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HomeMy WebLinkAboutCBPR-07-2016-24265.TIF v a\3 • A THIS IS NOT A PERMIT Case # CBPR-07-2016-24265 `� 111 CATAWBA COUNTY HEALTH DEPARTMENT , �o•`� f 0 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES •' !lc 3 1842 sM+ Commercial Building Plan Review - Building Addition uo IMPROVEMENT- AUTH_CONST- EXPANSION J' '' Rad Il I Applicant ARLIE ROTEN, 1173 ZEB HAYNES RD, MAIDEN NC 28650 C:8282340955 Architect STEPHEN WIDDOWS, PO BOX 40, IRON STATION NC 28080- B:7047321831 C:7047321831 S@WIDDOWS.ORG Contractor TBD/TO BE DETERMINED, , Owner MEADOW RIDGE CHURCH TRUSTEES OF, PO BOX 597, MAIDEN NC 28650 B:828-428-1463 NAME TO APPEAR ON PERMIT MEADOW RIDGE CHURCH TRUSTEES OF SITE ADDRESS: 1173 ZEB HAYNES RD, MAIDEN NC 28650 PIN # 363708985048 NAME of SUBDIVISION: NELLIE S HAYNES PROPERTY Loth 15 & PT 14 Section/Block PROPERTY SIZE: Square Feet 295,772.40 Acres 6.79 DIRECTIONS: Business 321 south to Zeb Haynes road church is 3/10 mile on zeb haynes road PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 800 WATER SUPPLY: Private Well DESCRIBE WORK: Existing Church with 100 Seats. Existing system sized at 500 GPD in 2001. Church does have an existing kitchen with NO Food Service or Daycare. Expanding the Sanctuary out 28 ft to add an additional 100 seats requiring an additional 300 GPD. 200 Total Seats at 800 GPD. 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: "" NO STRUCTURE SELECTED ** FACILITY TYPE: Church OTHER DESCRIPTION: DESCRIPTION OF Church with 100 seats EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 72x49 NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: Addition to Sanctuary 28x28 EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES: SEATING CAPACITY: 200 TOTAL FLOOR SPACE (SQ FT): DAYCARE OCCUPANCY: KITCHEN: Yes Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: 19-ehappl ication 07/12/2016 10:39 Page I of 4 �AT THIS IS NOT A PERMIT Case # CBPR-07-2016-24265 '7.1111 L CATAWBA COUNTY HEALTH DEPARTMENT trlo r El PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES r• .ir { 1842 sm Commercial Building Plan Review - Building Addition ro • G IMPROVEMENT - AUTH_CONST - EXPANSION • • t oa • Applicant ARLIE ROTEN, 1173 ZEB HAYNES RD, MAIDEN NC 28650 C:8282340955 Architect STEPHEN WIDDOWS, PO BOX 40, IRON STATION NC 28080- B:7047321831 C:704732 1 83 1 S@WIDDOWS.ORG Contractor TBD/TO BE DETERMINED, , Owner MEADOW RIDGE CHURCH TRUSTEES OF, PO BOX 597, MAIDEN NC 28650 B:828-428-1463 NAME TO APPEAR ON PERMIT MEADOW RIDGE CHURCH TRUSTEES OF SITE ADDRESS: 1173 ZEB HAYNES RD, MAIDEN NC 28650 PIN # 363708985048 NAME of SUBDIVISION: NELLIE S HAYNES PROPERTY Lot k 15 & PT 14 Section/Block PROPERTY SIZE: Square Feet 295,772.40 Acres 6.79 DIRECTIONS: Business 321 south to Zeb Haynes road church is 3/10 mile on zeb haynes road PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 800 WATER SUPPLY: Private Well DESCRIBE WORK: Existing Church with 100 Seats. Existing system sized at 500 GPD in 2001. Church does have an existing kitchen with NO Food Service or Daycare. Expanding the Sanctuary out 28 ft to add an additional 100 seats requiring an additional 300 GPD. 200 Total Seats at 800 GPD. 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: ** NO STRUCTURE SELECTED ** FACILITY TYPE: Church OTHER DESCRIPTION: DESCRIPTION OF Church with 100 seats EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 72x49 NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: Addition to Sanctuary 28x28 EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES: SEATING CAPACITY: 200 TOTAL FLOOR SPACE (SQ FT): DAYCARE OCCUPANCY: KITCHEN: Yes Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-ehapplication 07/12/2016 10:39 Page 1 of4 tlak.