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HomeMy WebLinkAboutRBPR-07-2016-24313.TIF v,A �G THIS IS NOT A PERMIT Case # RBPR-07-2016-24313 2 CATAWBA COUNTY HEALTH DEPARTMENT ❑' �{ •o• : L� w' Ik.�'�l PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ,� fr r• t 1842 sm Residential Building Plan Review - Manufactured Home o3° •13 � 4 T IMPROVEMENT itirA Contractor *OAKWOOD HOMES#712 (ELIOBERTO ALFONSO), 1265 70 H WY W,NEWTON NC 28658 B:(828)217-1862 C:(828)464-2662F:828-464-4301 R7 I 2@CLAYTONHOMES.COM Land Owner JACK SAIN, 1279 BRANNOCK SMITH DR, HICKORY NC 28602 Owner JACK WILSON, 7305 HEMPHILL RD, CATAWBA NC 28609 NAME TO APPEAR ON PERMIT JACK WILSON SITE ADDRESS: 7305 HEMPHILL RD, HICKORY NC 28602 PIN # 277004608702 NAME of SUBDIVISION: ADVENT ACRES Lot# 33 Section/Block C PROPERTY SIZE: Square Feet Acres 3.08 DIRECTIONS: 40 WEST EXIT 121, TOP OF RAMP TURN RIGHT ON 33RD ST SW KEEP STRAIGHT ONTO OLD SHELBY RD KEEP LEFT ON OLD SHELBY RD TURN LEFT ON HEMPHILL RD PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: Swapout-SW 16x76 2 BdRM w/ Decks: Front 12x8, Back 4x6 HOME MUST MEET APPEARANCE CRITERIA---SCREEN OR REMOVE TOWING TONGUE, FRONT DECK MUST BE MINIMUM 36 SQ FT, HOME MUST BE MASONRY UNDERPINNED (CAN USE VINYL IF SINGLEWIDE). HOME MUST BE PARALLEL TO ROAD AND MUST FACE FRONT OF PROPERTY **IF THIS NEW HOME IS A REPLACEMENT FOR AN EXISTING OCCUPIED HOME-THAT EXISTING HOME MUST B REMOVED FROM THE SITE WITHIN 30 DAYS OF THE ISSUANCE OF THE CERTIFICATE OF COMPLIANCE.** 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? Yes Property Easements Description: RUTHERFORD ELECTRIC ROW APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF SW 2 BdRm EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 14x70 NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: SW 16x76 w/Decks: F 12x8, B 4x6 #OF NEW BEDROOMS:: 2 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: F9-eliapplication 07/19/2016 13:25 Page 1 of4 ; xA CATAWBA COUNTY Case/i RBPR-07-2016-24313 dp L, I.a Public Health Department Subdivision ADVENT ACRES �tLn ti Environmental Health Division PIN# 277004608702 PO Box 389. 100-A Southwest Blvd.Newton.NC 28658 Jg.2 s. NAME ON PERMIT: (JACK WILSON), 7305 HEMPHILL RD, CATAWBA NC 28609 ( JACK WILSON) Site Address: 7305 HEMPHILL RD, HICKORY NC 28602 Property Size; Square Feet Acres3.08 Directions: 40 WEST EXIT 121, TOP OF RAMP TURN RIGHT ON 33RD ST SW KEEP STRAIGHT ONTO OLD SHELBY RD KEEP LEFT ON OLD SHELBY RD TURN LEFT ON HEMPHILL RD 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 I�IiIIFEENAMF 4tllu'G��l !Rte " , a`59h�i � ;!�t l ' T 1'21'Lli 1yiDATE ''I�I,II�1h FEIEIIIAM�IOIUNTJ ImprovementtPermit Fee 07/18/2016 $150.00 ]l �l TI:� lllq; TOTAL FEES r ����1 �G�'d�l�ll��u+'�Ni1J' • • ^��h lJ�lli�lO�illk�� ',��1l�ii'�� $kIl8150 00 , il.l)�I� II N�� 9Efd�.G-16,1 'sdWluW� • �t 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) I/9-ehapplicatinn 07/19/2016 13:25 Page 2 of 4 v4/3A • THIS IS NOT A PERMIT Case # RBPR-07-2016-24313 -7 rfin „ . 2 CATAWBA COUNTY HEALTH DEPARTMENT [".o', -M PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES • I ti Ig. 2 s' Residential Building Plan Review - Manufactured Home }o. -*'1.0•, 3 IMPROVEMENT . • o,- • Contractor *OAKWOOD HOMES 4712 (ELIOBERTO ALFONSO), 1265 70 HWY W,NEWTON NC 28658 B.(828)217-1862 C:(828)464-2662F:828-464-4301 8712@CLAYTONHOMES.COM Land Owner JACK SAIN, 1279 BRANNOCK SMITH DR, HICKORY NC 28602 Owner JACK WILSON. 