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Home My WebLink AboutIMPV-03-2016-070299.TIF ,g CATAWBA COUNTY Case# - ___ • „7 en Y Public Health Department Subdivision < Environmental Health Division PIN# 461601291353 ^c PO Box 389. 100-A Southwest Blvd,Newton, NC 28658 LO"r# 8.2 ,u .. • NAME ON PERMIT: JEFFREY SKIDMORE, 7981 BLUE WATER CT, DENVER NC 28037 Site Address: 4460 DER WOOD DR, SHERRILLS FORD NC 28673 Property Size: Square Feel:50,965.20 Acres:1.17 Directions: 16 S, Eon 150, TR Slanting Bridge, TL Drena, 1/2 mile left on Derwood, 2nd lot on right Owner/Authorized Representative Acknowledgement of Permit Receipt I certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the perty described above. r As the property owner or authorized representative, I have received the above referenced permit(s) as ‘t quested in the application for service RBPR-01-2016-23033 by the following method(s): Received in Person Facsimile Transmittal (Return form with signature required) Electronic Image Transmittal/ E-mail (Return receipt required) j As the property owner or authorized representative I have reviewed and understand the specific conditions ]` f 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: 03/22/2016 --___ Owner/Authorized Representative Signature s _ �/ ' Date cyi`/7/ 0 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 ehpemiit 03/22/2016 11:09 Page 3 of 3 ,�B CATAWBACOUNTY D�r, Sa Case# IMPV-03-2016-070299 T t' Public Health Department r;�.,}r -1 Ct Subdivision ' 0 'I p Ia.:1..... x'1'1 PIN# < �r�T ,,; Environmental Health Division � 461601291353 K� - y PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 { { LO'f# !g4 M -�ca T� NAME ON PERMIT: JEFFREY SKIDMORE, 7981 BLUE WATER CT, DENVER NC 28037 Site Address: 4460 DERWOOD DR, SHERRILLS FORD NC 28673 Property Size: Square Feet: 50,965.20 Acres:1.17 Directions: 16 S, Eon 150, TR Slanting Bridge, TL Drena, 1/2 mile left on Derwood, 2nd lot on right Improvement Permit Facility: Primary Residence - House Permit Category: New Septic Bedrooms 4 - WATER SUPPLY: Private Well Basement? Yes Basement Plumbing? Yes INITIAL SYSTEM SPECIFICATIONS Permit Valid: Expires In Five Years: _X_ No Expiration: Projected Daily Flow 480 g.p.d Proposed Wastewater System: 50% REDUCTION Type: IVA-ANY SYSTEM WITH LPP DISTRIBUTION PUMP REQUIRED ***** OPERATOR REQUIRED Permit Conditions: *Do not remove or knock down the flags in the drain field area. REPAIR SYSTEM SPECIFICATIONS Repair System Required? Required Proposed Wastewater System: 50% REDUCTION Type: IVA-ANY SYSTEM WITH LPP DISTRIBUTION PUMP REQUIRED wwwww OPERATOR REQUIRED 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 Ru/es 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. Robbie Phelps 03/22/2016 AUTHORIZED STATE AGENT APPROVAL DAT1 Permit Expiration Date: 03/22/2021 No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department. chpermit 03/22/2016 11:09 Page 1 of3 Catawba County Environmental Health A �t�_ - 2016 - 610302 wt_U - 1, - 70( 6 - n olo 0 G- C tv % I __ o 3 49.70 63 ® ° • ( 4w Ti 54J 3 Bt \ •V�� -A F,'II o f7I 3\ a t NOVT Q, v. 19 11.1841111 1)roct A Nil• o• ‘1‘0% q. • 0 M o S 91 J W,.n 0 ;v\4 C ° 44 evr,t_ (YY3) ( 42) 187.27 (87) vs 122.27 65.00 148.25 m Parcel: 461 601 291 353, 4460 DERWOOD DR 1in=60ft SHERRILLS FORD, 28673 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 03121/2016 d£ c^t + 7<✓icif t x , L y1 at `TS,-. :1,7,e f dor1' Y " n -..,.,i.!n x, °.r a , 4,14' _ s i .. ?njr74144 : ;;t ti zl [k: j DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES Ate- -- DIVISION OF ENVIRONMENTAL HEALTH PROPERTY ID M: ON-SITE WASTEWATERSECTION COUNTY: SOIUSll't EVALUATION rr for ON-SITE WASTEWATER SYSTEM OWNER �1 f Y S {(f tiro a&>• APPLICATION DATE 21)033 ADDRESS: ltt(do Off i.oed 1% DATE EVALUATED: v-u-16 PROPOSED FACILITY: 4 7L PROPOSED DESIGN FLOW(.1949): 4 DO PROPERTY 917F• LOCATION OF SITE: PROPERTY RECORDED:- WATER SUPPLY: f Povate 0 Public 8 Well 0 Sloping 0 Other EVALUATION METHOD: 0 Auger Baling I] Pit U Cut TYPE OF WASTEWATER: a-Savage 0 Industrial Process 0 }.Erzed • _ __-11.._--`-...° r_o e:: ?.::y Tiff V L_ v� 'i=':::3'r.'e_:5. ......K�..e:dm ...... s. :::...a_.:..n c.-r_ :_'' _::__-.._=eiiikFv_ _ ':___.:n-_ ...e --- i =- J� 1, _ i � s _ ...T Tvsij _'a r1wt FACTURS: ..._ ::_ eTiDItT4_ __: : �:.:;a:.=.t[[s_ta_a�s[s::::[::: ._:::_:-=t:::_t:`:F.:°«33st=s:_ �::__ ::::_ :._::.:__ __ ___::[:_rz=__=:: __:...:. �_-= .. :_ e[[�CiR-= -L _=_._._..__ :_—::.9R3}'i�"viii'=�_=tE$'O : ;:___.:__: : '.�� mP.:�1Ii =— ]IEPTLL: STTtU4L'11R1F3 iSB F/ AY;r`1 te$St. _ 5(231r SAX'B AAF�'9G dL?) ..: 1'1 ._ l�1R1LOY G94x3a DPP CE 3S' ' #IORI'C CZ.ASS a o—z G rtk 5 Y,J9 16 52 I Gtfa, wr1N Fr p . 52 o-vz. . • e +rth.. ..... I r- rr re st SI C+r19. Amt a Vr 5".1 re 2 S1 o—L 6-w c rkh t-r tr - 3 3'5-5-1 Gfiry , s;cA Dr c-i o-32 c rUx r'r , '2L•-` f C I-rr Fr ,rr re 4 9 S - DESaCBTTON II.TIAAL SYSrn t REPAIR SYSTEM OTHER FACTORS(.1946): Avuyble Spat(.1945) ,j S SITE CLASSIFICATION(.1948): I r •System Ty e(s) S O'I a 3-17 °/, EVALU TED BY: �► � Site LIAR , `� , COMMENTS: 3-) o — / 6 F,- 1.1 J I 41 1 L sr: zsgsvcit`S 4z r g4' 5°!,,pp s kS �• rsy�} g�yypg�� kti,4 ` r _nor r k. >�%, .mr?�J+W ,,�'rA4�*v: .4 avAi ': . td fs ,�Y„a Pv"-tqe=.. t-.. .:-'Y "- i I 'R Q rrk '1417 6 4S,, d ^`Satinf .ni5"+NZ�s'jL''.� 1,2 ....n