�$A` G THIS IS NOT A PERMIT Case # CBPR-07-2016-24265 d - CATAWBA COUNTY HEALTH DEPARTMENT X 7 x=1 a� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 4 ti ' /842 :M Commercial Building Plan Review - Building Addition o� o IMPROVEMENT - AUTH CONST - EXPANSION 0o� Applicant ARLIE ROTEN, , C:8282340955 Architect STEPHEN WIDDOWS, PO BOX 40, IRON STATION NC 28080- B:704732 1 83 1 C:704732]831 S @WIDDOWS.ORG Contractor TBD/TO BE DETERMINED, Owner MEADOW RIDGE CHURCH TRUSTEES OF, PO BOX 597, MAIDEN NC 28650 B:828-428-1463 NAME TO APPEAR ON PERMIT Arlie Roten SITE ADDRESS: 1173 ZEB HAYNES RD, MAIDEN NC 28650 PIN # 363708985048 NAME of SUBDIVISION: NELLIE S HAYNES PROPERTY Lot# 15 & PT 14 Section/Block PROPERTY SIZE: Square Feet 295,772.40 Acres 6.79 DIRECTIONS: Business 321 south to Zeb Haynes road church is 3/10 mile on zeb haynes road PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 800 WATER SUPPLY: Private Well DESCRIBE WORK: Existing sanctuary to add 100 seats go out 28' with adding to the septic system 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: ** NO STRUCTURE SELECTED ** FACILITY TYPE: Church OTHER DESCRIPTION: DESCRIPTION OF Church with 100 seats EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES: SEATING CAPACITY: 200 TOTAL FLOOR SPACE (SQ FT): DAYCARE OCCUPANCY: KITCHEN: Yes Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-chapplicaiion 07/12/2016 10:09 Page 1 of 4 yBn • CATAWBA COUNTY Case a CBPR-07-2016-24265 t: . 2 Public Health Department Subdivision NELLIE S HAYNES PROPER-P. `' Environmental Health Division , K PIN# 363708985048 -'+r- PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 1812 w • NAME ON PERMIT: (ARLIE ROTEN),, ( Arlie Roten) Site Address: 1173 ZEB HAYNES RD, MAIDEN NC 28650 Property Size: Square Feet 295,772.40 Acres 6.79 Directions: Business 321 south to Zeb Haynes road church is 3/10 mile on zeb haynes road 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 AREA1 FEENAME DATE FEE AMOUNT Authorizabon Construct to Construct Fee (New/Expansion) 07/12/2016 $500.00 Fee Building Services Plan Review Fee 07/12/2016 $40.00 Fire Plan Review Fee 07/12/2016 $10.00 Improvement Permit Fee 07/12/2016 $150.00 TOTAL FEES 5700.00 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-chapplication 07/12/2016 10:09 Page 2 of 4 CATA\ �a, THIS IS NOT A PERMIT counry :�. � . CATAWBA COUNTY HEALTH DEPARTMENT „ „�, -2a,o'- Page 1 g Application for Environmental Services Improvement Permit% Authorization to Construct% Septic Repair n Septic Malfunction❑ Septic Expansion X New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair I Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility g Property Address 7/773 2aA ,4 tt/ms's ,&/. Subdivision ,I)L7.;ieA/ /e-::a_j L5--t, Lot# Acres Section/Block/Phase Driving Directions to Property bio5ideSS 3;2/ 5 eh A/ At 7 ” A gocrvrr s 21., CA- yr�.4 ../5. 6 te e . NAME TO APPEAR ON PERMIT? Owner n Applicant n Contractor Applicant Contact Information Jr,Namh� s•,14 i- ,4 r/,o >t J A I _ / Address / 73 �,,b f�c y.,i.nn'Ad •/%k..dt ir) vCe11 Phone J� Phone 274,- #c/-er/S's Owner Contact Information Name eetu // �4, e S/ tV P bWi cice ' 'J S Address//73 ref, /4 / / ei. ial/,,,, 42c ' /'a Gs-o Phone Fa-g-Lvzg-/ 3 1 Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Ownerlpplicant Lf Contractor Description of Existing Structures on Site # of Bedrooms *t Structure Dimensions #of Occupants Basement ❑ Yes ❑ No Basement Fixtures 0 Yes 0 No The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in question. If the answer to any question is "yes", applicant must attach supporting documentation. ©Yes No Does the site contain any jurisdictional wetlands? Yes o Does the site contain any existing wastewater systems? p Yes No Is any wastewater going to be generated on the site other than domestic sewage? "Pes 0 No Is the site subject to approval by any other public agency? O Yes KNo Are there any easements or right of ways on this property? Describe Existing water supply in use Individual Well ❑ Community Well I Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** n YesNo If applying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) 0 Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other eitis My CATATHIS IS NOT A PERMIT • , ou 1JLC_ ,� CATAWBA