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gA �� THIS IS NOT A PERMIT Case # RBPR-06-2016-24020
v •e CATAWBA COUNTY HEALTH DEPARTMENT }0
PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ;I r • •. r ti
842 t�, Residential Building Plan Review - Manufactured Home o • �•o
Y.' 1
EXS SYSTEM
Contractor SAME AS OWNER, ,
Owner KA WALL INVESTMENTS LLC (KEN WALL),20359 CHRISTOFELE DR, CORNELIUS NC 28031
C:704-617-2565
NAME TO APPEAR ON PERMIT
KA WALL INVESTMENTS LLC (Ken Wall)
SITE ADDRESS: 3090 LEE ST, CONOVER NC 28613 PIN # 376005191831
NAME of SUBDIVISION: Lot# 5-6&9-10 Section/Block
PROPERTY SIZE: Square Feet Acres 0.63
DIRECTIONS: Emmanuel Church RD to Keistler RD , right on Zebulon, right on Lee ST, 2nd space on right
PRIMARY CONTACT: Owner WER TYPE: Septic Tan
GALLONS PER DAY: 240 _ - . •• • : Community Well
DESCRIBE WORK: Changing out Mobile Home 2 BdRm SW 14x66 w/ Decks: Fronf& Back 6x6
SITE INFORMATION
Do any of the following apply to the property for which this application is applied?
If the answer to any of the questions below is"YES", then supporting documentation is required:
Does this site contain any jurisdictional wetlands? No
Does this site contain any existing wastewater systems? Yes
Is any of the wastewater going to be generated on the site other than domestic sewage? No
Is the site subject to approval by any other public agency? Yes
Are there any easements or right-of-ways on this property? No
APPLICATION FOR: Existing Structure
STRUCTURE TYPE: PRIMARY RESIDENCE
FACILITY TYPE: Mobile Home OTHER DESCRIPTION:
DESCRIPTION OF 12x56 SW - to be removed
EXISTING STRUCTURES
ON SITE (IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 2
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: 14x66 w/Decks: front& back 6x6
#OF NEW BEDROOMS:: 2
Desired system types (Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL:
OTHER: INNOVATIVE: ANY: YES
Other described:
E9-ehapplication 06/21/2016 16:12 Page 1 of 4
Iz CA AWItA COUNTY Case# RBPR-06-2016-24020
�' L�] G Public Health Department Subdivision
V .°"�
„ ��ti „�, Environmental Health Division PINA 376005191831
PO Box 389. 100-A Southwest Blvd.Newton,NC 28658
IH. o
NAME ON PERMIT: KA WALL INVESTMENTS LLC ( KEN WALL),20359 CHRISTOFELE DR, CORNELIUS NC 28031
KA WALL INVESTMENTS LLC ( Ken Wall)
Site Address: 3090 LEE ST, CONOVER NC 28613
u
0.63 Pro
Property Size: S 9 re Feet Acres
Directions: Emmanuel Church RD to Keistler RD , right on Zebulon, right on Lee ST, 2nd space on right
Improvement Permits issued as a result of this information are valid for 5 years or may be non-expiring under certain specified conditions.An
Authorization to Construct issued by this department is valid for(5)five years from the date issued and is not transferable; Improvement Permits and Well
Permits are transferrable. Permits may be revoked if the information on this application,site plans or intended use changes for the proposed facility.
I have read this application and certify that the information provided herein is true,complete and correct. Authorized county and state officials are granted
right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the
proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed.
Date: _ Signature of Applicant or Agent
An Environmental Health Specialist will contact you within 5 working days of application date.
If you need further information or assistance please call 828-466-7291
AREA2
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Existing Tank Check Fee 06/03/2016 $80.00
r" 1�I •nmulMh" t i ild 111911u n i t It 77� JII 1 7;
III" TOTAL R;EES 1 olliJ, .111 tiaaill IIIIIII��i��(Illl(li�lif 11 1 1.i771a�(I�ll(1(IImLi �Sg OOP
ryi1111 r ln9lllP p; ql�i
I illumaw U an I '� Y �n,.�IS,IWIIfWPJIur� 1'ttitl f�.�(MWm.
