HomeMy WebLinkAboutAUTH-03-2016-070482.TIF �gA CATAWBA COUNTY Case N AUTH-03-2016-070482
¢te Public Health Department Subdivision SANDY FORD DEVELOPM
.L 371120925180
6 Environmental Health Division PINE
� �� `PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 I.O'f# 1-5
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NAME ON PERMIT: DONALD & EUNICE COPLEY, 1921 DAVENPORT ST, NEWTON NC 28658-8340
Site Address: 1921 DAVENPORT ST, NEWTON NC 28658
Property Size: Square Feet: 18,295.20 Acres:0.42
Directions: From North side of Startown Rd, Right onto Robinwood Rd, 4th St on Right-Hileman at bottom of St, Right
onto Davenport (dirt road) 2nd house on left.
Owner/Authorized Representative Acknowledgement of Permit Receipt
-�E/� I certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the
property described above.
7" As the property owner or authorized representative, I have received the above referenced permit(s) as
requested in the application for service EHPR-03-2016-23366 by the following method(s):
Received in Person
,,Z.
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/ E-mail (Return receipt required)
ecAs 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: 03/28/2016 /�
)Owner/Authorized Representative Signature & � �ipl�,!
Date 3/2046
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name ofperson sendingpermlt)
Signature Date/Time
Method: Fax Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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ehpermii 03/29/2016 11:05 Page 4 of 4
CATAWBA COUNTY Case AUTH-03-2016-070482
t Public Health Department Subdivision SANDY FORD DEVELOPM
. yw�,, Environmental Health Division PINY 371120925180
PO 13ox 389. 100-A Southwest Blvd.Newton, NC 28658 l.0'I 1-5
1842 mm
NAME ON PERMIT: DONALD & EUNICE COPLEY, 1921 DAVENPORT ST, NEWTON NC 28658-8340
Site Address: 1921 DAVENPORT ST, NEWTON NC 28658
Property Size: Square Feet: 18,295.20 Acres:0.42
Directions: From North side of Startown Rd, Right onto Robinwood Rd, 4th St on Right-Hileman at bottom of St, Right
onto Davenport(dirt road) 2nd house 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 Ru/es for Sewage Treatment and Dds'nasa/Systems' (I5A NCAC ISA
.1900). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to
function satisfactorily for arty Eiven oerind of time.
Steven Price 03/28/2016
AUTHORIZED STATE AGENT APPROVAL DATE
Permit Expiration Date: 03/25/2021
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
ehpenni9 03/29/2016 11:05 Page 2 of4
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43-5A CATAWBA COUNTY 0 �{ 1'� 0 Case# AUTH-03-2016-070482
.7i Public Health Department 'T `g. Y Subdivision SANDY FORD DEVELOPM
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Q ��" Environmental Health Division �`' • 371120925180
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NAME ON PERMIT: DONALD & EUNICE COPLEY, 1921 DAVENPORT ST, NEWTON NC 28658-8340
Site Address: 1921 DAVENPORT ST, NEWTON NC 28658
Property Size: Square Feet: 18,295.20 Acres:0.42
Directions: From North side of Startown Rd, Right onto Robinwood Rd, 4th St on Right-Hileman at bottom of St, Right
onto Davenport (dirt road) 2nd house on left.
Authorization to Construct Permit
•
Authorization to Construct Wastewater System (Required for Building Permit)
* See site plan and number ofadditional attachments ( ).
Proposed Wastewater System: Wastewater Flow g.p.d
Type: **** no system class assigned **** 0
Soil LIAR: g.p.d./ft2
Permit Category: Repairs
Type of Facility:
Basement? Basement Plumbing? Bedrooms:
Wastewater System Requirements
Tank Size: New 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: sq ft Total Length: ft Maximum Trench Depth in
Aggregate Depth in Trench Width ft
Minimum Soil Cover in Minimum Trench Separation ft on center
Number of Drain Lines
Distribution:
Pre Treatment: NONE
Additional Specifications: New septic tank only
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
System Class: Proposed System: Distribution Type::
Soil LTAR: g.p.d./ft2
ehpermit 03/29/2016 I I:05 Page I of