HomeMy WebLinkAboutIMPV-04-2016-071548.TIF vlpA CATAWBA COUNTY Case# IMPV-04-20 1 6-07 1 548
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Public Health Department Subdivision
G /Tip_1 ,t; Environmental Health Division PIN# 377105185421
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"+!' PO Box 389, 100-A Southwest Blvd.Newton.NC 28658 LOT 3
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NAME ON PERMIT: MICHAEL FRAZIER, PO BOX 1238, CONOVER NC 28613-1238
Site Address: 4165 HOLLOW OAK DR, CLAREMONT NC 28610
Property Size: Square Feet: 253,954.80 Acres:5.83
Directions: from Claremont 1.4 miles on Old Catawba Rd / right CE Ranch Rd / right Hollow Oak/at end of Hollow Oak on
left
Owner/Authorized Representative Acknowledgement of Permit Receipt
drtcertify that I am the owner or authorized agent(owner's authorization required) representing the owner of the
property described above.
4l/ As the property owner or authorized representative, I have received the above referenced permit(s) as
requested in the application for service RBPR-04-2016-23615 by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/ E-mail (Return receipt required)
NPr 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: 04/25/2016
5 Owner/Authorized Representative Signature .46 _ ,
Date
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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 04/25/2016 10'.05 Page 3 of 3
• CATAWBA COUNTY 0 ' f 0 Case# IMPV-04-2016-071548
f' llti✓ Public Health Department rr - •-1 Subdivision
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< ,;, t „"1, Environmental Health Division i t'+!. . + • PIM/ 377105185421
PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 in r LOT# 3
/842 w - - r-- "a
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NAME ON PERMIT: MICHAEL FRAZIER, PO BOX 1238, CONOVER NC 28613-1238
Site Address: 4165 HOLLOW OAK DR, CLAREMONT NC 28610
Property Size: Square Feet: 253,954.80 Acres:5.83
Directions: from Claremont 1.4 miles on Old Catawba Rd / right CE Ranch Rd/ right Hollow Oak/at end of Hollow Oak on
left
Improvement Permit
•.y , i7 fll rill 'i 71, 9' II� t TE .T """mlis 1 x'11 1fI r , ,i << ' , hld';(TI
,u, Ill,1x'511.'11,� ! �I,�t d . l IINITIAL�SYSTEIVI IEXLST�I1vG I ,NY� �1; w , ,. i
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9 ,H I,�h,r 1 I n q t•�L H i, 'k,hji�. I, a,,,.,..-,.,.,,.....� owlw,
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Facility: Primary Residence - mobile home
Permit Category: Other I3edrooms 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: CONVENTIONAL
Type: IIA-CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS)
Permit Conditions:
REPAIR SYSTEM SPECIFICATIONS
Repair System Required? Required
Proposed Wastewater System: 25% REDUCTION
Type: IIIG -OTHER 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 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.
Megen McBride 04/25/2016
AUTHORIZED STATE AGENT APPROVAL DATE
04/23/2021
Permit Expiration Date:
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
dim nnit 04/25/2016 10:05 Page I of3
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tioLde home. and all -her cocrer5 Must 6e 511. f on1 se?tie syskfM
Per convevsetion w II o ht(, 1 ilohoel Frazier, front pore . Will no-F hwvt kbOttiS, � w'��
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if M.o6J Lten will Conned, ejCi-sk,n<� we11 Iocc4Ari o- V370 Dedc Dr.
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DEYARTMEIITOF ENVIRONMENT AND NATURAL RESOURCES • Sitar _
DNLSION OF ENVIRONMENTAL HEALTH PROPERTY ID#:
ON-SITE WASTEWATER SECTION COUNTY:
SOH Ara EVALUATION
for ON-SITE WASTEWATER SYSTEM
owwER: MlckatI Frazier APPLICATION DATE yfY ie g-B PR-OV-2olb-23bI5
ADDRESS: DATE EVALUATED: yla�16
PROPOSED FACILITY: 3 aR MH /� PROPOSED DESIGN FLOW(.1949):.D11 • PROPERTY SIZE: 5.23Gcrt$
LOCATION OF SITE:_Ili‘5 POW Oalc W (lofeMOnk PROPERTY RECORDED:
WATER SUPPLY: U Puvate 0 Public III Well U Spring Q Other
EVALUATION METHOD: a Auger Boring 0 Pit U Cut
TYPE OF WASTEWATER: R Sewage Q Indust:dalPlocess U Mixed
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DFSOU1T1OW RCO^L SYSTEM R.E.PAIR.SYSTEM OTHER FACTORS(.1946):
SITE CLASSIFICATION(1948):
Mailable Space 1965)
Syctem Type(c) EVALUATED BY: Md'jf/"w_1
OTHER(S)PRESENT:
. Site LIAR 0.3
COMMENTS:
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ant cc oe -1c.nK o^ 6Ikty 4% or NTH -V aW;. Pure.
-150
Pit 2-BR-
-100.
1 grave\ (ma 41' thrill. �R
�o\lbo 004k Dr- ; J trd5 kw_ �ov�Wc� 95-R. eF�frds