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HomeMy WebLinkAboutRBPR-08-2016-24557.TIF PYA �� THIS IS NOTA PERMIT Case # RBPR-08-2016-24557 Ft`1I'1 CATAWBA COUNTY HEALTH DEPARTMENT 0 -n . •0 '11-44."�ara - PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ~ 1 �r \842 5M Residential Building Plan Review - Building Alterations & Additions '0 '3• .o ', . .o .;< r Irl • IMPROVEMENT - AUTH CONST- EXPANSION .:h oa Owner KAY MCALISTER, 3878 LANDMARK DR, SHERRILLS FORD NC 28673 H:7049664424 HOME:7049664424 NAME TO APPEAR ON PERMIT Kay McAlister SITE ADDRESS: 3878 LANDMARK DR, SHERRILLS FORD NC 28673 PIN # 460703143389 NAME of SUBDIVISION: AARON H LAIL Lot# 8 Section/Block PROPERTY SIZE: Square Feet Acres 0.43 DIRECTIONS: From instersection of 150 and NC 16 go north on#150 about 3 miles (over 1st bridge)turn left on Little mounntain Rd, go 1 mile, turn right on Lanmark-2nd house (red roof) on right. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Existing structure- Basement apartment (2 Bedrooms) with shell on main floor--finishing main floor(adding 1 bedroom, 1 1/2 bath, kitchen, laundry, living room) Also adding side deck 12x20 and detached garage 20x20 "FYI--do 2 separate building permits when ready for permit issuance. 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: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Accessory Structure OTHER DESCRIPTION: DESCRIPTION OF existing single family dwellling EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 36x30 NUMBER OF EXISTING BEDROOMS: 1 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: Detached Garage 20x20, Side Deck 12x20 #OF NEW BEDROOMS:: 1 BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-ehappl ication 08/22/2016 16:23 Page 1 o14 4-5A CATAWBA COUNTY Case ti RBPR-08-2016-24557 7, �Gj Public Health Department Subdivision AARON H LAIL 4 °i9® Environmental Health Division *'a�5 PO Box 389, 100-A Southwest Blvd.Newton,NC 28658 PINI{ 460703143389 18.2 u NAME ON PERMIT: ( KAY MCALISTER), 3878 LANDMARK DR, SHERRILLS FORD NC 28673 ( Kay McAlister) Site Address: 3878 LANDMARK DR, SFIERRILLS FORD NC 28673 Property Size: Square Feet _ Acres 0.43 Directions: From instersection of 150 and NC 16 go north on#150 about 3 miles (over 1st bridge)turn left on Little mounntain Rd, go 1 mile, turn right on Lanmark- 2nd house (red roof) on right. 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 i FFNAME.,»"F I"�iiiil „1i9'l i ;RFT:: 4:7w'GIt n illii{��prit iATE-r i ri,o EE A�MOUIgin NT I I u{1U�� 1Ci 1 I I e a.nan''r 1� 1,2u�ih1 Sny:ii�� tl)i JY Authorization to Construct Fee (New/Expansion) 08/22/2016 $150.00 Fee Improvement Permit Fee 08/22/2016 5150.00 �mil Pl;;ith1 tTOTAL`F;EES'It u r u ihIPI IPI ;8 4 ���lll'I) PILI PIEII > I ' t• IS �i �IP�dpi� ,.. � *rl tifG Ltll.i4 I , 1 �I�'�i ���i i�I it i S300 00 �4 al�ii I 1' .'+4r r quidtlkilt ` `WuIL,W>aath r, r._ Wluinrn1i.. 