7305 HEMPHILL RD. CATAWBA NC 28609 NAME TO APPEAR ON PERMIT JACK WILSON SITE ADDRESS: 7305 HEMPHILL RD, HICKORY NC 28602 PIN # 277004608702 NAME of SUBDIVISION: ADVENT ACRES Lot# 33 SectionfBtockC PROPERTY SIZE: Square Feet Acres 3.08 DIRECTIONS: 40 WEST EXIT 121, TOP OF RAMP TURN RIGHT ON 33RD ST SW KEEP STRAIGHT ONTO OLD SHELBY RD KEEP LEFT ON OLD SHELBY RD TURN LEFT ON HEMPHILL RD PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: MOVING A NEW 16X76 SINGLEWIDE WITH 12X 8 FRONT DECK & 4X6 REAR DECK HOME MUST MEET APPEARANCE CRITERIA---SCREEN OR REMOVE TOWING TONGUE, FRONT DECI MUST BE MINIMUM 36 SQ FT, HOME MUST BE MASONRY UNDERPINNED (CAN USE VINYL IF SINGLEWIDE). HOME MUST BE PARALLEL TO ROAD AND MUST FACE FRONT OF PROPERTY **IF TH NEW HOME ISA REPLACEMENT FOR AN EXISTING OCCUPIED HOME- THAT EXISTING HOME MUST REMOVED FROM THE SITE WITHIN 30 DAYS OF THE ISSUANCE OF THE CERTIFICATE OF COMPLIANCE.** 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? Yes Property Easements Description: RUTHERFORD ELECTRIC ROW APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF 14X70 SINGLEWIDE EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 16X76 SINGLEWIDE #OF NEW BEDROOMS:: 2 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: E9-ehapplication 07/19/2016 11:03 Page 1 of4 -5,6's CATAWBA COUNTY RBPR-07-2016-24313 Case cT ff Public Health Department ADVENT ACRES b�t�r, ig € '� Subdivision i w Environmental Health Division 277004608702 \ .. PO Box 389. 100-A Southwest Blvd.Newton. NC 28658 PIN# g : M NAME ON PERMIT: (JACK WILSON), 7305 HEMPHILL RD, CATAWBA NC 28609 ( JACK WILSON) Site Address: 7305 HEMPHILL RD, HICKORY NC 28602 Property Size: Square Feet Acres 3.08 Directions: 40 WEST EXIT 121, TOP OF RAMP TURN RIGHT ON 33RD ST SW KEEP STRAIGHT ONTO OLD SHELBY RD KEEP LEFT ON OLD SHELBY RD TURN LEFT ON HEMPHILL RD 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 ............................................................................................................ FEENAMEDATE i FEE'.AMOUNT , Improvement Permit Fee 07/18/2016 5150.00 TOTAE FEES -" '. $150.00 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 07/19/2016 11:03 Page 2 of4 644301 - MHC712 �j I 04:20:57 p.m. 07-15-2016 t l4 II CA.I�AWa-",. A THIS IS NOT A PERMIT a4 COUNTYY o` CATAWBA COUNTY HEALTH DEPARTMENT ..��.;�.,�xA ..._ , er . .,,.„,Canallm Application for Environmental Services Page 1 Improvement PermitAuthorization to Construct❑ Septic Repair U Septic Malfunction D Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandgnment❑ Well Repair `%/ Existing System Inspection (Pre-Approval Required) Application is for New ConstructionExistingFacility r � ❑ r�� Property Address1' t, 7�O S I-km /1 r (I i .d Subdivision IA•lc1cl f t�-K1 NC___ Lot# Acres J Section/Block/Phase Driving Directions to Property `fid (.3 - "`(i F Imo- I , TOP 0-P r0_,,,e Tt or , C f cS&J Yep Si-r- ;SC E- cin (-o U(d She ( (Th._, Rd - Kr°Pr L on Old S tie (6,, a - -r L 6 R F(f„ , p„I ( L NAME TO APPEAR ON PERMIT? Owner 0 Applicant ❑ Contractor - Applicant Contact Information II II Name C _Ia\(.)� t ()OCC —(UWi1 P C) 4, q't �(-e�\�n Address ( Dc }4. 1 `� O Li - Cc.,_,'+Gn KC �V-(O J 8" Phone ? _ `4_P'- , �( co-, _ Cell Phone Owner Contact Information Name --I-cc C L. )( SL✓L Address -i 3O5 rim )h ( Cd -( c-4c1, . > 4 ,c iUC Phone gr.�R - 5 i 4 _Cc, 01 J I Cell Phone Contractor Contact Information L Name Irl r a ` )( i C til t17 Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? 