FEES ARE NON-REFUNDABLE
ONCE A SITE VISIT IS MADE OR
WORK ON A PLAN REVIEW HAS COMMENCED
SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
09-ehapplicatinn 06/21/2016 16:42 Page 2 of 4
THIS IS NOT A PERMIT Case # RBPR-06-2016-24020
;5: ' a CATAWBA COUNTY HEALTH DEPARTMENT D ;W:kg
� ' :k y.
L �t PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES
Ig42 sM Residential Building Plan Review - Manufactured Home o o T
Y• H
EXS_SYSTEM a o f moo"
Contractor SAM AS OWNER, ,
Owner KA WALL INVESTMENTS LLC (KEN WALL), 20359 CHRISTOFELE DR,CORNELIUS NC 28031
C:704-617-2565
NAME TO APPEAR ON PERMIT
KA WALL INVESTMENTS LLC (Ken Wall)
SITE ADDRESS: 3090 LEE ST, CONOVER NC 28613 PIN # 376005191831
NAME of SUBDIVISION: Lot# 5-6& 9-10 Section/Block
PROPERTY SIZE: Square Feet Acres 0.63
DIRECTIONS: Emmanuel Church RD to Keistler RD , right on Zebulon, right on Lee ST, 2nd space on right
PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank
GALLONS PER DAY: 240 WATER SUPPLY: Private Well
DESCRIBE WORK: Changing out Mobile Home 2 BdRm SW 14x66 w/ Decks: Front & Back 6x6
SITE INFORMATION
Do any of the following apply to the property for which this application is applied?
If the answer to any of the questions below is"YES", then supporting documentation is required:
Does this site contain any jurisdictional wetlands? No
Does this site contain any existing wastewater systems? Yes
Is any of the wastewater going to be generated on the site other than domestic sewage? No
Is the site subject to approval by any other public agency? Yes
Are there any easements or right-of-ways on this property? No
APPLICATION FOR: Existing Structure
STRUCTURE TYPE: PRIMARY RESIDENCE
FACILITY TYPE: Mobile Home OTHER DESCRIPTION:
DESCRIPTION OF 12x56 SW-to be removed
EXISTING STRUCTURES
ON SITE (IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 2
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: 14x66 w/ Decks: front& back 6x6
#OF NEW BEDROOMS:: 2
Desired system types (Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL:
OTHER: INNOVATIVE: ANY: YES
Other described:
09-ehapplicatnon 06/21/2016 13:14 Page I of4
se CATAWBA COUNTY case tt RBPR-06-2016-24020
„fit!'"y Public Health Department Subdivision
<IR•e ^< Environmental Health Division PIN# 376005191831
�r"Il PO Box 389, 100-A Southwest Blvd.Newton.NC 28658
/842 w
NAME ON PERMIT: KA WALL INVESTMENTS LLC (KEN WALL),20359 CHRISTOFELE DR, CORNELIUS NC 28031
KA WALL INVESTMENTS LLC ( Ken Wall)
Site Address; 3090 LEE ST, CONOVER NC 28613
Property Size: Square beet Acres 0.63
Directions: Emmanuel Church RD to Keistler RD , right on Zebulon, right on Lee ST, 2nd space on right
Improvement Permits issued as a result of this information are valid for 5 years or may be non-expiring under certain specified conditions.An
Authorization to Construct issued by this department is valid for(5)five years from the date issued and is not transferable: Improvement Permits and Well
Permits are transferrable. Permits may be revoked if the information on this application,site plans or intended use changes for the proposed facility.
I have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state officials are granted
right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the
proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed.
Date: Signature of Applicant or Agent
An Environmental health Specialist will contact you within 5 working days of application date.
If you need further information or assistance please call 828-466-7291
AREA2
iIl 11p�l �� I r ail tl Mle. t w�.Alt,�g ._ ..9 r 16;- -.r G
.
