HomeMy WebLinkAboutIMPV-03-2016-070386.TIF r A CATAWBA COUNTY Case#
Public Health Department Subdivision COUNTRY CLUB HEIGHT:
� �- ,� Environmental Health Division
PIN#
372014330842
V"pb ( PO Box 389. I n0-A Southwest Blvd, Newton,NC 28658 LOT# 9-17
/842
NAME ON PERMIT: ANA FILIP, 2087 MOSS FARM RD, HICKORY 28602
Site Address: 1067 SPRUCEWOOD LN, NEWTON NC 28658
Property Size: Square Feet:33,105.60 Acres:0.76
Directions: 10 E / right Startown RD / left Sandy Ford Rd/ right on Sprucewood Ln
Owner/Authorized Representative Acknowledgement of Permit Receipt
olf I certify that I ant the owner or authorized agent(owner's authorization required) representing the owner of the
property described above.
rAs the property owner or authorized representative. I have received the above referenced permit(s) as
requested in tl application for service RBPR-03-2016-23317 , by the following method(s):
rReceived in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/ E-mail (Return receipt required)
/"-'- As the property owner or authorized representative I have reviewed and understand the specific conditions
of 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: 03/24/2016
Owner/Authorized Representative Signature it �G
Date 3/2 5146
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
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ehpennit 03/24/2016 09:49 Page 3 of 3
P CATAWBA COUNT o :�����r�, r-b 0 Cased IMPV-03-2016-070386
G •` aaf• Subdivision ;
z, Public Health Department }�''. COUNTRY CLUB HEIGHT,
2r Environmental Health Division ��• PID18 372014330842
PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 �• LOT# 9-17
84 sm A r
NAME ON PERMIT: ANA FILIP, 2087 MOSS FARM RD, HICKORY 28602
Site Address: 1067 SPRUCEWOOD LN, NEWTON NC 28658
Property Size: Square Feet: 33,105.60 Acres:0.76
Directions: 10 E/ right Startown RD / left Sandy Ford Rd/ right on Sprucewood Ln
Improvement Permit
Facility: Primary Residence
Permit Category: New Septic Bedrooms 4
WATER SUPPLY: Community Well
Basement? No Basement Plumbing? No
INITIAL SYSTEM SPECIFICATIONS
Permit Valid: Expires In Five Years: No Expiration: _X_
Projected Daily Flow 480 g.p.d
Proposed Wastewater System: 25% REDUCTION
Type: NIB - SYSTEM W/SINGLE EFFLUENT PUMP
PUMP REQUIRED
Permit Conditions:
REPAIR SYSTEM M SPECIFICATIONS
Repair System Required? Required
Proposed Wastewater System: 50% REDUCTION
Type: IIIB - SYSTEM \V/SINGLE EFFLUENT PUMP
PUMP 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
applicanUproperty owner to insure that all Cunncba 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 'Lou's and Rules Jar Sewage Treatment and Disposal Systems' (I5A 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 03/24/2016
AUTHORIZED STATE AGE.AT APPROVAL DATE
03/24/2021
Permit Expiration Date:
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
ehpennit 03/24/2016 09:49 Page I of 3
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DEPARTMENT OF lIFALDI AND HUMAN SERVICES Sheet 1 glit_
DIVISION 01'PUBLIC I TEA TI-I,ENVIRONMENTAL I IL\LTI1 SECTION PROPERTY ID R:
4 ..... —
ON-SITE WATER I'RO'fL=CI`ION�13RAA'CH COUNTY:��—!,I__
SOIIJSI'LE EVALUATIONN _
fur ON-SITE WASTEWATER SYSTEM Cr)—?"_/(— Z.33/ 7
/' (Complete all ridds hi Bill)
OWNER: 6r-eii `.7`� APPLICATION DATE
ADDRESS: I0 67 sp..r:.G,,,-,,td [. DATE EVALUATED:
PROPOSED FACILITY:_`.'s _ PROPOSED DESIUN FLOW(.1949): `tko PROPERTY SIZE:
LOCATION OF SI'Z'E: PROPERTY RECORDED:
WATER SUPPLY: ❑Private N Public ANell I]Spring ❑Oilier
EVALUATION METHOD: Q Antler Goring I'll ❑Cut T"Y"PE OF WAS I LWA TER: )ZSewage ❑Industrial Process ❑mixed
R
0 SOIL MORPHOLOGY OTHER
F (.1941) PROFILE FACTORS
L
.1940 .q
E LANDSCAPE IIOREL,ON - -
POSITION/ DEPTH 1942 PROFILE
p SLOPE(11, (1i\-) 1941 .1941 SOIL .1943 .1956 .1944 CLASS
STitticEnv( CONSISTENCE! WETNESS! SOIL SA PRO RESTR & LTAR
TEXTURE \IINER-1 LOGY COLOR DEPTH CLASS R0121Z
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DISCRIPTION INlI[AL SYSreal R}3PAIRSYSTEM OTT-IE1.FACTORS(.1946):
SITE CLASSIFICATION(.1948): ri
Available Space(.1945) P C . �
IC-
System T>'pc'(s) EVALUATED BY: 3 IC—
z) ! �n b n`"/ OTHER(S)PRESENT:
•
Sue LTAR (J.3 D. 3
COMMENTS: