HomeMy WebLinkAboutEXSY-04-216-070919.TIF PA C.ATAWBA COUNTY Case# EXSY-04-20 1 6-0709 1 9
` *' HICKORY WOODS
��� G Public Health Department Subdivision
a Environmental Health Division PIN# 372410461086
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84 PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 LOT# 29
84 .
NAME ON PERMIT: TYLER WOODWARD, 6297 PINE RIDGE CT, HICKORY NC 28601
Site Address: 2614 36TH AV NE, HICKORY NC 28601
Property Size: Square Feet: 15,246.00 Acres:0.35
Directions: Snow Creek Rd /25th St NE/ right on 24th St PI NE/ left 26th ST Dr NE/go to end / house directly ahead
AUTHORIZED STATE AGENT DATE
NOT FOR LOAN APPROVAL Form E
Owner/Authorized Representative Acknowledgement of Permit Receipt
i I certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the
property described above.
Pti, As the property owner or authorized representative, I have received the above referenced permit(s) as
requested in the application for service RBPR-03-2016-23393 by the following method(s):
-/Received 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: 04/07/2016
(owner/Authorized Representative Signature /mod Itzeiteieci
Date 90,6
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 04/07/2016 08:29 Page 2 or2
6A Case# RBPR-03-2016-23393
•-A CATAWBA COUNTY Name Tyler Woodward—contractor
(`t'?II 1--,S Public Health Department
Joseph Paussa—owner
Q Env ronmental Health Division m
�® PO Box 389, 100A Southwest Blvd,Newton NC 28658 Address 2614 36 Av NE,Hickory NC
is 42 w (828)465-8270 Fax (828)465-8276 TDD(828)465-8200
EXISTING SYSTEM INSPECTION REPORT
Type of Facility: House ® Mobile Home ❑ #Bedrooms 3
Business ❑ • Mobile Home Park Re-connection ❑
Other ❑ . Specify
Proposed Additions/Accessory Structure: Sunroom, 12x29,going on existing concrete pad/expanding pad by 2 feet
Approved ❑ Not Approved ❑ Reason
Approval Not Required—Applicant Request Only
Evidence of System Malfunction: YES ❑ NO ® System TypelDescription PG—gravity 25%reduction
Non Compliance Items 1(/���ootte�d YES Z NO ❑ 1' (Describe Below)
1A `4L�I E AGNl REI'fS 4/1/16
A ED STATE AGENT' DATE
Compliance Items and Notes
*Existing septic system was visually functioning 3/29/16 however no guarantee can be given to its longevity.
*Based on notes on the original septic permit(WLS2003-01196)and 3/29/16 site visit,the lot appears to have been graded when
house was built.This,along with moving the driveway from the originally permitted location,has impacted future septic repair area.
Space is extremely limited for future repairs.
* Sunroom footers,support posts,concrete pad etc. must be at least 5 feet from all septic system components. Uncover tank and
drainfield as needed prior to construction to verify setbacks.
* Do not drive,grade,cut or fill over septic system or potential repair area. Do not use system area or potential repair area for storing
construction materials or equipment during sunroom construction.Rope off or otherwise protect septic system.
•
NOT FQR LOAK APPROVAL
EXISTING SYSTEM INSPECTION REPORT
Site/System Diagram
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101'
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NOT FOR LOAN APPROVAL