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HomeMy WebLinkAboutIMPV-07-2016-074766.TIF y,A CATAWBA COUNTY Casc# IMPV-07-2016-074766 .T Public Health Department Subdivision ¢i't: ' Enviraimental Health Division PIN# 279114441770 aPO BON 389. 100-A Southwest Blvd,Newton.NC 28658 LOTH 2 IR.2 ++ NAME ON PERMIT: GEORGETTA LUCAS, 2165 MOSS FARM RD, HICKORY NC 28602 Site Address: 2143 MOSS FARM RD, HICKORY NC 28602 Property Size: Square Feet: 130,680.00 Acres:3.00 Directions: From Hwy 127 South, Right onto Moss Farm Rd, The property is 1/2 mile down on the Left. Owner/Authorized Representative Acknowledgement of Permit Receipt �,,,/ I certify/that I am the owner or authorized agent(owner's authorization required) representing the owner of the property described above. At—As the property owner or authorized representative, I have received the above referenced permit(s) as quested in the application for service EHPR-06-2016-24110 by the following method(s): Received in Person Facsimile Transmittal (Return form with signature required) Electronic Image Transmittal/ E-mail (Return receipt required) As 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: 07/20/2016 Owner/Authorized Representative Signature -/17-,- - ����h -t Date ��� /2_01(0 Documentation of Permit(s) Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name of person sending permit) 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 We want to hear from you. Please take a few moments to complete our customer service survey at: http://www.surveymonkey.com/s/EHCustomerService ::hpermit (17/20/2016 09:07 ,ySA CATAR'BA COUNTY []e P ' �e Case# IMPV-07-2016-074766 ,T (.r.?�Ql Public Health Department ¢ ,•T •I Subdivision 4 '�3�f Environmental Health Division � ' PIN# 279114441770 '(J�tH' / PO Box 389, 100-A Southwest Blvd,Newton. NC 28658 _ \1842 s, .-�} _ LOTrI 2 j�f Ir DI . - 0 NAME ON PERMIT: GEORGETTA LUCAS, 2165 MOSS FARM RD, HICKORY NC 28602 Site Address: 2143 MOSS FARM RD, HICKORY NC 28602 Property Size: Square Feet: 130,680.00 Acres:3.00 Directions: From Hwy 127 South, Right onto Moss Farm Rd, The property is 1/2 mile down on the Left. Improvement Permit Facility: Primary Residence Permit Category: New Septic Bedrooms 3 WATER SUPPLY: Public Water Basement? No Basement Plumbing? No INITIAL SYSTEM SPECIFICATIONS Permit Valid: Expires In Five Years: _X_ No Expiration: Projected Daily Flow 360 g.p.d Proposed Wastewater System: 25% REDUCTION Type: IIIG -OTHER NON-CONN TRENCH SYSTEMS Permit Conditions: REPAIR SYSTEM SPECIFICATIONS Repair System Required? Required Proposed Wastewater System: DRIP IRRIGATION Type: IVA-ANY SYSTEM WITH LPP DISTRIBUTION PUMP REQUIRED ***** OPERATOR REQUIRED 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. The issuance of this permit by the Health Department does not guarantee the issuance of other permits. II is the responsibility of the applicant/property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are met. This Improvement Permit is subject to revocation if the site plan, plat or the intended use changes,or if site conditions are altered. The Improvement 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 Rules for Sewage Treatment and Disposal Systems' (15A NCAC 18A.1900). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for any given period of time. Steven Price 07/20/2016 AUTIIORIZED STATE AGENT APPROVAL DATE 07/20/2021 Permit Expiration Date: No grading or construction activity is allowed in areas designated for system and repair mithout approval of the Health Department. ehpennit 117/20/2016 09:07 EHPR 06-2016-24110 2143 Moss Farm Rd, Hickory • Do not cut, drive, fill,or grade over septic or repair areas. • This is an improvement permit only and is not intended for septic installation purposes. • Proposed subdivision. Lot lines shown are proposed and are marked in the field. Lot must be recorded prior to issuance of AC. � � a .71 o" 1 pcu• P111711.9) si \ If 1 - i� N DEPARTMENT OF HEALTH AND HUMAN SERVICES Sheet / of DIVISION OF PUBLIC HEALTH,ENVIRONMENTAL HEALTH SECTION PROPERTY ID 4: ON-SITE WATER PROTECTION BRANCH &7//I( 0 6 -Zarb - 2_coo COUNTY _Catawba SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM (Complete all fields in full) OWNER: GO. {s 1—,,,0.) _ APPLICATION DATE ADDRESS: DATE EVALUATED: 7k -74� PROPOSED FACILITY: PROPOSED DESIGN FLOW(.1949): PROPERTY SIZE: LOCATION OF SITE: 2013 /144.51 'Fc..� A PROPERTY RECORDED: WATER SUPPLY: 0 Private 14 Public ❑Well 0 Spring 0 Other EVALUATION METHOD: 0 Au,er Boring SPit 0 Cut TYPE OF WASTEWATER: 0 Sewage 0 Industrial Process 0 Mixed er • kk P _ u' ° s x 8 ..., � r DSOH.MORTHOLOGY 1. `Y,.,. , OTHER � w "+, F' la 9411_ fig,. PROFILE FACTORS , 1940 ? ..': i: -;" ' '',1 r E-A" LANDSCAPE t AORIZON .„ i sir POSITION! -DEPTH -if. A' PROFILE /In/ 'SCOPE°A;:-; •), x '__1941 - 1941 ,SOIL -t'= 1943 '-I 1956 .1944` -CLASS .. ; RESTR &LTAR -- , :.: STRUCTURE/ ' CONSISTENCE/ -WETNESS!" SOII. K ' ' .Sry ' :' .,, . TEXTURE'` ,'.• MINERALOGY.. -COLOR 't c:.DEPTH " PROASS 'inORIZ 0^ 9 ids6k s“- SG .1I4v- r✓A .. .e S LS g- go i s6- c Ft3t� " Y8 0 3 1 /St 30 -YP watt. cL Ft Se' - 4/ o-s- ws60c ScZ fit Sr NA-- u P-S e^-1A- S,3 ¢ liS S-3/ .-stk. c F/ SE ©i3 2 31-33 "S€k cc F/ SL _ ICI kise 0-Z7 Set c FL -CC A- tti-c z7_4/2 WS (c Cc. S "CCPJ 3 /07° 41/4- r, sev0 • D /k st3/c c FIE sc- N¢ /gip 3 (6 -2y N /tNc cc F / Sr _ 411- 2.)-1N.F 4 to% zv- vz c,c fr,o t _ O. I zs DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTI'IER FACTORS(.1946): Available Space(.1945) P5 O 5 SITE CLASSIFICATION(.1948): PS System Type(s) ZA� �!^ EVALUATED BY: �' et P OTHER(S)PRESENT: Site LIAR b, 3 0, 125 COMMENTS: S°..� r-...k 7n <!r re.Ai'4.1 Updated February 2014 a'c 06— tog, •- Zy ix) Catawba County Environmental Health t4 (ems v 1 4 ill° C 11 1 15 laNill I Ili CP \\\N\ . ' N.% :a4,„ „a, 0 IAlik11111 ill SSSS _ — :1\,. of \ __ _ -- . --- -- 0 IT% ©. kil:.:......\ Selrilli,jj \\;\ 41111 to;\ ri Parcel: 279114441770, 2165 MOSS FARM RD 1 in=100ft 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