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Home My WebLink AboutIMPV-04-2016-070720.TIF _13 CATAWBACOUNTY Case# IMPV-04-2016-070720 7.7 art n", Public Health Department Subdivision ROXBURY FIELDS : *® Environmental Health Division PIN# 375501351758 PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 LOT# 2 /842 :u NAME ON PERMIT: LAVINE SCROGER, 383 N THOMAS LN, STONY POINT NC 28678 Site Address: 6245 ROCKY RD, CLAREMONT NC 28610 Property Size: Square Feet;21,780.00 Acres:0.5 Directions: 140 East, Exit 132, LEft at 2nd light, Right onto Hwy 16 & go about 7 or 8 miles, Right onto River Bend Rd, Left onto Rocky Rd, 1st vacant lot on the Left. 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 property described above. As the property owner or authorized representative. I have received the above referenced permit(s) as requested in the application for service EHPR-02-2016-23254 by the following method(s): Received in Person _ acsimile 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 7` 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: 04/01/2016 Owner/Authorized Representative Signature Date Documentation of Permit(s) Transmittal (permit transmitted by electronic or other means) Permit trap fitted sy O�� T AI I • f$ frame of person sendi g permit) _ IL• l � Signature Sin 44t 1 �o Date/Time I d_ 15 Method: _ Fax Email US Mail Other Owner's request to send by the above indicated method of transmittal in lieu of signature W ant to hear from you. Please take a few moments to complete our customer service survey at: http://www.surveymonkey.com/s/EHCustomerService ehpermit 04/0t/2016 08:20 Page 3 o13 tygA CATAWBA COUNTY EISA El Case# IMPV-04-2016-070720 Q'men Public Health Department Tj• ,._ �} Subdivision ROXBURY FIELDS 375501351758 4 c Environmental Health Division r �� • PIN# PO Box 389. 100-A Southwest Blvd,Newton,NC 28658 _ a• �i{- LO"I'N 2— 1642 •�, - • 'J. T•� ERIC or' • ..O NAME ON PERMIT: LAVINE SCROGER, 383 N THOMAS LN, STONY POINT NC 28678 Site Address: 6245 ROCKY RD, CLAREMONT NC 28610 Property Size: Square Feet:21,780.00 Acres:0.5 Directions: 140 East, Exit 132, LEft at 2nd light, Right onto Hwy 16 & go about 7 or 8 miles, Right onto River Bend Rd, Left onto Rocky Rd, 1st vacant lot on the Left. Improvement Permit Facility: Primary Residence Permit Category: New Septic Bedrooms 2 WATER SUPPLY: Private Well Basement? No Basement Plumbing? No INITIAL SYSTEM SPECIFICATIONS Permit Valid: Expires In Five Years: _X_ No Expiration: Projected Daily Flow 240 g.p.d Proposed Wastewater System: 50% REDUCTION Type: 111E- PPBPS GRAVITY DOSED SYSTEM Permit Conditions: REPAIR SYSTEM SPECIFICATIONS Repair System Required? Required Proposed Wastewater System: 50% REDUCTION Type: IIIE- PPBPS GRAVITY DOSED SYSTEM 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 I3uilding 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 Rules for Sewage Treatment and Disposal Systems' (I5A NCAC ISA .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 04/01/2016 AUTHORIZED IZED STATE AGENT APPROVAI.DATE Permit Expiration Date: 03/31/2021 No grading or construction activity is allowed in areas designated for system and repair without approval of the health Department. el-permit 04/01/2016 08:20 Page 1 of EHPR 02-2016-23254 6245 ROCKY RD, CLAREMONT • Do not cut, drive, fill, or grade over septic or repair areas. • This permit is not intended for septic installation purposes. • Septic system must be 10 ft from property lines; 50 ft from wells and streams; 5 ft from building foundations and appurtenances; 10 ft from water lines; 15 ft from a cutbank; 15 ft from a basement; and out of right-of-ways and easements. 