HomeMy WebLinkAboutOP-07-2016-074466.TIF s
gi7A � CATAWBA COUNTY ;• �o. F. �� a Case# OP-07-2016-074466
Public Health Department .:Ct Subdivision
< r Environmental Health Division j_y' l'IN# 376301279838
PO l3os 389, 100-A Southwest I3Ivd, Newton.NC 28658 •C • o i o k 1 O[# A-4
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NAME ON PERMIT: RANDY PHILLIP MOSER, 4061 CARLTON DR, CLAREMONT NC 28610
Site Address: 4942 ROCK BARN RD, CLAREMONT NC 28610
Property Size: Square Feet: 17,859.60 Acres:0.41
Directions: 1-40/Rock Barn Rd Ext/ left on Rock Barn Rd/go past Golf Course/cross Bridge across from Community
Rd/just above 3nd Mobile home on right/vacant lot
Catawba County Health Department Operation Permit
System Type: IIIG - OTHER NON-CONV TRENCH SYSTEMS
(In accordance with Table Va)
Description: 25% REDUCTION
System Code: IQ4PS System Code Description: Infiltrator Quick 4 Plus Standard
Types V and VI systems expire in 5 years.
Owner must contact health department 6 months prior to expiration for permit renewal.
System Installation Comments:
PERMIT CONDITIONS:
1. All maintenance, monitoring, and performance requirements shall be in accordance with
15A NCAC 18.1900, Rule .1961
2. Operation & Maintenance Specifics:
Subsurface system operator required? Yes No_X_
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage
Treatment and Disposal, and All conditions of the Improvement Permit and Construction Authorization.
kelly isenhour#1099 07/08/2016
SYSTEM INSTALLER INSTALLATION DATE
Steven Price 07/13/2016
AUTHORIZED STATE AGENT DATE OF OPERATION PERMIT
ISSUANCE Form F
chpeuuit 07/13/2016 12:34
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DEPARTMENT OF HEALTH AND HUMAN SERVICES t� Sheet_L of_(
DIVISION OF PUBLIC HEALTH,ENVIRONMENTAL HEALTH SECTION A ✓ bit -23/6—I&O S 6 PROPERTY ID N:
ON-SITE WATER PROTECTION BRANCH �6�7� COUNTY:Catawba
SOIL/SITE EVALUATION
for ON-SITE WASTEWATER SYSTEM
/ (Complete all fields in full)
OWNER: �"" /t-/L O %lt . _ APPLICATION DATE
ADDRESS: DATE EVALUATED: ____
PROPOSED FACILITY: PROPOSED DESIGN FLOW(.1949): .'b o PROPERTY SIZE:
LOCATION OF SITE: I/5 z_ t€-L 4t 41 PROPERTY RECORDED:
WATER SUPPLY: 0 Private 0 Public 0 Well 0 Spring 0 Other
EVALUATION METHOD: 0 Auger Boring U Pit 0 Cut TYPE OF WASTEWATER: 0 Sewage 0 Industrial Process U Mixed
Rot
SOIL MOREHOLOGY, ,
PROFILE FACTORS
1 .4 1940 Ifr _'tir R .. ' re's ,t'fr e yr
--B LANDSCAPES HORI7.ON - _ � _ '
1942
q az SLOPE:%tS (IN) 'e x tr t:. "'i ' to 1 '� 1943 1 56 .CLASS
.. 1944, t
"° aSTRUCTUREl .1 CONSISTENCE/ WETNESS/ ,4 SOIL SAPRO -RESTR
A., F to ?':TEXTUREr n MINERALOGY°_, COL/OIV /
'kR PPTH�S AGLA_SS, y yHORIZe .
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DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946):
Available Space(.1945) �ts SITE CLASSIFICATION(.1948): (S
EVALUATED BY: 1"
System Type(s) 2444 L4 &G OTHER(S)PRESENT:
Site LTAR O-i
COMMENT'S:
Updated February 2014