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HomeMy WebLinkAboutEHPR-04-2016-23548.TIF /A THIS IS NOT A PERMIT Case # EHPR-04-2016-23548 fi� �,�, H CATAWBA COUNTY HEALTH DEPARTMENT m u 0 ''� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES q�? _ '4842 sM Environmental Health Plan Review - OSWP $•moo ° •. OO IMPROVEMENT •m" , y 1 OI .JhF T Elk- Applicant STAN LINEBERRY, 324 BEN F1 rr4 LN, TAYLORSVILLE NC 28681 B:828455I398 NAME TO APPEAR ON PERMIT Stan Lineberry SITE ADDRESS: 5982 SPRINGS RD, CONOVER NC 28613 PIN # 375517117032 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 63,162.00 Acres 1.45 DIRECTIONS: corner of Hwy 16 and Springs Rd PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 265 WATER SUPPLY : Public Water DESCRIBE WORK: IP For change of use new mattress store by appt only 2000 sq ft retail 500 sq ft storage, existing garage with 1 employee SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is"YES", then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? Yes Is the site subject to approval by any other public agency? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: Existing Structure STRUCTURE TYPE: ** NO STRUCTURE SELECTED ** FACILITY TYPE: Business OTHER DESCRIPTION: DESCRIPTION OF business garage with 1 employee and new matress store by appt only EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 188 x 100 NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES: SEATING CAPACITY: TOTAL FLOOR SPACE (SQ FT): 500 RETAIL FLOOR SPACE (SQ FT): 2,000 DINING AREA FLOOR SPACE (SQ FT): Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: E9-ehapplication 04/01/2016 14:33 Page 1 of 41$• • CAPAWBA COUNTY Case d EI-IPR-04-20 1 6-23 348 , _.).R.2 Public Health Department Subdivision 6 „if® ,� Environmental I-lealth Division PIN# 375517117032 PO Box 389. 100-A Southwest Blvd,Newton,NC 28658 !84 su NAME ON PERMIT: (STAN LINEBERRY), 324 BEN FULLER LN, TAYLORSVILLE NC 28681 ( Stan Lineberry) Site Address: 5982 SPRINGS RD, CONOVER NC 28613 Property Size: Square Feet 63,162.00 Acres 1'45 Directions: corner of Hwy 16 and Springs 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 an I beli of all property lines and corners and making the site accessible at a co 4 plete ite evaluation can be performed. Date: i/f/ /' (• 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 FEENAME DATE FEEAMOUNTJ Improvement Permit Fee 04/01/2016 S150.00 TOTAL FEES 5150.001 FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ONA PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) hO-chappl ication 04/01/2016 14:33 Page 2 of 4 CATAWBA THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT ^-.-4^t h - - Application for Environmental Services Page 1 Improvement Permit Authorization to Construct n Septic Repair n Septic Malfunction n Septic Expan ion n New Well Permit❑ Replacement Well n Well Abandonment❑ Well Repair n Existing System Inspection (Pre-Approval Required) n Application is for New Construction ❑ Existing Facility n Property Address 5/�7r2 5 n'ld AA.p( Subdivision ( allouer AA. ate./3 Lot# Acres Section/Block/Phase Driving Directions to Property (o raver Q F big,.., 16 /- Sp,.,,,, r /focal NAME TO APPEAR ON PERMMIT? ❑ Owner ❑ Applicant n Contractor Applicant Contact Information Name STAN LrN,,A —fin'J Address 3a9 4 ,,s Her lei—r la7 /Orr.Ji ,lx. Pycn Phone Or' ii Cr— /3 9f Cell Phone SAM r,- Owner Contact Information Name 446 L ,EE/F Address ai-rj I spot.) foacA #6a#410,3 ,a-C• ?f-(,OI Phone Aar, p c or Cell Phone 1/4549,41g Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? n Owner ✓Applicant ❑ Contractor Description of Existing Structu es on Site 4OCO SC ash cif, a f dv,/J'If # of Bedrooms *tr Structure Dimensions 1 %l/r lob # of Occupants / Basement ❑ Yes No Basement Fixtures n Yes r(No The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property ietyquestion. If the answer to any question is"yes", applicant must attach supporting documentation. ❑ Yes No Does the site contain any jurisdictional wetlands? Yes lino Does the site contain any existing wastewater systems? Yes Is any wastewater going to be generated on the site other than domestic sewage? Yes ! � Is the site subject to approval by any other public agency? Q ❑ Yes • o Are there any easements or right of ways on this property? Describe Existingyvater supply in use ❑ Individual Well n Community Well ❑ Semi-Public Well [County/City/Township Water Line Is a public water supply available? ** ❑- ces ❑ 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) ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other ❑ Any cATA BA THIS IS NOT A PERMIT l.cotl VV,1J ! CATAWBA COUNTY HEALTH DEPARTMENT .,o„„�,o„�a Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions #of Occupants Basement n Yes No Basement Fixtures ❑ Yes ❑ No n Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes n No Plumbing ❑ Yes n No Describe Plumbing Needed . n Multi-Family Residence# Units #Bedrooms per Unit*t Total # Bedrooms *t Structure Dimensions ❑ Food Service Specify Type # Seats Floor Space -Entire Food Service Facility (Sq Ft) # Employees per Shift #of Shifts Dining Area (Sq. Ft.) Business Specific Type of Business " 91Cea S, /J /�f<&I Retail Floor Space P000 s# # of Employees per Shift # of Shifts 1,�!^..,- 6.fony,,� SOGsr ❑ Other Facility Type Specify U I5 0 SG�lcir}2- kl t 1 eemo i.A. s� sx ,y If Church # of Seats Kitchen 1 1 Yes n No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type n Individual Well n Semi-Public Well ❑ Community Well Abandonment Type n Drilled ❑ Bored ❑ Dug n Unknown Well Repair Requested ❑ Yes ❑ No Describe �y� Calculated Design Flow, Commercial t 211C- 11' Additional information may be required to determine design flow from certain facilities. This value will 6e 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 corners and making the site accessible so that a complete site evaluation can be performed. ,//� Signature of Owner or Agent 4 4 % • - Date `f 4c Printed Name of Owner or Agent STA., h�-,5'6isn1 Catawba County Environmental Health 1 (222 ti 20 Alt,CS • 2 Ra 192) • • • N (495 in U -- L 5 (398) 1 _ . _ 155 (295) • 1 Parcel: 375517117032, 5982 SPRINGS RD 1in=60ft CONOVER, 28613 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 04/01/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 375517117032 Owner: LITTLE BOBBY ALVIN Parcel Address: 5982 SPRINGS RD Owner2: null City: CONOVER, 28613 Address: 6009 N NC 16 HWY LRK(REID): 42548 Address2: null Deed Book/Page: 1089/0609 City: CONOVER Subdivision: null State/Zip: NC 28613-8716 Lots/Block: null/ null Last Sale: School Information: Plat Book/Page: School District: COUNTY Elementary School: OXFORD Legal: 5982 SPRINGS RD Calculated Acreage: 1.450 Middle School: RIVER BEND Tax Map: 0900 00053 High School: BUNKER HILL Township: CLINES School Map State Road #: 1517 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: OXFORD