HomeMy WebLinkAboutIMPV-04-2016-071351.TIF .x5A CATAWBA COUNTY Case# , „ . __ii,�� Public Health Department Subdivision KOOL VALLEY
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2 41 3 Environmental Health Division PIN# 372415545703
' PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT# 1-8
1842 2 ,
NAME ON PERMIT: JEREMY HARSTICK, 3351 30TH ST NE, HICKORY NC 28601
Site Address: 3351 30TH ST NE, HICKORY NC 28601
Property Size: Square Feet:40,075.20 Acres:0.92
Directions: Springs Rd/to Kook Park Rd/right on 18th St NE / right 34th AVe NE/ right on 30th St NE/ 1st house on right
Owner/Authorized Representative Acknowledgement of Permit Receipt
ill
I certify that I am the owner or authorized agent (owner's authorization required) representing the owner of the
operty described above.
r .
ly
As the property owner or authorized representative. I have received the above referenced permit(s) as iC
in the application for service RBPR-10-2015-22632 by the following method(s):
i Received in Person
Facsimile Transmittal (Return form with signature required)
kVAs Image Transmittal/ E-mail (Return receipt required)
VI 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: 04/19/2016
Owner/Authorized Representative Signature / 4 '/.tL±'`II,
Date 9-W70((
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 04/21/2016 08.55 Page 3 of3
■d CATAWI3A COUNTY n- ti El o Case# IMPV-04-2016-071351
Q' .11 G Public Health Department i 7 4 ti Subdivision KOOL VALLEY
6 � t H Environmental Health Division
0 1 ti • PIN# 372415545703
I,.
PO Box 389. 100-A Southwest Blvd, Newton.NC 28658 c . A LOT# 1-8
Igg2 :, A
.4 O O
NAME ON PERMIT: JEREMY HARSTICK, 3351 30TH ST NE, HICKORY NC 28601
Site Address: 3351 30TH ST NE, HICKORY NC 28601
Property Size: Square Feet:40,075.20 Acres:0,92
Directions: Springs Rd/to Kook Park Rd/ right on 18th St NE / right 34th AVe NE/ right on 30th St NE/ 1st house on right
Improvement Permit
Facility: Primary Residence - house
Permit Category: Expansion Bedrooms 5
WATER SUPPLY: Public Water
Basement? Yes Basement Plumbing? Yes
INITIAL SYSTEM SPECIFICATIONS
Permit Valid: Expires In Five Years: _X_ No Expiration:
Projected Daily Flow 600 g.p.d
Proposed Wastewater System: 25% REDUCTION
Type: IIIB - SYSTEM W/SINGLE EFFLUENT PUMP
PUMP REQUIRED
Permit Conditions: Existing system is a gravity, gravel bed. System is to be expanded. Will be pump to pressure
manifold; additional drainfield will be 25% reduction.
REPAIR SYSTEM SPECIFICATIONS
Repair System Required? Required
Proposed Wastewater System: 25% REDUCTION
Type: IIIB - SYSTEM W/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 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' (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.
Megcn McBride 04/19/2016
AUTHORIZED STATE AGENT APPROVAL DATE
04/19/2021
Permit Expiration Date:
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
elipeinut 04/21/2016 08:55 Page 1 of3
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tJvs--\uj1 3)0addikibn&■ -leek oc 7520 Redoc ion ; 5- 01-R. -}rehabs .
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DEPARTMENT OF ENVIRONMENT.AND NATURAL RESOURCES - Shed_of—
DWISION OF ENVIRONMENTAL HEALTH PROPERTY ID N:
ON-SITE WASTEWATER SECTION COUNTY:
SOIL/SITE EVALUATION
IL I I, for ON-SITE WASTEWATER SY M
OWNER\1ecPm,/ RRrS tc1- APPLICATION DATE 10 Li 15 DATo-a015 )?(,3 �-Y I6
ADDRESS (.50 l� • PROPERTY SIZE: 0.91 actvS
PROPOSED FACILITY: S BR- Rouse. P�?QPOSED DESIGN FLOW(.1949):
LOCATION OPSRE: 3351 30+S c-i NE Hic rq PROPERTY RECORDED:
WATER SUPPLY: 0 Private rd Public 0 Wen 0 Spring 0 Other
EVALUATION METHOD: ® Auger Boring 0 Pit 0 Cut 1
TYPE OF WASTEWATER: 1 Sewage D IndustrialPmms 0 lard r..__! . ....._._.__
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DESCRIPTION innu..SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946):
SITE CLASSIFICATION(.1948):
Available Spate(-I94$) PS P
Syacm Type IlI� EVALUATED e`IA' U ri O=E
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OTHER(S)PRESENT:
• . Site LIAR 0.3 0.3
COMMENTS:
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Pro pO5lr1 +v -r`sk 'Oc'cerranA 0.nd cka 2 be*com5.
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