EENAME I ' 7WdIIL��Il �i l II DATE : : � EE?AMOUT
Existing Tank Check Fee 06/03/2016 $80.00
41 1I ITOTAL FEES?" ti 1 tinn + , 11' r """I r
'(( �R�.. a.R�i���hlll „ud�etiG I�yJLI�I�I�IIiIIU�I��� :�rt: $s000l
�l p 1 " t 1, Ilfllllliial a'I n tun,W!11 mash' -ttI illE IS111111111L 101111ut? rsglthi in mono niziAtningl
FEES ARE NON-REFUNDABLE
ONCE A SITE VISIT IS MADE OR
WORK ON A PLAN REVIEW HAS COMMENCED
SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
E9-ehapplical ion 06/21/2016 13:14 Page 2 of 4
�A �� THIS IS NOT A PERMIT Case # RBPR-06-2016-24020
a CATAWBA COUNTY HEALTH DEPARTMENT 0 Vi ''�� �
SW, PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ��.'•
\--k841-4. Residential Building Plan Review - Manufactured Home
EXS_SYSTEM
Contractor SAME AS OWNER,,
Owner KA WALL INVESTMENTS LLC (KEN WALL), 20359 CHRISTOFELE DR,CORNELIUS NC 28031
C:704-617-2565
NAME TO APPEAR ON PERMIT
KA WALL INVESTMENTS LLC (Ken Wall)
SITE ADDRESS: 3090 LEE ST, CONOVER NC 28613 PIN # 376005191831
NAME of SUBDIVISION: Lot# 5-6&9-10 Section/Block
PROPERTY SIZE: Square Feet Acres 0.63
DIRECTIONS: Emmanuel Church RD to Keistler RD , right on Zebulon, right on Lee ST, 2nd space on right
PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank
GALLONS PER DAY: 240 WATER SUPPLY: Private Well
DESCRIBE WORK: removing existing mobile home and replacing with a 14x66 2 bedroom mobile home
SITE INFORMATION
Do any of the following apply to the property for which this application is applied?
If the answer to any of the questions below is"YES", then supporting documentation is required:
Does this site contain any jurisdictional wetlands? No
Does this site contain any existing wastewater systems? Yes
Is any of the wastewater going to be generated on the site other than domestic sewage? No
Is the site subject to approval by any other public agency? Yes
Are there any easements or right-of-ways on this property?
APPLICATION FOR: Existing Structure
STRUCTURE TYPE: PRIMARY RESIDENCE
FACILITY TYPE: Mobile Home OTHER DESCRIPTION:
DESCRIPTION OF 12x56
EXISTING STRUCTURES
ON SITE(IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS:
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: 14x66
#OF NEW BEDROOMS:: 2
Desired system types(Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL:
OTHER: INNOVATIVE: ANY: YES
Other described:
E9-ehapplication 06/21/2016 13:04 Page 1 of 4
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. h CATAWBA COUNTY HEALTH DEPARTMENT
, ,- "tea Application for Environmental Services Page 1
1
Improvement,Permit Authorization to Construct❑ i' Septic Repair❑ Septic Malfunction❑
I Septic+Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment❑.