1 I f zs-i • /50" i J'ti �J_ 5t°C - o lel 1 1 c- ) l r q I � I 1 - - r unvc 1(F, V V St' tit DEPARTMENT OF HEALTH AND HUMAN SERVICES a+re 01- 2o(6 - 23 5L/ Sheet ( of 1 DIVISION OF PUBLIC HEALTH,ENVIRONMENTAL.HEALTH SECTION PROPERTY ID#: ON-SITE WATER PROTECTION BRANCH COUNTY: SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM (Complete all fields in full) OWNER: Mc 7 SL`-.,I< APPLICATION DATE ADDRESS: Ley, Lk, Cia.tw.4- DATE EVALUATED: PROPOSED FACILITY: 2 6(- PROPOSED DESIGN FLOW(.1949): PROPERTY SIZE: I.,OCATION OF SITE: PROPERTY RECORDED: WATER SUPPLY: ❑Private U Public tWeII U Spring U Other EVALUATION METHOD: U Auger Boring 9 Pit U Cut TYPE OF Sewage U Industrial Process ❑Mixed • • - P o SOIL MORPHOLOGY OTHER F (.1941) PROFILE FACTORS 1 .1940 L LANDSCAPE HORIZON E PROFILE DEPTH POSITION/ DEPTH # SLOPE'Yo (L1`•) .1941 .1941 SOIL. .1943 .1956 .1944 CLASS STRUCTURE/ CONSISTENCE/ WETNESS/ SOIL SAPRO RESTR &LTAR TEXTURE MINERALOGY COLOR DEPTH CLASS HORIZ 0 -1L Lis& Su<.. F2 se 'vs- /5 `5 12.--2-3 S6�- C Re.. SE 4).k. .✓,q 1 J(� 2 /ot z3— 31 At k_ c Tr . 4---, „�t, D 5 3(- S4- "S6 t- 5c-<- (2 se p 6 -tI L'S6k. Sc Fe �.} �q ( f LS i( - 2-t A6k- c Ice .1e- tA/�!k S� 2 0.3 1 bac 2-2.--3`f M� cc/s, Sr 3Y-szi hisak & %, FL ft b-P `Sad sCc_ f Z SE N/,� P F )(C- Z`( 56E C SC SD NA AM- 3 t 2..k 3s vikSk Fi .Se c----7/3 ...q .3k_ Sb '.'AiSk. c,_ Fr -5(-- _ 0 - t, mss L sct_ ria sC N/At ns 4 S/'� (b-3 I "*9- C it _SC _ e' YeiL- wtky Z� 39-3D Yet: L 5SC DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTI-IER FACTORS(.1946): Available Space(.1945) if 1f SPFE CLASSIFICATION(.1948): PS System Type(s) �6L11Ad ,5'bK 4,1 EVALUATED BY: s / -..,_OTHER(S)PRESENT: Site LTAR D. 0 2,5 COMMENTS: LEGEND 0z— 2-o — --szs use the following standard abbreviations • • SOIL CONVENTIONAL. LPP MINERALOGY/ LANDSCAPE POSITION GROUP TEXTURE .1955 LIAR* .1957 LIAR* CONSISTENCE STRUCTURE CC(Concave Slope) I S(Sand) 1.2-0.8 0.6-0.4 SEXY(Slightly Expansive) G(Single Grain) CV(Convex Slope) LS(Loamy Sand) EXP(Expansive) M(Massive) D(Drainage Way) CR(Crumb) DS(Debris Slump) TI SL(Sandy Loam) 0.8-0.6 0.4-0.3 GR(Granular) FP(Flood Plain) I,(Loam) SBK(Subangular Blocky) ES(Foot Slope) ABK(Angular Blocky) Ft(Head Slope) RI Si(Silt) 0.6-0.3 0.3-0.15 PL(Platy) L(Linear Slope) SiCL(Silty Clay Loam) PR(Prismatic) N(Nose Slope) CL(Clay Loam) R(Ridge) SCL(Sandy Clay Loam) MOIST WET S(Shoulder Slope) Sit.(Silt Loam) T(Terrace) VFR(Very Enable) NS(Non-sticky) IV SC(Sandy Clay) 0.4-0.1 0.2-0.05 FR(Friable) SS(Slightly Sticky) SiC(Silty Clay) Ft(Firm) S(Sticky) C(Clay) VFI(Very Finn v.Very Sticky) VS(Very Sticky) 0(Organic) None None EFI(Extremely Firm) NP(Non-plastic) SP(Slightly Plastic) *Adjust LIAR due to depth,consistence,structure,soil wetness,landscape,position.wastewater flow and quality. P(Plastic) NOTES VP(Very Plastic) HORIZON DEPTH In inches below natural soil surface DEPTH OF FILL In inches from land surface RESTRICTIVE HORIZON Thickness and depth from land surface SAPROLITE S(suitahlc)or U(unsuitable) SOIL WETNESS Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less-record Munsell color chip designation CLASSIFICATION S(Suitable),PS(Provisionally Suitable),or U(Unsuitable) Evaluation of saprolite shall be by pits. Long-term Acceptance Rate(LIAR):gal/day/62 Show profile locations and other site features(dimensions,reference or benchmark,and North). P7/ y O' d r� H sxM .>< yf c