0 Owner Applicant 0 Contractor Description of Existing Structures on Site <AN nc lc ( iry�c,C I ry uJ(d. '-e -1 Lit(__ #of Bedrooms 41' Structure Dimensions (.4 i () #of Occupants j Basement ❑Yes y-No Basement Fixtures CI Yes o The Applicant shall notify the local health department upon submitt of this application if any of the following apply to the propertyin q� uestipn. If the answer to any question is "yes", applicant must attach supporting documentation. ®Yes �° Does the site contain any jurisdictional wetlands? )(Yeso Does the site contain any existing wastewater systems? C Yes - ,lo Is any wastewater going to be generated on the site other than domestic sewage? XYes go Is the site subject to approval by any other public agency? ✓� Yes No Are there any easements or right of ways on this property? Describe&t1he✓YDYcI /r Iet Pock) Existing water supply in use Uividual Well U Community Well U Semi-Public Well ❑ County/City/Township Wa er Line Is a public water supply available? ** D Yes ❑No 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 0 Alternative 0 Conventional 0 Innovative 0 Other 0 My 8284644301 MHC712 04:21:15 p.m. 07-15-2016 2/4 CATAWBA THIS IS NOT A PERMIT coorry CATAWBA COUNTY HEALTH DEPARTMENT -s.r""' Y"� 3t Application for Environmental Services Page 2 ea m e..ai 4 Pr posed Facility Type Primary Residence ❑ New Residence ❑ Addition to Residence #of New Bedrooms *-r Project Description -±-5{'.k („,,z2 YlC.e..—.S icArc'-nm Si note co e1-rtOL1 i f Structure Dimensions 1 CP #of Occupants Kon-•C o't? 1-4clrne Basement ❑ Yes O] 4o Basement Fixtures ® Yes ' ‘lo Ian.$ ontd &k ilifreicuv detie, Accessory Structure(s) Describe #of New Bedrooms 41-j if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑ Yes ❑No Plumbing ❑ Yes ❑ No Describe Plumbing Needed U Multi-Family Residence#Units #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(Sq. Ft.) U Business Specific Type of Business Retail Floor Space #of Employees per Shift #of Shifts ❑ Other Facility Type Specify If Church#of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes 0 No Describe Calculated Design Flow,Commercial¶ 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 comers and making the site accessible so that a complete site evaluation can be performed. ��Q Signature of Owner or Agent,, . b? ( Wjiv24 At aLgate ( —( I Co Printed Name of Owner or AgenTh �\l s_e • Q\11"y ]Q/k. coy" Cyj 8284644301 MHC712 09:16:29 a.m. 07-18-2016 3/3tge 1 'ChIAWBA Geospatial 9 . 14 \*Real Estate Search .--issa05.22._ra Information Services 01 s \ !...ms 1 • i• — 2,01 I 3.2., 8, Ir ` ei,„ ... ►10 , ser ger C. s ss4' � tAH:1s nE� memo a, via w �ag.o1 ,. lb co 121457• 1�Ftiti I 220.n0 +�,4, 21$25 • 1 n' 128: . 3113-52 N1 in=200ft W+E S Parcel: 277004608702, 7305 HEMPHILL RD HICKORY, 28602 Owners: SAIN JACK, WILSON PENNY CARROLL Owner Address: 1279 BRANNOCK SMITH DR rih&CO`rp Et'fSr� hA Values-Building(s): $0, Land: $17,400, Total: $17,400 Per oru"- This map/report product was prepared from the Catawba County,NC Gsoopattal Information Senrlms. Ceiawha County has made eubslanlial efforts to ensure Ura eracy of lo<a0on and labellrrqq Information mntalnad on this map or data on this report.Cetawbo County promotos and recommends the Independent vedflwiton of any date cattatned on thio ruo report product by the user.The Count'of Ce�vba,Cry aggem� z,and personnel,disclaim and shall net be held liable far any and alldamagec•loss or llabifdy whether dirad,indirect:i consequur>tlaI which edeas or any arise from this map/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 07/11/2016 Catawba County Environmental Health fr::\ 1 19 ct \ \ N. : \ cr \ D \ \ , \ -' " a0 \ \ a co a \ \ q \ \ a v \ a 'o \ r r � 1 \ o / /2 ; w 41. r9 r m51 „ -,',5,1 'Pc s,.... lett-t *6 It 9W 220.00A > 455.00 0 O 1485 / .,„,...