HomeMy WebLinkAboutIMPV-08-2016-076178.TIF ,yiA \ CATAWBA COUNTYi. Case# IMPV-08-2016-076178
Q n i, Public Health Department Subdivision VAN DRESSER AND HOYL
Environmental Health Division PIN# 373512857470
� Y PO box 389. 100-A Southwest Blvd. Newton. NC 28658 LO'Fit 7A
18422.
NAME ON PERMIT: GINGER SMITH, 291 GRAPEVINE TRAIL, STATE RAOD NC 28676
Site Address: 6208 VANDRESSER PT, HICKORY NC 28601
Property Size: Square Feet: 17,424.00 Acres:0.4
Directions: Hwy 16, Right onto St Peters Ch Rd & go to the end, Right onto Wandering Ln, Right onto Sulphur Springs
Rd, Right onto Lynchburg, Left onto Van Dresser approx. 2/10ths of mile on Right. (across the beach from the
campground)
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.
RSAs the property owner or authorized representative, I have received the above referenced permit(s) as
requested in the application for service EHPR-07-2016-24366 , by the following method(s):
_Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/ E-mail (Return receipt required)
\ICS)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: 08/26/2016 Q � /1 1
Owner/Authorized Representative Signatures J Y - Q�1----->
) y�Qfi k� ✓ tts
Date c6121p 1 Le
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
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chpenit 08/26/2016 11:32
V\A CATAWBA COUNTY
ID 1 ID Case t! IMPV-08-2016-076178
insI r Public Health Department Subdivision VAN DRESSER AND HOYL
r PINft
*r ' ; Environmental Health Division s + S r ,y 373512857470
PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 �'f -7-i
1842 SM y r 'c LOT# 7A
r .
a J.51
NAME ON PERMIT: GINGER SMITH, 291 GRAPEVINE TRAIL, STATE RAOD NC 28676
Site Address: 6208 VANDRESSER PT, HICKORY NC 28601
Property Size: Square Feet: 17,424.00 Acres:0.4
Directions: Hwy 16, Right onto St Peters Ch Rd & go to the end, Right onto Wandering Ln, Right onto Sulphur Springs
Rd, Right onto Lynchburg, Left onto Van Dresser approx. 2/10ths of mile on Right. (across the beach from the
campground)
Improvement Permit
Facility: Primary Residence
Permit Category: New Septic Bedrooms 2
WATER SUPPLY: Private Well
Basement? No Basement Plumbing? No
INITIAL SYSTEM SPECIFICATIONS
Permit Valid: Expires In Five Years: _X_ No Expiration:
Projected Daily Flow 240 g.p.d
Proposed Wastewater System: 50% REDUCTION
Type: IIIB - SYSTEM W/SINGLE EFFLUENT PUMP
PUMP REQUIRED
Permit Conditions:
REPAIR SYSTEM SPECIFICATIONS
Repair System Required? Required
Proposed Wastewater System: 50% REDUCTION
Type: IVA-ANY SYSTEM WITH LPP DISTRIBUTION
PUMP 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. It is the responsibility of the
applicantproperty 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' (I5A NCAC ISA .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 08/26/2016
AUTHORIZED STATE AGENT APPROVAL DATE
08/26/2021
Permit Expiration Date:
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
ehpemtit 08/26/2016 11:32
EHPR 07-2016-24366
6208 Vandresser Pt. 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.
• Septic area should be protected from surface water from neighboring lot to prevent soil
erosion.
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DEPARTMENT OF HEALTH AND HUMAN SERVICES 'Ole& o'7- 2016- 29 3 6(, Sheet ( of f
DIVISION OF PUBLIC HEALTH,ENVIRONMENTAL HEALTH SECTION PROPERTY ID#:
ON-SITE WATER PROTECTION BRANCH COUNTY: Catawba
SOIL/SITE EVALUATION
for ON-SITE WASTEWATER SYSTEM
(Complete all fields in full)
OWNER: H rc(c( /RYt". _ APPLICATION DATE
ADDRESS: DATE EVALUATED: 9/274
PROPOSED FACILITY: PROPOSED DESIGN FLOW(.1949): PROPERTY SIZE: •`(
LOCATION OF SITE: 6 toy ✓44r,cssa- /°f' PROPERTY RECORDED:
WATER SUPPLY: 0 Private ❑Public g Well 0 Spring 0 Other
EVALUATION METHOD: E Auer Boring A Pit ❑Cut TYPE OF WASTEWATER: .A Sewage ❑Industrial Process ❑Mixed
P 1
R
O SOIL MORPHOLOGY OTHER
F (.1941) PROFILE FACTORS
1 .1940
E •
LANDSCAPE HORIZON
POSITION/ DEPTH PROFILE
# SLOPE/ (IN.) .1942 CLASS
.1941 .1941 SOIL .1943 .1956 .1944
STRUCTURE/ CONSISTENCE WETNESS! SOIL SAPRO RESTR <AR
TEXTURE MINERALOGY COLOR DEPTH CLASS IIORIZ
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DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946):
Available Space(.1945) 115
J 4 es A C SITE CLASSIFICATION(.1948): p (5
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Syslem't'ype(s) T a'Y�� ,SOL Q�t MCP Kee' OTHER(S)PRESENT:
Site LIAR D., O, 3
COMMENTS:
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Parcel: 373512857470, 6208 VANDRESSER PT 1 in=60ft
HICKORY, 28601
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