'tdtrnkJ r, Ildlltlt.t•'- FEES ARE NON—REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN ANDIOR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-ehappl i callnn 08/22/2016 1622 Page 2 of 4 G THIS IS NOTA PERMIT Case # RBPR-08-2016-24557 CATAWBA COUNTY HEALTH DEPARTMENT 0 "'o• �` 0 • PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 SM Residential Building Plan Review - Building Alterations & Additions . .13 IMPROVEMENT- AUTH_CONST- EXPANSION 4r • a Contractor TO BE DETERMINED„ Owner KAY MCALISTER, 3878 LANDMARK DR, SHERRILLS FORD NC 28673 NAME TO APPEAR ON PERMIT Ka McAlister SITE ADDRESS: 3878 LANDMARK DR, SHERRILLS FORD NC 28673 PIN # 460703143389 • NAME of SUBDIVISION: AARON H LAIL Lot# 8 Section/Block PROPERTY SIZE: Square Feet Acres 0.43 DIRECTIONS: From instersection of 150 and NC 16 go north on#150 about 3 miles (over 1st bridge) turn left on Little mounntain Rd, go 1 mile, turn right on Lanmark-2nd house (red roof) on right. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Existing structure finishing main floor(adding 1 bedroom, 1 1/2 bath, kitchen, laundry, living room, adding side deck 12x20 and detached garage 20x20 "FYI--do 2 separate building permits when ready for permit issuance. 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: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Accessory Structure OTHER DESCRIPTION: DESCRIPTION OF existing single family dwellling EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 36x30 NUMBER OF EXISTING BEDROOMS: 1 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 20x20 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-chapplication 08/22/2016 15:21 Page 1 of 4 3,A CATAWBA COUNTY Case# RBPR-08-2016-24557 rT r ®y Public Health Department Subdivision AARON H LAIL f - { Environmental Health Division PIN# 460703143389 '��' t N M PO Bos 389, 100-A Southwest Blvd, Newton.NC 28658 /84'2. s. NAME ON PERMIT: (KAY MCALISTER),3878 LANDMARK DR, SHERRILLS FORD NC 28673 ( Kay McAlister) Site Address: 3878 LANDMARK DR, SHERRILLS FORD NC 28673 Property Size: Square Feet Acres 0.43 Directions: From instersection of 150 and NC 16 go north on#150 about 3 miles (over 1st bridge) turn left on Little mounntain Rd, go 1 mile, turn right on Lanmark-2nd house (red roof) on right. 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 I bell g of all property lines and corners and making the site access les th t a c ple site evaluation can be performed. Date: aa 14 Signature of Applicant or Agent w §- ) c -M. An Environmental Health Specialist will contact you within 5 1vorking days of application date. If you need further information or assistance please call 828-466-7291 AREA1 ############################################################################################################ FEENAME, " ' ); DATE FEE AMOUNT' Authorization to Construct Fee (New/Expansion) 08/22/2016 $150.00 Fee Improvement Permit Fee 08/22/2016 $150.00 TOTAL FEES $300.00 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-ehapplication 08/22/2016 15:21 Page 2 of 4 -ao\CO SS-1-1 " .a.a... Application ix Envinnmuenta1 services -- --- Page 1 Improvement Permit lEr Authorization to Construct 0 Septic Repair❑ Septic Malfunction 0 Septic Expansion Igr New Well Permit 0 Replacement Well 0 Well Abandonment 0 Well Repair 0 Existing System Inspection(Pre-Approval Required) fit pApplicatio/n is for New Construction 0 Emoting Facility 0 Property Address _ 3p_ 1 _ (�cty(J oar t ri u('_ Subdivision .fit.a YAH_ f�'. . Aa.;I . Sherri IIS Ferret, NC 2g 73iot# g Acres O ._ _ LL� ' Section/Block/Phasse� Driving Directions toProperty_f"gym �rsec in of Nw. ./,i�:n.Nd Nt h, j0-47-4 i9:50er. Tlt 0 aim .sntdec (conn U hY__tdato) hi Ie-F}- Alt I ;tit, 4 1" t J 91) l knit, NAME TO s ' ' ON PERMIT? (t? weer ❑ Applicant ❑Contractor Applicant Contact Information Name Katy F WW1-stir -Address 38'78' La.r ki trk tarp sberri lls 1-nrrl M c an7-3 Phone 70y - 446- cl/„?g lCellPine Owner Contact Information Name Sane Address Phone I Cell Phone Contractor`Contact Information Name Atak + serl+erias a-C `Orfs dale- Address Phone Cell Pimm WHO WILL BE THE PRIMARY CONTACT? 