COUNTY HEALTH DEPARTMENT ,,, „c m, Application for Environmental Services Page 2 Proposed Facility Type U Primary Residence H New Residence n Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement n Yes IT No Basement Fixtures CI Yes D No Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling n Yes IT No Plumbing n Yes IT No Describe Plumbing Needed { Multi-Family Residence#Units #Bedrooms per Unit*t Total#Bedrooms *t Structure Dimensions Food Service Specify Type . # Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift #of Shifts Dining Area(Sq. Ft.) IT Business Specific Type of Business Retail Floor Space # of Employees per Shift #of Shifts i 4� a •� ♦^ �` J Other Facility Type Specify i - ies , ' e ci t I/ ' ' II If Church# of Seats. 2{i o Kitchen Z Yes n No • If Daycare Specify Occupancy 429 Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ individual Well ❑ Semi-Public Well I Community Well Abandonment Type E Drilled ❑ Bored IT Dug ❑ Unknown Well Repair Requested In Yes IT No Describe Calculated Design Flow, Commercial t Boo Additional information may be required to determine design flow from certain facilities. This value will be determined during consultation with on-site staff. *Any room that will be intended for sleeping at the time 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 may prevent the need for septic system size increase in the future. t If structure is plumbed but no 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 CHARGE (SEE FEE SCHEDULE) 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. *Signature of Owner or Agent A Date 7/., /r Printed Name of Owner or Agent Ate/'E" a 4...67 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 363708985048 Owner: MEADOW RIDGE CHURCH TRUSTEES Parcel Address: 1173 ZEB HAYNES RD OF City: MAIDEN, 28650 Owner2: null LRK(REID): 900415 Address: PO BOX 597 Deed Book/Page: 2083/1181 Address2: null Subdivision: NELLIE S HAYNES PROPERTY City: MAIDEN Lots/Block: 15 & PT 14/ State/Zip: NC 28650-0597 Last Sale: $25,000 on 1995-06-01 Plat Book/Page: 44/175 School Information: School District: COUNTY Legal: LOT 15 & PT 14 PL 44-175 Calculated Acreage: 6.790 Elementary School: MAIDEN Middle School: MAIDEN Tax Map: 065N 01045 Township: NEWTON High School: MAIDEN State Road #: 2010 School Map Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: MAIDEN County Fire District: MAIDEN RURAL Zoningl: R-15 Building(s) Value: $309,600 Zoning2: Land Value: $45,800 Zoning3: Assessed Total Value: $355,400 Zoning Overlay: Year Built/Remodeled: null/null Small Area: null Current Tax Bill Split Zoning Districts: null/null Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: null Building Details 2010 Census Block: 3025 • WaterShed: null 2010 Census Tract: 011702 Voter Precinct: P20 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This mapireport product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,arid personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity.tie.1, Attins ©2016, Ca wba County Government, North Carolina. All rights reserved. s http://gis.catawbacountync.gov/nomap/parcel_report.php?key=363708988&typ=P 7/12/2016 • Catawba County Environmental Health • I ote 32.75 yv 75.00 I )S� 'Q 7 is I • 31 . 7 75.0C • 1 05 I AO I 5r 14t0 I I `ryb 1 I J \ N. I N C]\ f \ ,73T<c> N. Z. I N. \ N. \ f \ \ I \ \ 900 \® it a I I1 r Ix \ \ I N. N 1 N. 895 \ \ \ I \ \ 1 N \ I N. T°Q? N. Parcel: 363708985048, 1173 ZEB HAYNES RD 1in=80ft MAIDEN, 28650 This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 07/12/2016 • Catawba County Environmental Health Ea 12? I k' s 70 3 IFS 2.7. t I �h 43 s.00 /71110•41 0 I \ ;3741-11r5:0 �$rj .,,,d \ \ nI \ \ 7\, N \� I C o © cn co N 0 g; 1\ -CA\ \ N ■ t----\\ W \ I co \ \ N I . I \ \ \ i • I \ \ /r:J \ 1, \ I \ \ I _I Parcel: 363708985048, 1173 ZEB HAYNES RD 1 in=150ft MAIDEN, 28650 This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba, its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 07/12/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 