HomeMy WebLinkAboutAUTH-06-2016-072968.TIF $B _,ip CATAWBA COUNTY Case 4
T f r9 L Public Health Department Subdivision
< "9r3'r1 Envir<.nmental Health Division PIN# 361903115375
e„fig. - PO Box 389, 100-A Southwest Blvd,Newton, NC 28658 LOT#
/8.2 s.'
NAME ON PERMIT: DAVID QUEEN, 3846 W NC 10 HWY, NEWTON NC 28658
Site Address: 3846 W NC 10 HWY, NEWTON NC 28658
Property Size: Square Feet: 127,630.80 Acres:2.930
Directions: 70 toward Startown Rd / left Startown Rd /right 10 W/ pass under 321/about 1 mile down / lot on left
Owner/Authorized Representative Acknowledgement of Permit Receipt
I certify that lam the owner or authorized agent(owner's authorization required) representing the owner of the
property described above.
As the property owner or authorized representative, I have received the above referenced pennit(s) as
requested in the application for service RBPR-04-2016-23668 by the following method(s):
Received in Person
csimile Transmittal (Return form with signature required)
Electronic Image Transmittal/ E-mail (Return receipt required)
As the property owner or authorized representative I have reviewed and understand the specific conditions
\-7°of the permit issued, and further understand that all applicable regulatory requirements specified under the North
Carolina Laws and Rules for Sewage Treatment and Disposal Systems (15A NCAC 18A .1900), and/or
Well Construction Standards (15A NCAC 2C .0100), shall apply to the issuance of this permit and the
construction of the wastewater system and/or water supply well permitted.
Permit Issue Date: 06/01/2016
�wner/Authorized Representative Signature
Date
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted b so, M '• Si '► (name of person sending permit)
1 � t 1
Signature II j$ u ut a if S Date/Time
Method: Fax Email US Mail Other
Owner's re est to send y the above i dicated method of transmittal in lieu of signature
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ageing' 06/01/2016 09:07 Page 3 of3
r
y,A CATAWBA COUNTY 0 0 Case# AUTH-06-2016-072968
T fa'9�G� Public Health Department rza . --P Subdivision
< si Environmental Health Division ti•o •o f PIN# 361903115375
�113t 2 „ PO Box 389. 100-A Southwest Blvd,Newton,NC 28658 LT. LOT#
L. v . .
NAME ON PERMIT: DAVID QUEEN, 3846 W NC 10 HWY, NEWTON NC 28658
Site Address: 3846 W NC 10 HWY, NEWTON NC 28658
Property Size: Square Feet: 127,630.80 Acres:2.930
Directions: 70 toward Startown Rd / left Startown Rd / right 10 W/ pass under 321/about 1 mile down / lot on left
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 360 g.p.d
Type: IIIG -OTHER NON-CONY TRENCH SYSTEMS
Soil LTAR: 0.3 g.p.d./ft2
Permit Category: Expansion
Type of Facility: Primary Residence - modular home
Basement? No Basement Plumbing? Bedrooms: 3
Wastewater System Requirements
Tank Size: Existing 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: 450 sq ft Total Length: 150 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 3
Distribution: Distribution Box
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
. Repair System Required? Required System Class: IIIG Proposed System: 25% REDUCTION
Distribution Type:: Serial Soil LTAR: 0.3 g.p.d./ft2
ehperniit 06/01/2016 09:08 Page 1 of4
,SS CATAWBA COUNTY Case# AUTH-06-2016-072968
s •
.Q' rr: Public Health Department Subdivision
< Environmental Health Division PIN# 361903115375
`-4 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT#
/g 2 ,.
NAME ON PERMIT: DAVID QUEEN, 3846 W NC 10 HWY, NEWTON NC 28658
Site Address: 3846 W NC 10 HWY, NEWTON NC 28658
Property Size: Square Feet: 127,630.80 Acres:2.930
Directions: 70 toward Startown Rd / left Startown Rd / right 10 W/ pass under 3211 about 1 mile down/lot on left
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 Rides for Sewage Treatment and Disposal Systems' (15A NCAC ISA
.1900). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to
function satisfactorily for any riven neriod of time
Megen McBride 06/01/2016
AUTHORIZED STATE AGENT APPROVAL DATE
Permit Expiration Date: 06/01/2021
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
ehpemtil 06/01/2016 09:08 Page 2 of
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