Well Repair ❑ Existing System Inspectioui(Pre-Approval Required) ,
Application is for N�w Construction ❑ Existing Facility D.-- m [/ n
Property,Address nqo LP tree-t Subdivision Covn+ry Knolls W 4 A4re,&L
i vio 'r 1 1 r • Lot# vl Acres
Section/Block/Phase
Driving Directions to Property e ni 4/10,iue( ii` ehvch Ro Q"6 K P(S-1-1.07-7-Ed i 113 YI+ Or)
�. //UN / ri'gh-(- or l Pe S-r / 2cdt' On ,_ righ f
NAME TO APPEAR ON PERMIT? [Owner ❑ Applicant ❑ Contractor
Applicant'Contact Information
Name. '}K r} 1A.oil, Ues-t(no n-t- 1 (.U-
Address:Q7035q I hri5 +off1le Ur co rile (iu5 AI( . 263,I
Phone ! Cell Phone 70c' c/7-a5Co5
•
-Owner„Co ntactlnformat io n
Name }{Q n woo
. iAddress:, 31 IChr SStvI tr br co( e f wu s Au! p4/051
Phone,.70\1 f , 2:5-60 c— I Cell Phone '7o 4 CQ17 2s-eiSl
Contractor Contact Information
■Name
,Address
Phone I Cell Phone
WHO WILL BE,THE PRIMARY CONTACT? aOwner ❑ Applicant ❑ Contractor
Description of Existing,Structures on Site (r.2' X 5CP %Vl nhi"le ho pfd: -
#ofBedrooms *j'I Structure Dimensions,, 'c �'#ofOccupants 5
' Basement ❑ Yes IV.- o Basement Fixtures CI Yes p , o 4 ,, :
The Applicant shall'potifyithe'locaLhealth department upon submittal of this applicationyifany`of the'following apply to
the property question. If the answer to any question is"yes", applicant'must attach supporting documentation.
p es C'I No Does'the site contain any jurisdictional wetlands?
Yes ;' No ' Does the site contain any existing wastewater systems?
Des 1C?No Isjany wastewater going to be generated on the site other than domestic sewage?
tir Yes i'Alo Is the site subject to approval by any other public'egency?
Yes !e3igo , Are there any easements or right of ways do this.property?, Describe ..
Existing water•supplytin use L Individual Well [J'CominunityWell ❑ SemiL Public Well
❑ County/City/Township Water Line I Is a public water ,supply available?'** ❑ Yes „❑No
If applying.for an Improvement Permit or Authorization to-Construct 9Please Indicate Desired System Type(s):
(systems ban be ranked in order of your preference)
❑ Accepted O Alternative ❑ Conventional . ❑,Innovative ❑ Other ❑ Any
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*'h^ s ,I;Ti`N:r''7-W :Y' b,°I4"1M ,r,am:,. .
CCTA 1,A ' HS IS NOT A PERMIT
counry , t� CATAWBA COUNTY Y HEALTH DEPARTMENT
-".4,7441 4 f '
:... iAppltcationior Environmental Services
Page 2
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Proposed r'Reside Type / ❑ s �` of ew,Be 8f c ,
❑ Pnmary Residence. ❑ New Residence Addition to Residence .,.#of New Bedrooms *t '
z„ _mob !e ham e ' ,replacemen n d [c _:�CoYlo _race lex(e.
Project Descnptton • �
Structure Dimensions '.11-kV<„Jp(p - #of Occupants;'
Basement ❑ Yes [ N r ,<,Basement Fixtures'nixes
,. .. ,,. _ _ o ...
Li Accessory,.Structure(s) Describe'
#of New Bedrooms *t if applicable Structure Dimensions
#'of Occupants Accessory,Dwelling ❑ Yes ❑No
Plumbing ii,Yes,❑,No ,Describe Plumbing Needed . ' ;:, ,
U Multi-Family Residence#Units ry "#Bedrooms.per Unit*t
Total#Bedrooms"t Structure Dimensions
U Food'Service ''Specify Type..
# Seats Floor,Space-Entire Food Service Facility,,,(Sq Ft)
#.Employees;per Shift . #of Shifts:, ], Dining Area(Sg. Ft.)__.
Li Business*Specific Type'ofBusines§ ''.''';,:;!' . „, ;11';'1:11!111,"t, :1:'C ' Retail Floor Space
# of Employeesper Shift #ofyShifts
❑ Other Facility Type'Specify`
If Church#of Seats! . ,Kitchen D'Yes I i❑No If Daycare Specify Occupancy
Application for` WelFCo'nstruction/Abandon nent/Repatr
Proposed Well;Type ❑ Individual Well ❑ Semt Public Well ❑,Community Well
Abandonment Type ❑ Drilled :❑',Bored;, • . .® Dug "❑ ,Unknown
' ' Describe
Well RepadrrRegbested ,❑ Yes;❑ No ,.:
1 -
Calculated Design Flow, Commercial t Additional information maybe required to determine
design flow from certain facilities This value'wi l be determined during consultation with on7site staff
*Any room that will be intended for.sleeping at the tune of construction or for future consideration should be noted as a bedroom and
counted on all applications The number of bedrooms will be confirmed by rooms,identified on'house plans as a bedroom at the time
of building permit issuance [This duty preventthe need:for septic system size increase in the future. .
t If structure is plumbed but tno,bedrooms,calculated'design flow is required. .
