HomeMy WebLinkAboutIMPV-04-2016-071144.TIF tLA CATAWBA COUNTY Case# IMPV-04-20 1 6-07 1 144
.0 e y Public Health Department Subdivision Eyan Townsend
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',�®-3 a ,�, EnatromnenWl Health Division I INIk 376004608799
%.84,2„y? PO Box 389. 100-A Southwest Blvd, Newton,NC 28658
LOTH 1
NAME ON PERMIT: CHRISTOPHER BURCHELL, 3781 ANDERSON MOUNTAIN RD, MAIDEN NC
28650
Site Address: 1300 FOX DAIRY RD, NEWTON NC 28658
Property Size: Square Feet:87,163.56 Aeres:2.001
Directions: hwy 10 E, right on Balls Creek, left Love Rd, 2 miles right on Fox Dairy Rd, approx 1/4 mile on left,
intersection of Fox Dairy and Walling Dr
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.
\'(/FAs the property owner or authorized representative, I have received the above referenced permit(s) as
requested in he application for service EHPR-03-2016-23296 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.
5 Permit Issue Date: 04/12/2016
Owner/Authorized Representative Signatur; ,-
Date z — /..5'—/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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ehpermit 04/13/2016 09:43 Page 3 of 3
c g_ • CATAWBA COUNTY 0 -!r • 0 Case/1 IMPV-04-2016-071144
fPublic Health Department $! -. Ali' Subdivision Eyan Townsend
‘ .< �c Environmental Health Division y61 261 -••.1 PIN# 376004608799 ISII.
� PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 _•�.• � LOT# 1
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NAME ON PERMIT: CHRISTOPHER BURCHELL, 3781 ANDERSON MOUNTAIN RD, MAIDEN NC
28650
Site Address: 1300 FOX DAIRY RD, NEWTON NC 28658
Property Size: Square Feet: 87,163.56 Acres:2.001
Directions: hwy 10 E, right on Balls Creek, left Love Rd, 2 miles right on Fox Dairy Rd, approx 1/4 mile on left,
intersection of Fox Dairy and Walling Dr
Improvement Permit
Facility: Primary Residence - House
Permit Category: New Septic Bedrooms_ 3
WATER SUPPLY: Private Well
Basement? No Basement Plumbing?
INITIAL SYSTEM SPECIFICATIONS
Permit Valid: Expires In Five Years: _X_ No Expiration:
Projected Daily Flow 360 g.p.d
Proposed Wastewater System: 25% REDUCTION
Type: IIIG -OTHER NON-CONY TRENCH SYSTEMS
Permit Conditions: *Do not drive, grade, or fill over any designated septic area.
REPAIR SYSTEM SPECIFICATIONS
Repair System Required? Required
Proposed Wastewater System: 25% REDUCTION
Type: BIG -OTI-IER NON-CONY TRENCH SYSTEMS
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 Rules for Sewage Treatment and Disposal Systems' (15A 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.
Robbie Phelps 04/12/2016
AUTHORIZED STATE AGENT APPROVAL DATE.
Permit Expiration Date: 04/12/2021
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
ehpernat 04/13/2016 09:43 Page 1 of 3
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES Skeet_of_
DIVISION OF ENVIRONMENTAL HEALTH PROPERTY ID fi:
ON-SITE WASTEWATER SECTION COUNTY:
SOIL/SITE EVALUATION
f for ON-SITE WASTEWATER SYSTEM .
OWNER //'YI r1✓ 6 ve c h.e I( PLICA'IION DATE - z y
ADDRESS: I-S DJ F0 v, 1Oa IM t DATE EVALUATED W L-/ 6
PROPOSED FACILITY: 3 02 PROPOSED DESIGN FLOW(.1949): I4O . PROPERTY SITE:
LOCATION OF SITE: PROPERTY RECORDED:
WATER SUPPLY: Titivate 0 Public 0 WeIl 0 Spring 0 Other
EVALUATION METHOD: E Auger Boring 8'Pit 0 Cut
TYPE OF WASTEWATER: BrSavago 0 indusmal Nun 0 Mixed
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DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946):
Aw7ihle Spars(.1945) J .J•- SITE CLASSIFICATION(.1948): AU I
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Parcel: 376004608799, 1300 FOX DAIRY RD 1in=60ft
NEWTON, 28658
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
04/12/2016
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Parcel: 376004608799, 1300 FOX DAIRY RD 1in=60ft
NEWTON, 28658
This map/report product was prepared from the Catawba County,NC Geospaual 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 vedfcation 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
04/12/2016