0 Owner 0 Applicant 3 Contractor Description of ExistingStnsxmesonSite 8asen7PM7` A-parhwrt"f- unlit •C heli u I 5`Igf s #of Bedrooms if a Structure Dimensions #ofOaapants a Basement [ales 0 No Basement Fixtures geYes a No The Applicant shall notify the local health dgrartment upon submittal of this application if any of the following apply to theproperty in question. If the answer to any question is`yes",applicant nest attach supporting documentation. D Y of 0 Does the site contain any jurisdictional wetlands? t@ Yes El NoDoes the site contain any existing wastewater systems? Cl Yes 7 Is any wastewater going to be generated on the site other than domestic sewage? 'YesYes Is the site subject to approval by any other public agency? �No Are there any easements or right of ways on this property? Describe Existing water supply in use Er Individual Well Q Comnwnily Well 0 Semi-Public Well ❑ Coorty/City/Toeasship Water Line isapublic eater supply available?** ❑ Yes [ ra If applying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s); (systems can be ranked in order ofyour preference) :? ❑ Accepted 0 Alternative 0 Conventional • 0 Innovative 0 Other AY 11 4 f -Raj auf I cavt �0 7�Yword to Al CoYIS�Yur i i.n CA'T+AU A THIS IS NOT A PERMIT COUNTY .IVI'�. CATAWBA COUNTY HEALTH DEPARTMENT .e. Application Son Environmental Services Page 2 Proposed Facility Type • gg. Primary Residence D New (Residence Addition to Residence if of New Bedrooms 9. l Project Description Male it s. IYc Cs IUlvto ay eta Structure Dime,ions fr l IC 3/)/ #oofOcccu ants ' Bacemment j -Yes ❑ No Basement Fixtures laYes No V Accessory Strtactnre(s) Describe '-_ _ a s' , r /4 r r, / hal f hki h V #of New Bedroom •'I• if applicable I Structure Dimensions ha x Otte #of Occupants a Accessory Dwelling ❑ Y'e/s����❑./ No Pluming Yes 0 No Disirdre Plumbing Needed K rh. a ❑ Multi-Family Residence#Units //Bedrooms per Unit'}• Total if Bedrooms•t Structure Dimensions ❑ Food Service Specify Type #Seats Floor Space-Entire Food Service Facility (Sq Ft) if Employees per Shift if of Shifts Dining Area(Sq. Ft.) L] Business Specific Type of Business Retail Floor Space if of Employees per Shift #of Shifts ❑ Other Facility Type Specify If Church if of Seats Kitchen ❑ Yes 0 No If Daycare Specify Occupancy Application for Weil Construction/Abandonment/Repair Proposed Well Type 0 Individual Well 0 Semi-Public Well ❑ Community Well Abandonment Type 0 Drilled 0 Bored ❑ Dug ❑ Unknown Well Repair.Requested 0 Yes 0 No Describe Calculated Design Flow,Commercial j_ _ __._ Additional information may be required to determine design flow from certain facilities. This value will be determined during consultation with on-site start *Any room that will be intended ler 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 fiance. T If structure is plumbed but no bedrooms,calculated design flow is required. **If No,a well permit meat 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 rimer 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 arrresible so that a complete site evaluation can be performed. Signature of Owner or Agent 1L( t "cADate ` � /) 6� aJ /l° Primed Name ofOwner or Agent / / 17- / ..r Catawba County Environmental Health 1/4.. \ d , 11i '.M'411; 'uta% \ \ ' . 