** If No,a well permit must be}issued with the'Authorization to Construct. '
SYSTEM REDESIGN;AND/OR RETRIP WILL INCUR AN ADDITIONAL CIIARGE'(SEE FEE'SCHEDULE)
Improvement Permits issued as a result of thus deformation are valid for 5 yearsor may be non expiring under certain specified
t a„ , ,
conditions t'An Authorization to Construct issued by thusidepartrnent is'valid for(5)five years from the date issued'and is not
transferable Improvement Permits"and WelfPermns are transferrable Permitsemay be revoked if the information on,this application,
site plans or intended use changes.for the proposed facility: j- . ',
I have read this application and :certify that theinformation'provided,herein is true,,complete and correct'Authorized county and state
officials are grantedright ofentry,to conduct necessary inspections to`determine'compliance with:applicable laws andrules. I
understand that I amtsol'ely responsible for the proper identification'and labeling,of all property'linesta id comers and making the site
accessible so diet a complete site evaluatibn'cad be performed. '
Signature of Owner or Agent , / !/(/ / Date id-3-o?0160
Printed Name of Owner or Agent ' iCCM/- Gi. l
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Parcel: 376005191831,, 3105 SANDFORD ST 1in=50ft
CONOVER, 28613f !.
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This map/report product was prepared from the Catawba County,NC Geospatial Inforaiation Services .Catawba County has made substantial karts,i ,10' ,. ■s '
to'ensbre the accuracy of location and labeling information!contained on this map ocdata on this report:Catawba County promotes and recommends,. Its...s51- • ft
the independent verification of any data contained on this map/report product by th&user.`,The County of Catawba its employees agents and ;Iiir
personnel,disclaim,and shall not be held liable for any and all damages loss or liabilityc whether direct indirect or consequential which arises or may
arise from this map/repoft product or the use there'of by any personlotentity. • 'tir - ' tql, : .',. fleck,w,,,...rop,,:, !.17,
. • Copyright 2014 Catawba County NC ,s •s.lc toro.., Nll'ip - •,.., ,
. 41 . ''•,',!!!:1' ! ;!06/03/2016
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. - '..1Parcel,Report -.' II I
Parcel Report -Catawba County NC
Dr
Parcel Information: Owner Information: • ;!' -tt Ill;;;It.' ;)
' • . —. Parcel ID 376005191831 I Owner KA WALL INVESTMENTS LLC
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(farce' Address: 3105 SANDFORD ST Owner2: null
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City: CONOVER,t28613 Address: 20359 CHRISTOFLE DR • .- ;;I:' 'ft.
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LRI<(REID): 38614 Address2: null
Deed Book/Page 3219/1740 City: CORNELIUS
Subdivision: null I State/Zip: NC i6031-7057
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Lots/Block: 5-6 8(.9-10/null
I ' School Information:
Last Sale:
School District: COUNTY
Plat Book/Page: 29/76 '
e Elementanj SChool: CLAFIEMONT
Legal:: LOT 5'26 &t9-10 5-6 & 9-10 PL 29r76 PL
Middle Seh661:,RIVERIBEND
29-76 tt
I High School: BUNKER HILL
r• Calculated Acrea6e: :630
f. t , 0: .
Tak Map: 0741402018F 1 School Map.
