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CONSTRUCTION For Office Use only
AUTHORIZATION 'CDPt File Plumber 3.1-51-,9 4 .9
r Catawba County Public Health Department County ID NumberEHPIR-11 09-2437
tz' y
Environmental Health Division
f,.. Evaluated Fbr. REPAIR
' - P.0 Box 389, 100-A Southwest Blvd Tb`, nship:
Newton NC 28658 PERMIT VALID UNTIL:
Phone: (828)-465-8270 Fax: (828) 465-8276 1 1/ 0 9 a 0 1 4
Applicant: Kaelue Gersich Property Owner: Kaelue Gersich
Address: 7023 Tallent Court Address: 7023 Tallent Court
City: Sherrill-s Ford City: Sherrill-s Ford
State/Zip: NC State/Zip: NC
Phone (828) 315-1030 Phone
Property Location 8 Site Information
Address/Road Subdivision: Holiday Park Phase: Lot: 5
7023 Tallent Court
Sherrillws Ford NC Directions
Structure: SINGLE FAMILY HWY 16 S, LT HWY 150, LT. Mt. Pleasant Rd, RT onto
Tallent Court, 4th house on RTgray with burgundy
of Bedrooms: 3 shutters)
# of People:
'Water Supply: EXISTING WELL
-Svstem ecl Ica Ions
Minimum Trench Depth:
Inches
"Site Classification: MinirnUill Soil Covet
Inches
Design Flow: 3 6 0 Maximum Trench Depth:
Inches
Soil Application Rate.- Maximum Soil Cover:
Inches
'System Classification/Description: 'Distribution Type:
Septic Tank:
1 0 0 0 Gallons
'Proposed System: 1-Piece: QYes QNo
Nitrification Field Pump Required.- QYes ()No ( May Be Required
sq. ft. Pump Tank: Gallons
No. Drain Lines
1-Piece', QYes ()No
Total Trench Length:
ft. GPM -vs-- ft. 7DH
Trench Spacing: 8Inches O.C.
Feet O.C- Dosing Volume: _ Gallons
Trench Width: (aInches
Feet
Aggregate Depth: inches Grease Trap_ Gallons
Pre-Treatment: QNSF ~?TS-I CATS-11
Septic Tank Installer Grade Level Required: 01 011 0111 ON
Pagel of 3
CDP File Number 35949 County ID Number. EHPR-11-09-2497
❑ Open Pump System Sheet
Repair System Required:OYes ON o ONO, but has Available Space
Repair System
Trench Spacing: Inches Q.C.
'Site Classification: - Feet O.C.
Trench Width: 8Inches
Design Flow: - _ Feet
Soil Application Rate: Aggregate Depth: inches
Minimum Trench Depth:
"System Classification/Description: Inches
Minimum Soil Cover,
Inches
Proposed System: Maximum Trench Depth: Inches
Maximum Soil Cover:
Nitrification Field Sq ft Inches
. .
No. Drain Lines 'Distribution Type:
Total Trench Length: ft Pump Required: OYes ()No OMay Be Required
Pre-Treatment: (NSF OTS-1 OTS-II
'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 bythe 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.
REPAIR PERMIT IS BEING ISSUED FOR REPLACEMENT OF COLLAPSED TANK ONLY`New lank must be minimum: 50' from lake and any
individual well, 5' from home, 1o' from property lines'Tee and filter to be installed on new tank`Use pvc schedule 40 supply line from tank to existing
drainfield
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 may be issued at the sametime the Improvement Permit Issued (NCGS 139A-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, or the site is altered, the permit or Construction Authorization shall become
invalid, and may be suspended or revoked (.1937(g)). 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? Yes ONo
Applicant/Legal Reps. Signature ~ 1 LIN Date:
'Issued By: 1810-Boyd, Jason Date of Issue_ _ 1 1/ 0 9 a 0 0 9
Malfunction Log OYes
Authorized State Agent:
A- 13-1,4
Hand Drawing Olmport Drawing Total Timei(HH4AM)
*Si a Plan/drawing attached.**
Page 2 of 3 Hours M inutes
CDP File Number: 35949 County ID Number: EHPR-II-09-2497
Drawing Type: Construction Authorization Date: 1 1/ 0 9/ a 0 0 9
Y) Inch
Dra~tiin6 Scale: 1 C} Block = 0 0 ft.
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