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HomeMy WebLinkAboutIMPV-04-2016-071584.TIF ,g3A CATAWBA COUNTY Case it IMPV-04-2016-071584 .7 L.r.'1II 7 Public Health Department Subdivision 4 4,'Im41 Enviconmental Health Division PIN# 376301279838 PO Box 389. 100-A Southwest Blvd.Newton,NC 28658 LOT# A-4 1842 NAME ON PERMIT: RANDY MOSER, 4061 CARLTON DR, CLAREMONT NC Site Address: 4942 ROCK BARN RD, CLAREMONT NC 28610 Property Size: Square Feet: 17,859.60 Acres:0.41 Directions: 140 Rock Barn Ext from Hickory, Left onto Rock Barn Rd, Go past the golf course, go across the bridge, Community Rd will be on the Left& right across is 3 mobile homes, vacant lot past the 3rd. 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. r- As the property owner or authorized representative, I have received the above referenced permit(s) as requested in the application for service EHPR-04-2016-23545 by the following method(s): Received in Person Facsimile Transmittal (Return form with signature required) Electronic Image Transmittal/ E-mail (Return receipt required) Ni ✓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: 04/26/2016 `Owner/Authorized Representative Signature g q4,, 177 0aa2 Date Lf — (7),‘*` c,R,6j6 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 We want to hear from you. Please take a few moments to complete our customer service survey at: http://www.surveymonkey.com/s/EHCustomerService chpcnnit 04/26/2016 09:11 Page 3 of 3 ,D CATAWBA COUNTY 0:AT-7 Ps 0 Case# IMPV-04-2016-071584 Public Health Department t �� Subdivision G 4a , „ Environmental Health Division r PIN# 376301279838 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 a , LOT# A-4 1812 N f r• r ,8 r NAME ON PERMIT: RANDY MOSER, 4061 CARLTON DR, CLAREMONT NC Site Address: 4942 ROCK BARN RD, CLAREMONT NC 28610 Property Size: Square Feet: 17,859.60 Acres:0.41 Directions: 140 Rock Barn Ext from Hickory, Left onto Rock Barn Rd, Go past the golf course, go across the bridge, Community Rd will be on the Left & right across is 3 mobile homes, vacant lot past the 3rd. Improvement Permit Facility: Primary Residence - mobile home Permit Category: New Septic Bedrooms 3 WATER SUPPLY: Private Well Basement? No Basement Plumbing? No 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: REPAIR SYSTEM SPECIFICATIONS Repair System Required? Required Proposed Wastewater System: 50% REDUCTION Type: IVA-ANY SYSTEM WITH LPP DISTRIBUTION PUMP REQUIRED ***** OPERATOR 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' (ISA 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. _ Megen McBride 04/26/2016 AUTHORIZED IORIZED STATE AGENT APPROVAL DATE. 04/26/2021 Permit Expiration Date: No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department. ehpennit 04/26/2016 09:11 Page 1 or 3 AG,U\.EW 1 ? -04-)0%-:)3738 . Lit-1) Rock burn Rd, Glare/pion]- i ,- ,stmt IDOOauf{on Se fF;c—r,w\ qr..d 3DO o-1 D57 ReduJ-iDn ; ci- 75.1 -\-renclie5. 