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ToWnlehip: NEWTIONI•
State'Road #: null
Ta)WaliiejnforrnatiOn: Tax Rates(pdf)I Zoning information:
Cify Tax District:All trl-County Zoning-DiCffict dOuNTY
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County:Fire District: CLAREMONT RURAL Zoningl: R-20
Budding(s)ValUe:;$0: ZoninIa2: null
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Land Value: $10,2004 i Zonirid3: null
il: 4,
Assessed Total V $10,200 Zonin
alue: g;Overlay:WP70
Year Built/Reniodeled:mill/mill SmallArea:,CATAWBA•
•
Current Tax Bill . I Split Zoning Districts: null/null I
Zoning Apenci•Plione Numbers
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Miscellaneous:' 1 .If Firm PanelDate: 2007-09-05
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Iitr-Building'perinitsfor this parcel. I Firm Panel #: 3710376000,1
Building Details I ' "II,•-tiiII!1 :” ,
2010 pensue,Block:-1057
WaterShed: WS-IV Protected Area 1 2010 Census Tract: 011401
Voter P22
I Agricultural'Distriat:
'ParbetRepon Data Descriptieins
List all Owners , Deed HistoryiReport Assessment Report
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This map/report product was prepared from the Catawba County.NC Geospatlal Information Services.Catawba co urity has made dubstandal efforts to ensure
the accuracy of kali?and pl4bollrig Information contained on this map or data on this reporl.:Critawba County promotes and recommends the Indoperildent
verification of an'y data contained on this map/repOd product by;the'tier.The County of Catawba,Its employees,agenda,and Personnel,disclaim and shall not be
' ..,iheld liable for any and all dainOgei,loss or Ilablidy,whether direct,Indirect or consequential which arises or may arise iron,this mapirepont product on the use
thereof bii any person or eddy.
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@2016, Catawba County Gcniernment, North CVali
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CATAWBA COLLTYHHEAT.TH DEPARTMENT r 70
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NEWTON, NORTH CAROLINA t t
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i COMPLETIONIPERMIT FOR SEPTIC ,TANKS
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. . PERMIT N! :3549
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.! . i .DATE : •111.- .2$.7-ta-
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OWNER (1.0d r feti it:kills'At ft-41r ADDRESS$11 :':0: -- :AL a:' .me„.",
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BUILDING CONTRACTOR ' I kugbivisibici
LOCATION . 1 . LOT # 9
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LOT SIZE , BLOCK OR SECTION:
HOUSE L),) MOBILE HOME • ( i,-)-1 BUSINESS ( 0 OTHER, ( ) THA-VA LOAN ( )
SEPTIC TANK: (SIZE F/4d'th'GALS) WATER,!SUPPLY::!'d,
NOMEDROONSJ . .1:NO : IXTU S. I niravIpp4T4 ,-, . -.:.1, 1),IJBLIC;1,1*-.
GARBAGE iNsPosAL UNIT:YES ''(' ) NO ( ) • IF'WELL%:PTiYPE :: BORED bRILLED.e..-DUC
AUTO WASHING MACHINE : YES ( ) NO ( ) DISTANCE FROM SERTIC—TA' NK ORINWAREST
NITRIFICATION FIELD: giky:47-- SQ.FT. POLLUTIONii,.: :-': -;' FT.
1). NUMBER: OF LINES ..'4,77 1 SEPTIC TA1I(90S,...r4i-l-ED BY
2) LENGTH AND WIDTH OFLINES1 i .:c_ .:ISe.e.--i': '
I 15 KL:/It 1 PERffitt FsETsS;:r,
. . - . -60-BED '-$YSTEW( t)--- ' 4'. [ - cw.DIFIdAtEah..comPttTioN BY: . - . . ..
b) iTRENCH SYSTEM ( ,) i. ,
3) DEPTH OF STONE IN LINES (0 REMARKS
ADEQUATE FALL- (GRADE) ON '
1) BUILDING .(HOUSE) SEWER LINE
YES Qt :NO. ( ): . „ ........ . . .
2) NITRIUCATION LINES : .
i • - ‘ •• ' b : ':'' — .23 -- • t
YES -(v) :NO ”( )-
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SEPTIC :TANK LAYOUT
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i CATAWPA,COUNTYG,HEALTH�IDEPARTMENT 1 2 9 4 1'
IMP.RCVE'.NT IERMI1� 'FOR SEPTIC TANKS , e�i't!•No
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MAE OF,:OWNS�R end Al {!'/7a&(:S /�C)_, . ,,On-q. f' DATE � - '.4 2 .