38.00 Pettlip i plgtiOtit g�r still I III IijlW , ' k B 0 ri':iti g �illl I,1 * I, lT. � xk1 l , ----\\\ .. 216.8 Vk�I�lli;�p-r�lf�1 ',Y�� �"411. m � �I t ,1. I 7111 I, I, tIIli: III ' 1�wAli lfil t 1� R jr Ili ,al Gyf�� 0 IP '^1^y�Ilt �l) Iwo r; r l,l C ...; 1\\ 1411 t111� ?I �� 14 �I` .S ; Icy il . j, C192.op I `� 41I�1 N l l It lal illiS N { �III't � 'i I .n 11 . 4, iI 9 ,I , cc,.5.0 I,g ,S1N� f� l t t r,iY p� II��Y qw,i,,,i4,,iii 6 ! r „aha , ;' � 4iP5c ,11�� if ,,!„,i, .'j, 2 ‘... g !II1 11v I� F�� 'L II 'X'kI, o pl, � II I ti fillip_ 1p: tit!_t�� { 1 ,, , ,. l ,I f,, II, ,i , x u I I , , r I �l� ��p I 190.00 1 tit " ''o.,,,,�I ll l j i, ,� II' 1 A �Mj 1��a1 { � � Ir�i1 ? : 1��.:�e�. II �r'„t I * Illlu� I '�(1 ''1� Fxu„ b ax ddII ,I , 1 1 I \ 1 ..76 'a I11�fr. l f I' 4,111"I;titi'"t tu1i ' ,? 1 ,-.01 . SIIxi4SS :4jr- ,1P. lir �ili Itl li I I i ltl i4!r1P t1, IM; I� Ium *mt. Ii 11 41 ra ti 1IIh, yNI 44l1 �. l I h�,,il1�I, ;id,�Y, ,ry(� 1O I , k•/ ,1 , �,./ . Ilrn tI Wit ��1�), III I ,(t" 4, lI �, lr l 'n1n ii, ,i � 11 1 444„illl�� it ' I �' ul 1 i41i'" � „ ,t I,I,„A„I ,� , ISI „rl a .,4„ „lI 't1 II„�~„ �,.11,, 111 „llrt. 14M1� / ,.,.1 14 ( I Ily / 1 I / '#9i15:47 ..}�"sw11i1 i 11Illl�ll� X IIII � ,I h i I� Parcel: 460703143389, 3878 LANDMARK DR lin=50ft SHERRILLS FORD, 28673 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 08/22/2016 a3, ia 'xa° I Cv o . /6. 7 ' / 95.. 312" ‘13 0_L ` 0_ �7 4Ta q 2 ao'x do ' e- 1 F. fitic-Mistvl.gls" 3875 Lavt4mark tmite 5�eir; 1ls ford. AJC 28P47?. its' 964- ligan Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 460703143389 Owner: MCALISTER KAY Parcel Address: 3878 LANDMARK DR Owner2: City: SHERRILLS FORD, 28673 Address: 3878 LANDMARK DR LRK(REID): 13298 Address2: Deed Book/Page: 2570/0855 City: SHERRILLS FORD Subdivision: AARON H LAIL State/Zip: NC 28673-0000 Lots/Block: 8/ School Information: Last Sale: Plat Book/Page: School District: COUNTY Legal: LOT 8 AKRON H LAIL PROP Elementary School: SHERRILLS FORD Middle School: MILL CREEK Calculated Acreage: .430 Tax Map: 012AX 05008 High School: BANDYS Township: MOUNTAIN CREEK School Map State Road #: 1939 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoningl: R-30 Building(s) Value: $62,500 Zoning2: Land Value: $105,300 Zoning3: Assessed Total Value: $167,800 Zoning Overlay: CRC-O,WP-O,FPM-O Year Built/Remodeled: 1967/ Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710460700J Building Details 2010 Census Block: 3027 WaterShed: WS-IV Critical Area 2010 Census Tract: 011504 Voter Precinct: P31 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. ©20 , Catawba County Government, North Carolina. All rights reserved. S� _ •-fine ► n - — -� Ow ci) 61 n5 ten I '/i r&1 4-h,ICS iehln ��„ , I ,, L.G dr, LMr15R iirn- l pec! z� b I '3l�U C- �lcs S�ce 7 12x20 wase 2°X2c' http://gis.catawbacountync.gov/nomap/parcel_report.php?key=460703143389&typ=P 8/22/2016 11) :30 CATAWBA COUNTY HEALTH DEPARTMENT poS Pd t Telephone: (828) 465-8270 TDD: (828)465-8200 WLS #IOOY - 00 V2$ Improvement Permit AC Repair Permit. Operation Permit. System Type Well Permit. X Replacement Well _ Owner/Agent 1-4--.0 Mc Act ./.C77'!2, Phone Z Address e N . i P. Subdivision /M on&J f, hive- - /=rei - A _ • ' Section/Block/Phase Lott/ S Lot SizeO, „:3ng,Directions: SO C _/y • .v L ► . _--qa , / _ 1 ,t./lib ' boz,or 3.41- #ayse- oN 0 Property Address 3 g 7 e L.A./VD Ths.e, J7?)1.