HomeMy WebLinkAboutIMPV-06-2016-072990.TIF 4 N'. CATAWBA COUNTY Case# IMPV-06-2016-072990
ti ill ,2, Public Health Department Subdivision
Z ,���2 4 w ,; Environmental Health Division PIN# 470001178019
�WW- PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT#
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NAME ON PERMIT: JIM ESTES, PO BOX 376, TERRELL NC 28682-0376
Site Address: 1410 BROWN CHAPEL RD, CATAWBA NC 28609
Property Size: Square Feet: 30,492.00 Acres:0.7
Directions: Hudson Chapel Rd, Right on Brown Chapel, cross bridge to top of hill. On Left before Washington Lane
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
NiKproperty described above.
X As the property owner or authorized representative, I have received the above referenced permit(s) as
I requested in the application for service EHPR-03-2016-23536 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
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
Owner/Authorized Representative Signature
____)
Date
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit trans, it -d .y _i tte,1 t,/MI I (name of person sending permit)
Signature Zl�� affil ] sS Date/Time V CV.
Method: Fax {mail US Mail Other
Ow er's r quest to send by the above indicated method of transmittal in lieu of signature
--��� nr� � 14
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ehpermit 06/02/2016 08:57 Page 3 of 3
„ys CATAWBA COUNTY 0 Case# IMPV-06-2016-072990
[Al„4 Public Health Department �y
1 � •• Subdivision
Environmental Health Division f . • r PIN# 470001178019
PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 r � q•F LOT#
/842 s• —' r �
1
8 G a-;
CI • •
NAME ON PERMIT: JIM ESTES, PO BOX 376, TERRELL NC 28682-0376
Site Address: 1410 BROWN CHAPEL RD, CATAWBA NC 28609
Property Size: Square Feet:30,492.00 Acres:0.7
Directions: Hudson Chapel Rd, Right on Brown Chapel, cross bridge to top of hill. On Left before Washington Lane
Improvement Permit
Facility: Primary Residence - House
Permit Category: New Septic Bedrooms 3
WATER SUPPLY: Private Well
Basement? No Basement Plumbing?
INITIAL SYSTEM SPECIFICATIONS
Permit Valid: Expires In Five Years: _X_ No Expiration:
Projected Daily Flow 360 g.p.d
Proposed Wastewater System: 25% REDUCTION
Type: IIIG -OTHER NON-CONY TRENCH SYSTEMS
Permit Conditions: *Septic system does not get a 25% reduction.
*400 linear feet of drain line required
*48 inch trench depth required
*This permit Is issued in accordance to the design submitted by Ashley Rollans LSS.
REPAIR SYSTEM SPECIFICATIONS
Repair System Required? Required
Proposed Wastewater System: 50% REDUCTION
Type: IVA-ANY SYSTEM WITH LPP DISTRIBUTION
PUMP REQUIRED ***** OPERATOR 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' (I5A 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.
Robbie Phelps 06/01/2016
AUTHORIZED STATE AGENT APPROVAL DATE
06/01/2021
Permit Expiration Date:
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
ehpumit
06/02/2016 08:57 Page I of 3
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