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)DRESS •OF OWNER , 1j 6 •c' 11-eff'GACLN / I/QU17o PHONE; 416-4=0g7C4/ ! G
-4WE 1OF,CONTRACTOR . 1 '1 ADDRESS
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��)CATION I . _:�i�
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JBDIVISION. I LOT NO. `' II SECTION OR BLOCK
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)T SIZE l FHA, rVA LOAN , .,!.;.1 .
• )USE'. ' /BUSINESS, (''POTHER', ( ) 4u SEPTIC ,TANK. LAYOUT,.
( ) MOBILE HOME u( r1 , r, ,x , , ,T , . ,• . ..
). BEDROOMS '(#) NO IFIXTURES '( )
UtBAGE DISPOSAL UNIT. YES ( ) NO ( )
SUMBING UNDER'#BASEMENT FLOOR , YES1i (''y'.) NO ( )
CZE;.OF TANK ' '7,26°0 LIQUIDg GALLONS ' ��
CTRIFICATION?}F ELD "` ' I 1
. 1'. Number?of lines i j 'V 7
• 2'. Length;ands width 1of:,lines
a..-Bedi System SV/Z 1 ft. �/S
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b. Trench system ,. i ' 1 ft.
3. Total `D'epth of.'s tone.' 7 22 / .) :I inches j'
30UNDWATERt'INTERCEPTOR}DRAIN { '
(IF REQUIRED) I I jj
4TEReSUPPLY .. IPRIVATE ( ) PUBLIC (ICY I 1 a
JNER,NOTIFIEDjTO CHECK VONING YES. ( ) NO ( ) 1
, ANER AGREES WITH LAYOUT f,YES ( ..NO ( �) y
' 1INER AGREES WITH SPECIAL INSTRUCTIONS: YES NO ( ) 41 .
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JNER OR CONTRACTOW1SI ATU f, I'S -
•ERMIT ::Fit Ai !sb?b ::, Q� ,i, I) Ili . I1 ,�a , S'c ',,; ji , S•r r. .. _.
ERMIT •VOIDIAETER 36I MONTHS r I' ` ,an. "'
11PROVEMENT, PERMIT ISSUED.BY SEPITIC TOF THIS MUST FOLLOW ALL
i'/� I DETAILS OF THIS PERMIT (LAYOUT)
9NITARIAN t'//'` S n.',.',...;;,;•-,..• ,
I I HEALTH DEPARTMENT,jCOPY
.
•)IL':iCLASSIFICATION: SUITABLE (w )IrPROVISIONALLY SUITABLEI1'(..'1);'IUNSUIT4BLE. (_ )
▪ SLOPE (%). ) .� SOILR ER EA ILITY S - PS - [
�S - PS - U 7 SOIL PERME
. ; SO OILTTE6 TEXTURE (12-48 ,IN., S "'PS - U fn N OVER.60-MIN.
SANDY LOAMY,• CLAYEY 8°1 '"OTHER •' •, ' S - PS - I
• SOIL�1STRUCTURE-i(42'=4'8 :IN.) (S. - PS - U _(SP.ECIFY)
. +SOIL4,DEPTH I(IN•) 1'. IS - PS - U ' 9.1 SOIL SERIES:
▪ "RESTRICTIVE HORIZONS (IN.) rs - PS - U 'i4' A. CECIL ( ) B. HIWASSEE ( )
(IMPERVIOUS STRATA, .ROCK) ! ii C. MADISON ( ) D. APPLING X;,)
▪ SOIL DRAINAGE : GROUNDWATER 'S - PS - U E. PACOLET ( ) .F. FLOODPLAIN (' ) .
(EXTERNAL•' .INTERNAL) r G. 2-1 CLAY SOIL H. OTHER-SPECIFY ,.
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