Zoningl: HC Building(s) Value: $175,800 Zoning2: null Land Value: $60,400 Zoning3: null Assessed Total Value: $236,200 Zoning Overlay: WP-O Year Built/Remodeled: 1974/null Small Area: ST STEPHENS/OXFORD 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 #: 3710375500J Building Details 2010 Census Block: 2000 WaterShed: WS-IV Protected Area 2010 Census Tract: 010201 Voter Precinct: P27 Agricultural District: PROXIMITY 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/nornap/parcelreport.php?key=3 755 1 71 1 7032&typ=P 4/1/2016 Case g Sp•- , CATA�VBACOUNTY � ' r � IMPV-10-2012-032429 .4' 6111 2 Public Health Department r a'�'� {yt Subdivision \11�•�,.., Environmental Health Division ,� �'+ PIN;.' 375517117032 \ ;l PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 �o G • ... LOT#sh, Val" ?fi,l8 NAME ON PERMIT: RUSTY CANIPE, 232 14TH AV SE C, HICKORY NC 28602 Site Address: 5982 SPRINGS RD, CONOVER NC 28613 Property Size: Square Feet 63,162.00 Acres 1.45 Directions: CORNER OF HWY 16 AND SPRINGS RD Improvement Permit INITIAL SYSTEM EXISTING • Facility: Business - auto garage & sweepstakes with 7 machines maximum Permit Category: Other Bedrooms 0 WATER SUPPLY: Private Well Basement? No Basement Plumbing? No INITIAL SYSTEM SPECIFICATIONS Permit Valid: Expires In Five Years: _X_ No Expiration: Projected Daily Flow 200 g.p.d Proposed Wastewater System: CONVENTIONAL Type: IWB - CONV SYSTEM WITH <750 LINEAR FEET OF LINE Permit Conditions: This IP is issued to designate septic repair; a change in use of the exisitng facility is proposed. Per owner, Bobby Little, and original septic permits, only the business is connected to the existing system. Adjacent mobile homes have their own separate system. No additional connections to the business septic system are permitted; this system is to serve the business only. Proposed sweepstakes is permitted to have 7 machines maximum & 1 employee; any additional machine_s beyond 7 will result in the revocation of this permit. REPAIR SYSTEM SPECIFICATIONS Repair System Required? Required Proposed Wastewater System: 25% REDUCTION Type: 111G -OTHER NON-CONY TRENCH SYSTEMS PUMP *MAY BE* 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 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 Rides for Sewage 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. Megen McBride 10/30/2012 AUTHORIZED STATE AGENT APPROVAL DAMF. Permit Expiration Date: 10/30/2017 No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department. 1i9.chpermii 10/30/2012 09:15 Page 1 of 3 13 E41? - 10 -2012 4381 5182 Set Rd, Cono4ev y 11,, �drlire, lof 21112, kowitVev r c�varewke. CGi. Exc4 c Sy4 w vJac �Isva11 + �J v3e ac -4o its I ovv eV i1r. iE TIniS evnAIlk desjoy\a-f6 S4±c- rcrir avta . t D— 64-k■J -rcieilt4 IS a 6,5 e55 W>AI^ 2 USeS ; av‘ exc5-1-ien3 ago alaraac air,/ U rrreDso4 Weerd1`•-k--P5. Sykepsk5 6 revrv■rf-kd -for 7 frukckv,e5 womoA. 4 D6 Hel4 *‘4 tirade, cvF 01' fi11 oJev seiie cp!e►w 0' feral( C ura. 'HI f�is Prt ray 1iA{ 5kc \ - E�dc1ir Builino5 4 Iros Ixr-r�re o Auld Gara t t SvIer eSJ • 's (.7 ni h i nes MaX) IIc•owe.11 a6 11a41 o. 3 \ril N paned Parkin.3 arw • y� 2 � i 9 "-�o' geld. . DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES Shed of DIVISION OF ENVIRONMENTAL HEALTH PROPERTY ID q; ,ON-SITE WASTEWATER SECTION AUNTY: SOIL/SITE EVALUATION APPII«iv!: Rush/Ccon.re, far ON-SHE WASTEWATER SYSTEM OWNER:3061,1 LL.144-10 APPLICATION DATE 16 IZ It E.H?R -It- 2012-I638i ADDRESS: DATE EVALUATED: IO-21-(Z PROPOSED FACILITY: PROPOSED DESIGN FLOW(.1949): 200 PROPERTY SIZE: 1.'15 OCYCS LOCATION OF SITE:'5982 Sari_4c H . (ono)e( PROPERTY RECORDED; WATER SUPPLY: 0 Private 0 Public ® Well 0 Spring 0 Other EVALUATION METHOD: 0 Auga goring Q( Pit U Cut TYPE OF WASTEWATER: IN Sewage 0 Industrial Process 0 lrfviced _.r......