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Home My WebLink AboutIMPV-05-2016-072410.TIF ,(� CATAWBA COUNTY Case# .t* � , Public Health Department Subdivision � : l Environmental Health Division PIN# 361701366567 PO Box 389. 100-A Southwest Blvd. Newton. NC 28658 LOU 1 78.2 s. NAME ON PERMIT: JAMES (EARL) ANDERSON, 5915 PICNIC WOODS RD, JEFFERSON NC 21755 Site Address: 4979 HICKORY LINCOLNTON HWY, LINCOLNTON NC 28092 Property Size: Square Feet: 175,546.80 Acres:4.03 Directions: RIGHT ON SOUTHWEST BLVD, RIGHT ONTO WEST C ST, GO 6.1 TURN LEFT ON HKY LINCOLNTON HWY, 2.8 Ml PROPERTY ON RIGHT, RD TO LEFT HAS ACCESS TO THE PROPERTY Owner/Authorized Representative Acknowledgement of Permit Receipt 7 7 //J I certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the property described above. grAs the property owner or authorized representative, I have received the above referenced permit(s) as requested in the application for service RBPR-04-2016-23677 by the following method(s): -, /Received in Person Facsimile Transmittal (Return form with signature required) Electronic Image Transmittal/E-mail (Return receipt required) / KAs 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: 05/15/2016 /� JJ Owner/Authorized Representative Signature /�/`2✓�iG� Date Sf/‘//b 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/ENCustomerService chpermit 05/16/2016 10.57 Page 3 of3 ' 7. '=f Case# 4A � CATAWBA COUNTY 0 � o � IMPV-05-20 1 6-0724 1 0 C' r�� Public Health Department f; . -r ., Subdivision p YvCti. �) Environmental Health Division r :- oft PIN# 361701366567 /842 PO Box 389, 100-A Southwest Blvd,Newton, NC 28658 4- r • LOT# 1 842 s, "ti —'y J CI Sr NAME ON PERMIT: JAMES (EARL) ANDERSON, 5915 PICNIC WOODS RD, JEFFERSON NC 21755 Site Address: 4979 HICKORY LINCOLNTON HWY, LINCOLNTON NC 28092 Property Size: Square Feet: 175,546.80 Acres:4.03 Directions: RIGHT ON SOUTHWEST BLVD, RIGHT ONTO WEST C ST, GO 6.1 TURN LEFT ON HKY LINCOLNTON HWY, 2.8 MI PROPERTY ON RIGHT, RD TO LEFT HAS ACCESS TO THE PROPERTY Improvement Permit Facility: Primary Residence Permit Category: New Septic Bedrooms 4 WATER SUPPLY: Public Water Basement? No Basement Plumbing? No INITIAL SYSTEM SPECIFICATIONS Permit Valid: Expires In Five Years: _X_ No Expiration: Projected Daily Flow 480 g.p.d Proposed Wastewater System: 25% REDUCTION Type: 111G -OTHER NON-CONY TRENCH SYSTEMS Permit Conditions: REPAIR SYSTEM SPECIFICATIONS Repair System Required? Required Proposed Wastewater System: 25% REDUCTION Type: 1IIG -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. Steven Price 05/15/2016 AUTHORIZED STATE AGENT APPROVAL DATE 05/13/2021 Permit Expiration Date: No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department. ehpermit 05/16/2016 10:57 Page 1 of 3 RBPR 04-2016-23677 4979 Hickory Lincolnton Hwy,Lincolnton • Do not cut, drive, fill, or grade over septic or repair areas. • Septic system must be 10 ft from property lines; 50 ft from wells; 5 ft from building foundations and appurtenances; 10 ft from water lines; 5 ft from driveways; and out of right-of-ways and easements. • Install a 1,000 gallon septic tank and 440 linear feet of 25%reduction system; (4) 110 ft lines on contour. • Final grade of septic area must shed surface water off and away from system. • se 4j 5 kl 339' 'it, fit. If' Ner t4cw< 5r „o $4R + ‘0.1 + 5 aJ , e' 90 , ,\h „ r U ( = loo 404 DY- Z.,1C - 2-3C77 Catawba County Environmental Health l�2 (2; ROB HEAVNER FARM RD l�: 4ti C,tiL oy A\1/4amoopr 00 Parcel: 361701366567, 4979 HICKORY 1 in=100ft • LINCOLNTON HWY LINCOLNTON, 28092 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 DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF PUBLIC HEALTH,ENVIRONMENTAL HEALTH SECTION eig DY_ 7°4 L 36 7 7 PROPERTY ID Shee(4r of ( ON-SITE WATER PROTECTION BRANCH COUNTY:nA SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM ( A - // (Complete all fields in full) OWNER: J e^9 (p'cdil N _ APPLICATION DATE ADDRESS: DATE EVALUATED: 45.2iii. PROPOSED FACILITY: PROPOSED DESIGN FLOW(.1949): 77o PROPERTY SIZE: LOCATION OF SITE: 5/F 7 9 LTS2k+ c G+'r.c.41 A_[., 11✓y PROPERTY RECORDED: WATER SUPPLY: ❑Private .Public ❑Well ❑Spring ❑Other EVALUATION METHOD: ❑A%er Boring lAttil ❑Cut TYPE OF WASTEWATER: Sewage U Industrial P.rocess ❑Mixed O 4 - ""'i .n++., SOIL MORPHOLOGY ' `T` OTHE - - ' '. ` �' ...�+ fi<, ^.: (1941 x , v' -PROFILE rFACTORS - .� -.-' . - .1940 ! . -y if „;E ACAPE HORIZON - POSITIONL - ` DEP'IH q . << SLOPE% ,r 1941 r SOU .1943 � .1956 .1944 CLASS 4 'x :r , STRUCTURE/. CONSISTENCE! WETNESS! SOIL v k` S PRO RESTR ;&LTAR s ` TEXTURE MINERALOGY COLOR 'DEPTRxi LASSr HORIZ„ia+.Sx _ � ,.'i' o - 7 itig fGC �e Ser PS t-} 7- 313 S6,L L rot SE- WA- ,5-L At+ riff- 0_,t.'71- 1 5'` 3 c - sZ "s.6/c C l>2 J� • 0-Z? `"'& cc-c- ig 're- 7 aSic c � f All- S o Al ✓e f i l 2 33 se- ae- c- re- 3 ,AA_ l. ) 1Z-sy S �6 3yAd 4-S6 k- cc fer 6 .3 4 DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): Available Space(.1945) . SITE CLASSIFICATION(.1948): �rt b___ Gd( - 1 EVALUATED SENT: k System Type(s) 1� OTHER(S)PRESENT: Site LTAR V.2,-?)-- 0- r,lf 1 COMMENTS: Updated February 2014