HomeMy WebLinkAboutIMPV-05-2016-072750.TIF OM :COOL PARK PUMP ING, INC. FAX NO. :828 256 2926 Jun. 06 2616 05: 15PM P1
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CATAWBA COUNTY Casco _ _
® /a.�(f{ Fublic Flcalth Department Subdivision
q; '`Ray Environmental Health Division PIN# 377302663313
`� PO Bo, 389. 100-A Southwest Blvd.Newton.NC 28658 LOTu
NAME ON PERMIT: MATTHEW COHN, 4541 LOOKOUT DAM RD, CATAWBA NC 28609
Site Address: 4541 LOOKOUT DAM RD, CATAWBA NC 28609
Property Size: Square Feet:1,134,738.00 . Acres:28.05
Directions: HWY 3218/HWY 16 N/RT OXFORD SCHOOL RD/STRAIGHT TO LOOK OUT DAM RD/DRIVEWAY ON
RT AFTER TREE NURSERY
1 Owner/Authorized Representative Acknowledgement of Permit Receipt
_1 certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the
property described above.
1s the property owner or authorized representative,I have received the above referenced permit(s)as
requested in the application for service RBPR-04-2016-23889 by the following method(s):
Received in Person
csimile Transmittal (Return form with signature required)
Electronic Image Transmittal/ E-mail (Return receipt required)
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 (13A 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: 05/25/2016
�� Owner! uthorized Representative Signature .�_ i `ACI A I
Date ---11 -- t!/
Documentation of Permits)Transmittal
(permit transmitted by electronic or other means)
s MI
Permit va fitted • ���ll��r it�s (name ofperson.tendlrr/gpermit)
Signature lint_h Ake ( t e Date/I'ime5?sit tU
Method: Fax \,..,4MailUS Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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ehpermn 05/31/2016 14:33 Page 3 o13
ys • CATAWBA COUNTY o • 7-
-G-r f o Case# IMPV-05-2016-072750
.F' T.r5� Public Health Department 7�. i} Subdivision
4 LE61! y Environmental Health Division I4' r r 't :1 PIN# 377302663313
� .-1 PO Box 389, 100-A Southwest Blvd,Newton. NC 28658 r r G I''G C h LOT#
Ig42 :. ,• — #
NAME ON PERMIT: MATTHEW COHN, 4541 LOOKOUT DAM RD, CATAWBA NC 28609
Site Address: 4541 LOOKOUT DAM RD, CATAWBA NC 28609
Property Size: Square Feet: 1,134,738.00 Acres:26.05
Directions: HWY 3215/ HWY 16 N/ RT OXFORD SCHOOL RD/STRAIGHT TO LOOK OUT DAM RD /DRIVEWAY ON
RT AFTER TREE NURSERY
Improvement Permit
Facility: Primary Residence - house
Permit Category: Expansion Bedrooms 5
WATER SUPPLY: Private Well
Basement? No Basement Plumbing? No
INITIAL SYSTEM SPECIFICATIONS
Permit Valid: Expires In Five Years: _X_ No Expiration:
Projected Daily Flow 600 g.p.d
Proposed Wastewater System: 25% REDUCTION
Type: IIIB - SYSTEM W/SINGLE EFFLUENT PUMP
PUMP REQUIRED
Permit Conditions:
REPAIR SYSTEM SPECIFICATIONS
Repair System Required? Required
Proposed Wastewater System: 25°f°REDUCTION
Type: IIIB - SYSTEM W/SINGLE EFFLUENT PUMP
PUMP 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' (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 05/25/2016
AUTHORIZED STATE AGENT APPROVAL DATE
05/25/2021
Permit Expiration Date:
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
ehpermit 05/31/2016 14:33 Page 1 of 3
ZP I AG be t nsion gBPR d{-2o16-j3yy
45111 1,o0Kot4 Den Rd. CctLk
kEws}in%% h0. is • beciroomg. PropQseJ oddi4ion will have 3 ILeclroo&S• House. will 6ecor - 5 bedroorh5 -
* Pvo\ o'4 crvsl,, rind Fxckf■I( exisfiri1 SeP4 /4caj` •
*$el 'new I5o09aIlorn sep{c -lank OhS 1060 gs Il *' Furey -144.
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it will 6e necessaNi to clear -frees arc! uncler6rvst it dam!-field are .
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DEPARTMENT OP ENVIRONMENT AND NAIVIUI_RESOURCES Shut_of_
DIVISION OF ENVIRONMENTAL HEALTH PROPERTY ID it
,ON-SITE WASTEWATER SECTION COUNTY:
SOTLIST1E EVALUATION
ddee II II for ON-SITE WASTEWATER SYSTEM •
oWNER: 'rka-4keV4 ChLf, APPLICATION DATE Y-I8-I6 ( aPR-04.3.01(,-23669
ADDRESS; DATE EVALUATED: 513-IL
PROPOSED FACILITY: PROPO_�DES GNFLOW 61949): GOb . PROPERTY SUM: -0 5 Oc,ys
LOCATION OF SITE: 4591 Lool< Dam fill, Cc�,�tv4 o PROPERTY RECORDED:
WATER SUPPLY: 1 Pirate 0 Public 4 Well 0 Spring 0 Other
EVALUATION METHOD: 0 Auger Boring ® Pk 0 Cut
TYRE OF WASTEWATER: ® Sewage 0 Indust:dal Process 0 Mixed
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DESCRIPTION D.znALSYSTEM ItEPAIRSYSiEM OTHER FACTORS(.1946):
Mailable Spare(.1945) r5 pS SITE CLASSIFICATION(.1948)): p
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COMMENTS:
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