-..._.._......_•.................... c.... i.(l`i s`i i=iiiEi iz:=_t:::i:iFaisiii;s.;.:1941 : ..,..:,O.........,....:..ct,......s - - :;I^ i3t 'I7. HDBLa:::::::'.::' 3447 .. ... :..::....:7: `=: si:SCR ZON_::: 1 501li 1:c4j "•956. 1944 ... `-i '. °POSIERV .DEPTH��::::::E:'ST'#UCT(11t. f d3•P•CI•L'i.Ct2° WnTRCC1 $tJlIe . . .5.eP .RASTR PROFJ?" r-, _'.S... • 114151: 'iii!i!.1' •UR - ... ..,..:M4!•1:IiAL.QGY.. ..{0lAit ... AEP.T'EL:: = IL4$ t: F#?.RLZ[st:....CLASS¢:: 0-fo St )v- -Cr,Ss sexy fe-36 CL Ji , sbk fr. 55, sekp •1 6 es . 0,3 2 Sate— . 36 - _ PS 0.3 I I 3 • • 4 DESCRIPTION I ATIIAL SYSTEM I REPAIR SYSTEM OTHER FACTORS(.1946): Mailable Space(.1945) SITE CLASSIFICATION(.194nR): • _Systcm Tyre(s) T1b �1,,. of A� Illrfuen l`tari:C1� Site LIAR 0.3 COMMENTS: 10 5174 I Machine. (fiv Mc, pt s, ' 1{"11 JD i,) 7 Inaclkinn x 103riti Machine = 70 5rd 2l,v4M6 l \ rloya x 15(yd I employs. _ )5 9Pd S epsl�k6 95 —' 100 Ord ttiin retired bane- f\1/4.A-10 Garay, : 2- amelolcc5 I 3 t,v„ (9vi(?Gl )wjrd 411-t 6AIdin`1; LtsiKe595 Exisii� S14e11 �Yalvel Lea 4 IDox 15 J 166x 15 = 1500 _ IDOO°'conue ionJ e--- 5 -r 5 1 Prt'A USG ✓ rot/ �� = bbl°' (pnVek{lbnw� � U� 3 Lig TkK P r°/`�� 51r�lc. dell \l N �+veyat) WTI 57 TT • • WI. S2oo-0o0(o - . ' • CATAWBA COUNTY,HEALTIOEPARTMENT Telephone: (828) 465-8270 TDD: (828) 465-8200 N9 _$9 IP AC r. Prmt. Opr. Prim. Sys. Type Well Prmt. Replacement Well Well Rpr. Prmt. Owner/Agent Rokb rri•e Phone '��(07_ a.•),OS' Address 2.�$SY\ 4 SQ f, 7 c CO Subdivision Section/Block/Phase Lotf Lot Size a y, Directions: • - _ . • vJ / Property Address i_mi:• :zc7 iia•. Facility: House Mobile Home Business X Multi-family . Other: Pin Number '3 -7 5.—S-- —) 1j 7 03), Other . Zoning Approval N ---- N Bedrooms N Seats N Employees . Application Rate GPD Flow _ -- Hot Tub or Spa yes/no Special Fixtures Basement yes/no . 100%o Repair Area yes/ae-- Basement Plumbing yes/no Water Supply: Private Well Public Semi-Public Type of System: rench Bed Pump Pump/Panel Panel LPP Other Septic Tank Size . . . . ize Nitrification Field: Total Square Feet Depth of Sto•Bed Size Trench W i. • T. . ••• .-s Number of Trenches Trench Lengt / / / / Feet on Center Maximum Trench . Distance of Nearest Well *DO NOT 'STALL SEPTIC WHEN WET* *WELL RECORD REQ 7 I • COMPLETION* To.o % Slope Tex• re a , Structure — Clay Min. - .I Soil Wetness Soil Depth a " Restric. Ho . at " Availab • space yes/n. \Z xv` ' Ov• all Class S PS U �S lJ 5 / S• menu: _ \.— ... - - �U \ fir/, isilst ;%.0.1\ �\ \ \ \\ p \. \\\ \ \ Filter Required 1 \ \ \ \ \ \\ \ • Riser required when - - tank is more than 6 inches deep. **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** ************************************************************************************************************************* *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 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 guaran eed at any site by the Health Department. Permit Date •-•l j _ EHS 2- .S Owner/Agent Septic Tank 1 stalled Q} --- Date EHS� Well Installed By T3 .