363708985048 Owner: MEADOW RIDGE CHURCH TRUSTEES Parcel Address: 1173 ZEB HAYNES RD OF City: MAIDEN, 28650 Owner2: LRK(REID): 900415 Address: PO BOX 597 . Deed Book/Page: 2083/1181 Address2: Subdivision: NELLIE S HAYNES PROPERTY City: MAIDEN Lots/Block: 15 & PT 14/ State/Zip: NC 28650-0597 Last Sale: $25,000 on 1995-06-01 Plat'Book/Page: 44/175 School Information: School District: COUNTY Legal: LOT 15 & PT 14 PL 44-175 Calculated Acreage: 6.790 Elementary School: MAIDEN Middle School: MAIDEN Tax Map: 065N 01045 Township: NEWTON High School: MAIDEN State Road #: 2010 School Map TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District:.All in County Zoning District: MAIDEN County Fire District: MAIDEN RURAL Zoningl: R-15 Building(s) Value: $309,600 Zoning2: Land Value: $45,800 Zoning3: Assessed Total Value: $355,400 Zoning Overlay: Year Built/Remodeled: / Small Area: Current Tax Bill Split Zoning Districts: / Zoning Agency Phone.Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: Building Details 2010 Census Block: 3025 WaterShed: 2010 Census Tract: 011702 Voter Precinct: P20 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. ©2016, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=363708985048&typ=P 7/12/2016 -XI ' NON IagnSilt,,.1' �t:vt^ (Pvir,H►,,+ Fell 7 (_607—k56-04/21 i.9)p: `- 1 t llCATAWBA COUNTY HEALTH DEPARTMENT N Tele''o,`: (828)465-8 70 DD: -(828)46 00 '` 8588 IP AC k ` • .-Prrt t. �t1pI. Print. Sys. Type Well Print. Replacement Well Well Rpr. Print. Owned/Agent 1 —4 AL.. , Phone Address Subdivision SectionBlo k hase Lot# Lot Size Directions: tS 215— 0 2_t1. 4rlij £ ac( - ler at A( S if p Ctirtle. 1 Property Address _ I, I c OCI Facility: Hourse Mobile Home Business Multi-family . Other: Pin Number ,3—) —a? • ' - Other (V IT/T . Zoning Approval # 1 IA a f- (cu d&--,_ #Bedrooms #Seats la #Employees . Application Rate , 5 GPD Flow 500 Hot Tub or Spa yes/no Special Fixtures Basement yes/no . 100% Repair Are ye no Basement Plumbing yes/no Water Supply: "te Well Public V Semi-Public +kit ************ ************************************************************************************V�*** ******************** Type of System: Trench Y ed Pump Pump/Panel Panel LPP Other Septic Tank Size itertfer IS mp Tank Size Nitrification Field: Total Square Feet • Depth of Stone (L' Bed Size n Trench Width Total Length of All Trenches - OF N •/r o nches S Trench Length 7 S /tYS/-o /OS', / Feet on Center 9 lug men:, .-• 0 IStance of Nearest Well A *DO NOT INSTALL SEPTIC WHEN WET* ' ,CO. a REQUIRED AT COMPLE ION* ****************************************************************** * *** • * .a„**** *********************************** Topo C . Slope sn- T(el►n,1,J- ' Texture Sr, x 1 \ 41,> — I 0 Structure . f_ n- Cm*t\.1n.�Ll Clay Min. ��1`. / \c Soil Wetness Soil Depth lefs " 71 I Restric. Hoz. at " Available space no Overall Class "#�. I, . G�1C.thY Comments: V" k G� -- t I R gic i V c I?l+�S 1� 14 I 1 ygt?„--v1— � C 15o 4,14- , I Filter Required 0 •Riser required when ( a tank is more than 6 6, {istti 0, (2c1 inches deep. **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** *************************************************************************************************************************** *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility. An Authorization to Construct is valid for (5) five years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. The siting of the well by the Health Department staff is to provide protection from kn■wn possible sources of contamination. No volume of water is guaranteed at an si • by the Health Department. /�� Permit Date _ 0' ad 4 / EHS a`t „l d,_ _ A OwnJ1't y _r_r�eWi/s.' Septic Talk ir. .S �<<.� Sr i Date t1lT. r EHS , A,ME S eaght,ll :''� Well Installed By '` ' Well rout Ap oval Date `'9 1 M Well He:• Rproval Date Win G' Date Sample Collected n, , Date of Results 'es its EHS i t kith(White-Office Blue-Building inspection Operation Permit, Yellow-Owner/Agent Green-Buil Ihspecu tiono Construct