- Facility: House XMobile Home Business Multi-family Other: Pin Number 9/6 0 9 00 33&'7 Other . Zoning Approval# 4// #Bedrooms a. # Seats #Employees . Application Rate N�z9 GPD Flow 41/49- Hot v//3 Hot Tub or Spa yes o pecial Fixtures Basemet , es no . 100%o Repair Areay�esfxe— Basement Plumbing e S o Water Supply: Private Well )K. Public Semi-Public *4*****************t**4**4*4*4*******4*****4*********************4*******k**********4*44****,*4*********4*****444*****4* Tyr of System: Tr— h Bed • mp Pump!'. el Panel _ *P Other Septic Tan• . .• " mp Tank Size , Nitrifica '. F'• .. otal Square t !W. tone CA Be. • e Trench--•'ii '.ta ength of All Tres,-. .. Nu . renches Trench Length / / / / Feet .n Center -•aximum Trench Depth Distance of Nearest Well •' *DO NOT INSTALL SEPTIC HEN WET* *WELL RECORD REQUIRED AT COMPLETION* *4*4*4***4*4*****4*4*44*4***4***4*4*4*4**********************44*************************4***4****************************** Topo % Slope ° e E Te nue A, Stn, ipf )/0 Soi .epa st 'c. •r.. at Av.. .le sp. , es/no s_ Overal . sSPSUsr'S p 2 ,— • Co nts: [}duSc Sett O t \Iu 4 ti at'z a Si 1\ CNSNI Filter Required " \ . N Riser required when Y ek tank is more than 6 2. -r -1 inches deep. fir,?a ®`t,CCC **NO GU: t - • ' i ' "ARRANTY IS IMPLIED OR GIVEN A o • •FO•MANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** 44*4******************4*4***4********t********t*******44************4*****4#444* **4*4********4****4********4*****4**4* *Improvement Permit has no expiration date and is transferable, but may be revoked if site plan .r 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 known possible sources of contamination. No volume of water is guaranteed at any site by the Health Department. �__yr. J A_� Permit Date A-p (, r 9 d.200 EMS K Owner/Agentijj. ric�a,�!-'� Septic Tank Installed By Date EHS Well Installed By S4Ouaww kltZL Well Grout Approval Date G—22-09 Well Head Approval Date Date Sample Collected Date of Results Results EHS White-Office Yellow-Owner/Agent Pink-Building Inspection Authorization to Construct CATAWBA-LINCOLN-ALEXANDER DISTRICT HEALTH DEPARTMENT HICKORY, N. C.—NEWTON, N. C.LINCOLNTON, N. C..—TAYLORSVILLE, N. C. Phones 345-3883 464-2011 735-5521 632-3101 PERMIT TO INSTALL SEPTIC TANK PERMIT NO. ..�I , i. , b2 PERMIT DATE -'tel 196 Owner . . . C:. ... _ C` Address Tenant. ^ ���' Address Installed by �,I, r Address Location of Property &A 4 '6f r had I4,14. ' j Qk1t . AItf4t- /7' LCt.e-i !y 0r Ate 7 Kind of tank O � LL_C( Size S 7� - Length of trench �Sozttd r- NOTIFY HEALTH DEPARTMENT AT LEAST EIGHT HOURS BEFORE TANK IS TO BE INSP So , ED Final Inspection ;Z.._( 19C._ /... Approved ( / Disapproved ( ) Remarks: First five feet of line from outlet house should be o . ist ' • •'.e, • 1. -7I'(/4LG Z • Sanitarian. Sketch of tank and line showing distance from dwelling and well on subject property and on adjoining property. Ouotoer- bdtves-i-h)s hQ ama Petern,-J . Ptib,iS on 4h2 "opc I y re-keel - 41-\Q beak() op J - )mk °)mn e(cf .