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CATAWBA COUNTY Case# : sa'"I t ,y_ Public Health Department Subdivision 4 ill Environmental Health Division PIN# 361701366567 „wail� PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT# 1 /8342 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 Owner/Authorized Representative Acknowledgement of Permit Receipt ri /er I certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the property described above. /2 T—As the property owner or authorized representative, I have received the above referenced permit(s) as requested in the application for service RBPR-04-2016-23677 by the following method(s): /Received in Person Facsimile Transmittal (Return form with signature required) Electronic Image Transmittal/ E-mail (Return receipt required) \C, kAs the property owner or authorized representative I have reviewed and understand the specific conditions r 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 /" Owner/Authorized Representative Signature / ' 4.------ Date s//‘/ib 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 chpenn it 05/16/2016 1057 Page 3 of 3 ^?,A • CAT.a\\BACOUNTy El Case RUTH-05-2016-072415 7: Q n 2, Public Health Department cir Subdivision � • ' • - PINT; 361701366567 4 ---^• � �, s, Environmental Health Division F ' �N� PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 13•-�}a 1 • LOT# 1 /g42 o " ! CI 14" j'o r • 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 Authorization to Construct Permit Authorization to Construct Wastewater System (Required for Building Permit) * See site plan and number of additional attachments ( Proposed Wastewater System: 25% REDUCTION Wastewater Flow 480 g.p.d Type: IIIG -OTHER NON-CONY TRENCH SYSTEMS Soil LIAR: 0.275 g.p.d.lft2 Permit Category: New Septic Type of Facility: Primary Residence - Basement? No Basement Plumbing? No Bedrooms: 4 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: 1,320 sq ft Total Length: 440 ft Maximum Trench Depth 36 _ in Aggregate Depth in Trench Width 3 ft Minimum Soil Cover 12 in Minimum Trench Separation 9 ft on center Number of Drain Lines 4 Distribution: Serial 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: IIIG Proposed System: 25% REDUCTION Distribution Type:: Repair System Required? Required Soil LTAR: 0.275 g.p.d./ft2 PUMP *MAY BE* REQUIRED ehpennit 05/16/2016 10:58 Pave I of4 CATAWBA COUNTY Case# AUTI-1-05-20 1 6-0 724 1 5 .�.31.1��,�, • Public Health Department Subdivision cur, , Environmental Health Division PIN# 361701366567 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT# 1 /842 sv. 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 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 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 Svstem.s' (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 period of time Steven Price 05/16/2016 AUTHORIZED STATE AGENT APPROVAL.DATE Permit Expiration Date: 05/14/2021 No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department. ehpemiit 05/16/2016 10:58 Page 2 of 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. c 4 Sr 91 Me , �2. e- V" or l{q fc- „o et , Shy �aJ ';60 ( = loo