----- Parcel: -"'”Parcel: 277004608702, 7305 HEMPHILL RD lin=80ft HICKORY, 28602 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 07/18/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 277004608702 Owner: SAIN JACK Parcel Address: 7305 HEMPHILL RD Owner2: WILSON PENNY CARROLL City: HICKORY, 28602 Address: 1279 BRANNOCK SMITH DR LRK(REID): 1004 Address2: null Deed Book/Page: 3306/1014 City: HICKORY Subdivision: ADVENT ACRES State/Zip: NC 28602-9023 Lots/Block: 33/C Last Sale: School Information: Plat Book/Page: 13/101 School District: COUNTY Legal: LOT 33 PLAT 13-101 Elementary School: MOUNTAIN VIEW Middle School: JACOBS FORK Calculated Acreage: 3.080 Tax Map: 001CS 05016 High School: FRED T FOARD Township: BANDYS School Map State Road #: 2584 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: MOUNTAIN VIEW Zoning1: R-40 Building(s) Value: $0 Zoning2: null Land Value: $17,400 Zoning3: null Assessed Total Value: $17,400 Zoning Overlay: WP-O Year Built/Remodeled: null/null Small Area: MOUNTAIN VIEW 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 #: 3710277000J Building Details 2010 Census Block: 1020 WaterShed: WS-III Protected Area 2010 Census Tract: 011801 Voter Precinct: P24 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_repart.php?key=277004608702&typ=P 7/18/2016 / z i. as. 7'. • CATAWBA COUNTY HEALTH DEPARTMENT No 8 2 9 0 / Telephone (828)465-8270 TDD 28)46 8y� 20� P ,kCi Imp Print. (/ Auth. to ConstPant. Opr Print. Sys Type ) Well Print. Well Rpr Pnht. Owner/Agent o Phoned r___E n 0 ty Address -+'t • La r„ t Subdivision . Section/Block/Phase Lot# Lot Size • D' 'ons. - O n��i �_ ..L..�. ®�, , .� Facility: House .. Mobile Home!/ ISusiness Multi-family Other• Tax Map or Pin Number x770 — -Ori'6'0 — $37 0- OtherZoning Approval# Z / / GP00- 0 A- � #Bedrooms J #Seats # Employees Application Rate &I-21 Flow cycnl Hot Tub or Spa yes/no Special Fixtures Basement yes/c9 100% Repair Area 'es o //- Basement Plumbing yes/no Water Supply: Private Well, !/Public Semi-Public *************************************************************************************************************************** Type of System. Trench /../6d Pump Pump/Panel Panel LPP Other C Septic Tank Size/Q70/J�I.a Pump Tank Size Nitrification Field. Total Square Feet /a2_o)O Depth of Stone /1-04Bed Size d Trench Width ...—? Total Length of All Trenches 4'00 Number of Trenches Trench Length/CVVan Iv /6Q 1_/_Feet on Center 9 r Maximum Trench Depth ' P! stance est Well /Oc� *DO NOT INSTALL SEPTIC WHEN WET* *WELL RE : •D REQUIRED A MPLETION* ************************************************************************************ ***********************t.************ Top - 'a Slope rI Texture 311 D I Structure . • 1 Clay Min. 1/ t Soil Wetness k.,j " Soil Depth Restric Hoz. at `\ Available space "A no I<a .37 0/%r f Overall Class S iR'U I it; Q� Continents - - - - - .-;- -- - -- - - - --- -- tCR a iin' 4 i 0llI � _Z� ION fief A Filter Requiredte fij Riser required when tank is more than.6 inches deep. . o **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** ***********a*************************************************************************************************************** *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 andapproved by a representative of the Catawba County Health Department before any portion of the installation is put into use. The siting ofthe well by the Health Department staff is to provide protection from known possible sources of contamination. No volume of water is guaranteyat any rte by he Health Department- Permit Date r'C ^—Permit • EHS �� "4 Owner/A ent I .a.—/ Mi— A,t � •,� . Septic Tank Installed By / . iii _ ea Date_/ —OC EHS , ,.gyp .vl _if Well Installed By Well Grout Approval Date Well Head Approval Date Date Sample Collected Date of Results Results EHS White-Office Blue-Building Inspection Operation Permit Yellow-Owner/Agent Green-Building Inspection Authorization to Construct