4( 7rrs-till draih-cield &-' Co)r-hxY{, A. 5er{ru S1.s±-em nus-I be. aj leas- 50 f1- -From wel(s, I0-li -rrUm �roPer-7 lines 5f-l. -Crum S-�fuckxe5,inclvdi�9 decks, and our of nigh{- of- ways a.r<4 ecceneni5, 4. )u had arWe., arac.¢, Co{, or --Fil OVer �f,{.iC are05.LJ I t. Fir`u( arc& musk ,sincd Su&Fare wafer D-ff wc[ aU�a-/ -fcr-1 Sep c s1skem. 1 Se i i Are Re' r / * We-II P,vsi be.o LAL_H.�- 5ofl. -From Sep is s s eni, - 15(d. -Fnm skrve{iifes, incl`Jain i ! aecA(.S and forGhe5 I - 5{0. -torn Pro?e67 lines N. Jo 4' Ceer well w of all riah}-4-v>ars aria ease_nlerrl5. lo' sn,q 41TanY aXIMal E Areq of ra rrrota3gCtM 5 TI I5, P P �xl a IN aPp{i( SySifr� I 1 min if i n 9 �.//T m {b I o(:15: e{) -'— WO\ l5— I I. oY .. Rock Barn �d J . ' I" 11^' p5 - T � g C 1 "*, w xi ! $ .r;t:zz`n r. ::w Y . £ ;. sl.:,2 atjf rx "''. . � e U^. ... ,n. .:,p{ 4-..°4,. '.. e2 x7 .R.r ! b 1, t„ FC."`!rt,;. ., DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES Shed_of DIVISION OF ENVIRONMENTAL HEALTH PROPERTY 11)it: ,ON-SAE WASTEWATER SECTION COUNTY: SOIL/SITE EVALUATION Q,, 1 An for ON-SITE WASTEWATER SYSTEM OWNER: R noki In0Ser APPLICATION DATE Y-/-J& ENPR-o4. 2016-13545 ADDRESS: 1 DATE EVALUATED: 1124(16 PROPOSED FACIITY: 3ByM MPgpPq SEDDESI FLOW(.1949): 360 . PROPERTY SIZE:' ,giac.,f LOCATION OF SIM 9943 Roc p,.. Kai Cl a re Dr t PROPERTY RECORDED: WATER SUPPLY: i Private 0 Public 0 Well 0 Spring 0 Other EVALUATION METHOD: 0 Auger Baring gl Pit 0 Cut • TYPE OFWASTEWAIER: p Sewage 0 InayseialPmms 0 lvExcd . ::=__::;,,,:DTs:_ _:::: .anxi.. :--:......:::::__::-__::::: x ;..._.. ELI . .... .-: ::iii-: ;::.:::: -:[=•:_:-t-........ c::: ___..._....:_:.._.-::�:::::-....:......:::::::: -°--jaii:I.W 2i=: ......?iE::: ?REEF::::E:=3 F.E5[e[EP: :_::: ;g; :- `�i_ =:T10EL= ::=:[_ = .._..::c::c-c:::::......._...._.......__._.. _.. ._ 941[:::=_: :[._.___��n_��:� �[[; :_��;�=�;i= e:E=¢a_T E as =s[:-_�E�_: ._.: ._ :. _ __. ::::F:"...:0111;:.:... Eifilan}.v- ..._... . _ -_ - __ :,::: �: SON (6.,:...: 1:a„ 14i7L-i='c:r' =:_�-=:�94ff°�� a: ._. .._$ kr- _ - .. ,:, - .. _ - tr 4: .._ ,:_- `,n ; :,:,a1'r t . i,FkQf`1,41F” r_ Y.OSTIIpp[;i DFYTIL; 5'TTt4IeYFJREL _C1Stt$(5I'E3:Gr! `r:'_'.Vl'E'Tti�'�tf' =SQfIY;,, =t[Si[1`Rd_ `ti;i C`CYt:;;;;-: '.. . :-:::. siAPigg. i _{ - ... '3 arielkE..--:-:::._...tlt 1EIV� ?GY GOr.Ok DCP3RC �: Hf uz tSASS.:_ 0-19 sv.L fr,SS. seAp L 19-60 w5bk 11- fr.sS: cexP • 1 del. 60 - - D•3 0-7 . 56 .C.. .... .._., '-fr,5S. SPXP 7- 60 Nsbk C, i ft,ss , SPXP 2 rka me IS of jot/ `fkm hoof — 60 — — O.a5 0-5 5 b k- L it,55, Scxq 3 9-50 isbkG -f,-.ss, Sexp —� 0 _ — P5 0.3 0-13 SEX-1.. fr,55, Sexp _ - 13-39 SbK IA- -it',55, Sap PS 4 39- 50 w.%)(: LL +Sftf -Ir:S$ SPacc _ 5 o — 0•3 DEst °N INITIAL nsxtt REPAIR-SYSTEM OTHER FACTORS(-1946): Available spare(-1945) PS Oc SITE CLASSIFICATION(.111946):(�,, ,p Syerm Type(s) •-(-.J EVALUATED BY: ' `P•`en I c4CD 661C.) 9 J"o OTHER(S)PRESENT: v Site LIAR 0.3 0.3 . COMMENTS: -)0 lw l © 50 -q5 D �o'5' v L �, 50' == o rop 3 B—� Bock Born P-d. (Nol- w 5c6itt)