� - :la E lisliusiO 6 ---.....______„_ I Filter Required / r 9 - Riser required when �j4 A tank is more than 6 inches deep. **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** ************************************************************************************************************************ *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility An Authorization to Construct is valid for (5)five years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation,and protection must meet state and local regulations, and must be _ inspected and approved by a representative of the Catawba County Health Department befor• : y portion of the installation is put into use. The siting of the well by the Health Department staff is to provide protection from known .1 sources of contamination. No volume of water is guarantee. at . • site by the Health Department. Permit Date 02.C• L EHS - J - O ^•_'�d_'�JI���� j(j/ Septic ank Installed By Date E' ell Installed By -1 Well Grout Approval . . z-j-d-'I Well Head Approval Date y-1,14 L/ Date Sample Collected_ // Date of Results Results - -.E . (. %n/ArA White-Office Yellow-Owner/Agent Pink-Building Inspection Author:-• ion to Consul—let