�/ � -Sr- Well Grout Approval DateQai - Well Head Approval Date )) —C)1 Date Sample Collected Kt..., Date of Results Results EHS /� S- CATAWBA COUNTY HEALTH DEPARTMENT PERMIT COMPLETION PERMIT FOR SEPTIC TANKS N? 861 (Ground Absorption Sewage Disposal System — G. S. 130-13C) OWNER OR CONTRACTOR 647 –gti�"L L-i DAT - ADDRESS JJJ LOCATION L44A9..e. of :241 ) _, 7t/ 0 --r 7_r.,xr �hece,-, SUBDIVISION NAME _ LOT NO SECTION OR BLOCK NO. , HOUSE (—) MOBILE HOME (kr- BUSINESS (—) '�Y~ q`� i�P ,4p NO. BEDROOMS ( ) NO. BATHROOMS ( —) ;� it, .4.Li GARBAGE DISPOSAL UNIT: Yes (—) No (l< dl! 6.\ __,1, SIZE OF TANK l6 F• Total Gallons \\ NITRIFICATION FIELD (nO 6n Ft. I WATER SUPPLY: PRIVATE O PUBLIC (—) i S INSTALLED BYi L , rSyukz a , j CERTIFICATE OF COMPLETION BY *O , 664.01' DATE INSTALLED 41/7V Health Department HD 2-74 CATAWBA COUNTY HEALTH DEPARTMENT PERMIT COMPLETION PERMIT FOR SEPTIC TANKS �R (Ground Absorption Sewage Disposal System — G. S. 130-13C N? 2`"-' / v NER OR CONTRACTOR I f Ai , :1 _� DATF F/4/ '/ y CRESS „---1:9-7e- - i .—4 /_ � .i / �" — .f.�_ ' � /� . . �_% � �L.i/�.l( _!/i��: /r BDIVISION NAMF LOT NO. SECTION OR BLOCK NO. HOUSE ��MOBILE HOME (k<BUSINESS . b1d6 ' ' • ' • _ - /S-l0 0 � NO. BEDROOMS ( ) NO. BATHROOMS ( ) o- ; . 60a ft((11 V GARBAGE DISPOSAL UNIT: Yes (—) No SIZE OF TANK /67--0 0o...0 Total Gallon- I, t s' ' NITRIFICATION FIELD 0 F . ' WATER SUPPLY: PRIVATE (A< PUBLIC ( ) 4 INSTALLED BY 4# A. .��, / / ti', CERTIFICATE OF COMPLETION BY/// L / DATE INSTALLED �� 7y Health Department HD zaa(` I CATAWBA COUNTY HEALTH DEPARTMENT NEWTON, NORTH CAROLINA COMPLETION PERMIT FOR SEPTIC TANKS PERMIT N d 16 17 DATE : OWNER g, 6i 3/4.4_. 4(,),,,,1247 h z ADDRESS BUILDING CONTRACTOR SUBDIVISION A.4 LOCATION . gePhn nL Rat cuwn4� uA,.Aji.,. LOT It LOT SIZE BLOCK OR SECTION HOUSE ( ) MOBILE HOME (✓) BUSINESS ( ) OTHER ( ) FHA-VA LOAN ( ) SEPTIC TANK: (SIZE ,.,a, GALS) WATER SUPPLY : NO. BEDROOMS NO IXTU-RES INDIVIDUAL PUBLIC GARBAGE DISPOSAL UNIT :YES ()NO ( ) IF WELL, TYPE : BORED DRILLED DUG AUTO WASHING MACHINE : YES ( ) NO ( ) DISTANCE FROM SEPTIC TANK OR NEAREST NITRIFICATION FIELD : SQ . FT . POLLUTION:,,,,, ; ,� 04L,- St FT. 1) NUMBER OF LINES SEPTIC TANK INSITALLE EY : 2) LENGTH AND WIDTH OF LINES PERMIT FEE $ ,d, -�- a) BED SYSTEM ( ) CERTIFICATE OF COMPLETION BY : b) TRENCH SYSTEM ( ) DEPTH OF STONE IN LINES RE RKS : (I 2 ,'i 447c. /,w„,,., 64,, ADEQUATE FALL (GRADE) ON: 1) BUILDING (HOUSE) SEWER LINE : YES ( ) NO ( ) 2) NITRIFICATION LINES : DATE INSTALLED: --- YES ( ) NO ( ) SEPTIC TANK LAYOUT OK 1) - 31- YL, ia , I-1 ze " J 9 -1 y4 o i [ M. O (\t HEALTH DEPARTMENT COPY /14'A CATAWBA COUNTY 100A SOUTHWEST BLVD / , y NEWTON, NORTH CAROLINA 28658 INVOICE/RECEIPT ;.,,- ` PHONE: 828.465.8399 Friday, April 1, 2016 �84s n su www.catawbacountync.gov Invoice Number: 04-1 6-326772 Invoice Date: 04/0112016 EI-IPR-04-2016-23548 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 5982 SPRINGS RD, CONOVER NC 28613 Applicant STAN LINEBERRY, 324 BEN FULLER LN, TAYLORSVILLE NC 28681 B:8284551398 **NO PEOPLESOFTACCOUNTASSIGNED ** PAYO R: Lineberry, Stan FEES EHPR-04-2016-23548 FEE AMT DUE AMT Improvement Permit Fee 04/01/2016 $150.00 $0.00 FEES: S 150.00 $0.00 TOTAL FEES : $150.00 $0.00 PAYMENTS INVOICE NUMBER FEE NAME FEE AMOUNT TRANSACTION NUMBER: TRC-647825-01-04-2016 PAYMENT DATE : 04/01/2016 PAYMENT TYPE: Credit Card 160839478 04-16-326772 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 invoicereceipt 04/01/2016 14:35 Page I oil