HomeMy WebLinkAboutAUTH-05-2016-072077.TIF A,H \ CATAWBA COUNTY Case# AUTH-05-2016-072077
/call y Public Health Department Subdivision
y4 0 s, Environmental Health Division PIN# 371312858761
\ 8'b'42.2 PO Box 389, 100-A Southwest Blvd,Newton, NC 28658 LOT# 6-11 PT 5
NAME ON PERMIT: VANG PENG, 1511 21ST ST NE, HICKORY NC 28601
Site Address: 1511 21ST ST NE, HICKORY NC 28601
Property Size: Square Feet: 39,639.60 Acres:0.91
Directions: 140 Exit 146, McDonald Parkway, Follow to Springs Road & take a Left, About 1/2 mile down on Right 15th
Ave NE, 2nd Road on the Right, 2nd house on the Left.
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.
As the property owner or authorized representative, I have received the above referenced permit(s) as
requested in the application for service EHPR-04-2016-23727 by the following method(s):
Received in Person
Eacsimile Transmittal (Return form with signature required)
lectronic 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: 05/06/2016
---- Owner/Authorized Representative Signature
Date
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted y _ a.II A i% AN& (name of person s nding permit)
Signature YC3� $ 1 � Date/Time is • i 0 q,,1,
Method: Fax './ L;mail US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
___
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elipcmiii 05/06/2016 10:05 Page 4 of
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t3A CATAWBA COUNTY E + 4a r} • 0 Case ft AUTH-05-2016-072077
Public Health Department + r ' .'.Y' Subdivision
ti Environmental Health Division �t PINK 371312858761
0 K PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 r eu .. F 0 • LOT/1 6-11 PT 5
lg.2 ,.
8 ran
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•NAME ON PERMIT: VANG PENG, 1511 21ST ST NE, HICKORY NC 28601
Site Address: 1511 21ST ST NE, HICKORY NC 28601
Property Size: Square Feet:39,639.60 Acres:0.91
Directions: 140 Exit 146, McDonald Parkway, Follow to Springs Road & take a Left, About 1/2 mile down on Right 15th
Ave NE, 2nd Road on the Right, 2nd house on the Left.
Authorization to Construct Permit
Authorization to Construct Wastewater System (Required for Building Permit}
* See site plat and number of additional attachments ( ).
Proposed Wastewater System: *REPLACEMENT OF SEPTIC TANK ONLY* Wastewater Flow 360 g.p.d
Type: IIA-CONV SYSTEM (SINGLE-FAMILY OR 480 GAD OR LESS)
Soil LIAR: _ g.p.d./ft2
Permit Category: Repairs
Type of Facility: Primary Residence - house
Basement? Yes Basement Plumbing?No Bedrooms: 3
Wastewater System Requirements
Tank Size: New Tank 1,000 gal Pump Tank gal Grease Trap gal
Dosing Volume gal Pump Specs: GPM @ TDH
Pressure Head ft Draw Down in
Drainfield: Total Area: sq ft Total Length: ft Maximum Trench Depth in
Aggregate Depth in Trench Width ft
Minimum Soil Cover in Minimum Trench Separation ft on center
Number of Drain Lines
Distribution: Gravity
Pre Treatment: NONE
Additional Specifications:
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.
»»> DO NOT INSTALL SYSTEM UNDER WET CONDITIONS ««<
Proposed Repair
System Class: Proposed System: Distribution Type::
Soil LTAR: g.p.d./ft2
eltpermit 05/06/2016 10:05 Page I of 4
by to CATAWBA COUNTY Case# AUTH-05-2016-072077
3- IIIL �, Public Health Department Subdivision
; Y Environmental Health Division PIN# 371312858761
PO Box 389, 100-A Southwest Blvd, Newton.NC 28658 LOD! 6-11 PT 5
1842 s.
NAME ON PERMIT: VANG PENG, 1511 21ST ST NE, HICKORY NC 28601
Site Address: 1511 21ST ST NE, HICKORY NC 28601
Property Size: Square Feet: 39,639.60 Acres:0.91
Directions: 140 Exit 146, McDonald Parkway, Follow to Springs Road & take a Left, About 1/2 mile down on Right 15th
Ave NE, 2nd Road on the Right, 2nd house on the Left.
The issuance or this permit by the Health Department does not guarantee the issuance or 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
Authorization to Construct Permit is subject to revocation if the site plan,plat or the intended use changes,or if site conditions are
altered. The Authorization to Construct 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 niven neriod of time
Megen McBride 05/06/2016
AUTHORIZED STATE AGENT APPROVAL DATE
Permit Expiration Date: 05/06/2021
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
ehpennit 05/06/2016 10:05 Page 2 of 4
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