HomeMy WebLinkAboutIMPV-09-2016-076414.TIF , ,A • CATA�VBA COUNTY Case# IMPV-09-2016-076414
Ci' '` �n Public Health Department Subdivision
i e ,.c Environmental Health Division PIN# 265702598053
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1gg2 PO Box 389. 100-A Southwest Blvd.Newton.NC 28658 LOT#
NAME ON PERMIT: PHILLIP LEONARD, 2475 RIDGE E RD, SALISBURY NC 28144
Site Address: 9496 GOLDEN EAGLE RD, VALE NC 28168
Property Size: Square Feet: 71,438.40 Acres:1.640
Directions: HWY 18 SOUTH TURN LEFT ONTO GOLDEN EAGLE RD PROPERTY ON RIGHT
Owner/Authorized Representative Acknowledgement of Permit Receipt
v' `I certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the
property described above.
.1 (� riAs the property owner or authorized representative, I have received the above referenced permit(s) as
v requested in the application for service RBPR-08-2016-24442 by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/ E-mail (Return receipt required)
L,pAs 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: 09/02/2016
Owner/Authorized Representative Signat.re dear,
Date S - — ( C
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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dim rmit 09/02/2016 11:03
A6 CATAWBA COUNTY ❑e r� ❑e Case# IMPV-09-2016-076414
7ti Public Health Department �t Subdivision
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Environmental Health Division �r •1 PIN# 265702598053
's^ PO Box 389, 100-A Southwest Blvd, Newton,NC 28658 0 0 i G f LOT#
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❑i M S,1: 1O . .
NAME ON PERMIT: PHILLIP LEONARD, 2475 RIDGE E RD, SALISBURY NC 28144
Site Address: 9496 GOLDEN EAGLE RD, VALE NC 28168
Property Size: Square Feet:71,438.40 Acres:1.640
Directions: HWY 18 SOUTH TURN LEFT ONTO GOLDEN EAGLE RD PROPERTY ON RIGHT
Improvement Permit
Facility: Primary Residence
Permit Category: Other Bedrooms 3
WATER SUPPLY: Private Well
Basement? No Basement Plumbing? No
INITIAL SYSTEM SPECIFICATIONS
Permit Valid: Expires In Five Years: No Expiration: _X_
Projected Daily Flow 360 g.p.d
Proposed Wastewater System: 25% REDUCTION
Type: IIIG -OTHER NON-CONN TRENCH SYSTEMS
Permit Conditions: System already installed in 2015. This was to ensure setbacks would be met with proposed MH
location.
REPAIR SYSTEM SPECIFICATIONS
Repair System Required? Required
Proposed Wastewater System: 25% REDUCTION
Type: 1110 -OTHER NON-CONY TRENCH SYSTEMS
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 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 Sewa.ee Treatment and Disposal Systems' (15A 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 09/02/2016
AUTHORIZED STATE AGENT APPROVAL DATE.
Permit Expiration Date: 09/02/2021
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
ehpemi a 09/02/2016 11:03
IP RBPR 08-2016-24442
9496 Golden Eagle Rd, Vale
• Do not cut, drive, fill, or grade over septic or repair areas.
• Septic system already installed under permits for RBPR 07-2015-21896.
• This is an improvement permit only and was to verify correct setbacks for the proposed
mobile home (MH). Originally the MH was flagged too close (22 ft) from the existing
well. The owner moved the flag for the MH to meet the 25 ft well setback and keep the 5
ft setback from the septic system.
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