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HomeMy WebLinkAboutEHPR-05-2016-23900.TIF �Y A OG THIS IS NOT A PERMIT Case # EHPR-05-2016-23900 CATAWBA COUNTY HEALTH DEPARTMENT 0 • za --"WS 0 w'?� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES .G 1842 :� Environmental Health Plan Review - OSWP io o EXS_SYSTEM • fix) v r Owner DENNIS LEE, 9482 BAYLEAF LN, SHERRILLS FORD NC 28673 H:828478946I C:7046585288 HOME:828478946I NAME TO APPEAR ON PERMIT Dennis Lee SITE ADDRESS: 9482 BAYLEAF LN, SHERRILLS FORD NC 28673 PIN # 462802570040 NAME of SUBDIVISION: North Bay Shores Ph 1 Lot# 2 Section/Block PROPERTY SIZE: Square Feet 37,026.00 Acres .850 DIRECTIONS: HWy 16 South to Hwy 150, Hwy 150 East, Left onto Sherrills Ford Rd, Go about 3 miles, Right onto Island Point Rd, Go about 3 miles, Left onto Bayleaf Lane, 2nd house on the Left. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well • DESCRIBE WORK: Existing System Check. - Previous inspection of system noted issues with concrete over repair area as well as a retaining wall possibly going through septic area. Owner is trying to sell the home. - Need to identify all potential issues & possible solutions. No Operators Permit since 2006. 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? No Are there any easements or right-of-ways on this property? No APPLICATION FOR: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF House EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 75x51 NUMBER OF EXISTING BEDROOMS: 4 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION 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-chapplicat ion 05/18/2016 12:26 Page 1 014 • / • CATAWBA COUNTY Case ti EHPR-05-201 6-23 900 • q' �' Public Health Department Subdivision -/- North Bay Shores Ph 1 4:�a �'' Environmental Health Division PIN# 462802570040 '" l PO Box 389. 100-A Southwest Blvd. Newton.NC 28658 F42 u NAME ON PERMIT: ( DENNIS LEE), 9482 BAYLEAF LN, SHERRILLS FORD NC 28673 ( Dennis Lee) Site Address: 9482 BAYLEAF LN, SHERRILLS FORD NC 28673 Property Size: Square Feet 37,026.00 Acres .850 Directions: HWy 16 South to Hwy 150, Hwy 150 East, Left onto Sherrills Ford Rd, Go about 3 miles, Right onto Island Point Rd, Go about 3 miles, Left onto Bayleaf Lane, 2nd house on the Left. 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 co my and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws . d rules. I understand hat, - solely responsible for the proper identificati nd labeling,of all property lines and corners and making the site ca site .•le so that a o•-ptetYSi - - ation can be performed. Date: 41pac ja Signature of Applicant or Agent A jjeaa1 0 An Environmental Health Specialist will contact yon within ' working da . ap lication ..te. If you need further information or assista e please call 828-466-7291 AREA1 Np11llliiiropmmaI I I k, ,.. "vinjwt177,p'ru ,n, y q1 �r � rPltiN mlI use. m�,r'9(Mn4l(1ni g 1{bEEENANIE�l t G�l�i�w�. day liii tliilJh. ,.l !Ililtillil�JGir.DATEj P IIiIf FEE AMOUNTj, Existing Tank Check Fee 05/18/2016 $80.00 I !PHI 1 II I f 11. iiln7ln' I �IJ II I 11 n iYit �i��� l�"���i'l� �I� lroTALIFEESfll�llk111111/lillEhllsl�litd Irwl�vlllll�Ipl�G�� ,J�iIIIIIIG 141111101. 616111$s , _ill � lift l's.'' • i i ili 616 111;tr, ,d:LW,uy>w':rrty a .'Wflilllli 1X:_211115 .�Imlfilhfi d lii_ 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) P9-ehapplication 05/18/20 t6 12126 Page 2 of 4 CATAWBA THIS IS NOT A PERMIT COUNTY � CATAWBA COUNTY HEALTH DEPARTMENT „,.„,..q— Application for Environmental Services Page 1 Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) Application is for �N/ew Construction ❑ Existing Facility NI Property Address q7 0� t4y2l/V�(�//11C Subdivision /l )2-7 847 v k/2Cf ci..�� l• AreL/ Lot# 2- Acres 0, sec- / � / �7� Section/Block/Phase • Directions to Property /70477/4) Jo1' 73 %tier/522. 4 ///, () L---77C7-72) /2/Z/"cZ`e./ /4 ,G\ .J4Tdtj ph'x/[ii�� (2/9/l0Y• ti1i),ro/t/T- r .� f`�,4 (/�)°0/lOX 3 211 J ro,u/m saAyie4cLgif/L 12 4 /hide oh/ Lac--7— NAME TO APPEAR ON PERMIT? IXI Owner ❑ Applicant ❑ Contractor Applican Contact Information �i Name C-/W/4" c. . LAC Address Qe/ g4y c-g,c L4E J% ' /La t- NC 63 cG 73 Phone Tc'2, v �_4t/J / Cell Phone (70`' 1 ��cr--5 ��-J Owner ConTet Information J Name //�.UA AP / ✓ Address CS1'� 7),. GC7,1/C e¢/yy Cr gz�=8 2,/ze( F frzz Ale 0261'6 T5 Phone ( cZ�, y �G/ Cell Phone (-7a v)4,,_��fi Contracto Contac Information J Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? XOwner ❑ Applicant ❑ Contractor Description of Existing Structures on Site /U— /, 29d0 .7 ze • 6 w Xet / 6 / # of Bedrooms *t � Structure Dimensins =SI #of Occupants 7- Basement Yes ❑ No Basement Fixtures Yes ® No The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in question. If the answer to any question is "yes", applicant must attach supporting documentation. ® Yes ND No Does the site contain any jurisdictional wetlands? a Yes ® No Does the site contain any existing wastewater systems? ❑ Yes ® No Is any wastewater going to be generated on the site other than domestic sewage? El Yes E No Is the site subject to approval by any other public agency? ❑ Yes €No Are there any easements or right of ways on this property? Describe Existing water supply in use N Individual Well ❑ Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes J"' 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 CATAWBA THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence n New Residence n Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions ft of Occupants Basement (— Yes n No Basement Fixtures ® Yes D No n Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑ Yes n No Plumbing E Yes n No Describe Plumbing Needed ❑ Multi-Family Residence#Units #Bedrooms per Unit*t Total # Bedrooms *f Structure Dimensions ❑ Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift ft of Shifts Dining Area (Sq. Ft.) n Business Specific Type of Business Retail Floor Space #of Employees per Shift #of Shifts n Other Facility Type Specify If Church # of Seats Kitchen n Ycs ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well n Semi-Public Well n Community Well Abandonment Type ❑ Drilled n Bored ❑ Dug n Unknown Well Repair Requested r Yes n No Describe Calculated Design Flow, Commercial t Additional information may be required to determine design flow from certain facilities. This value will be 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 transferable. 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. `z. • • Signature of Owner r Agent •of�y -Asa. Date 2LE 6 Printed Name of Owner or • gent CiJi(/ 410 . Catawba County Environmental Health r r I I I pool n r s r in,n n i b, j 28 91 ti � llidi 1 111 Lt . , 1 i{,i 1 34.31 �IRr r, � �INIivyl III °°�� ,l�i ,r i l,v r-AI A'di ��pr�l�,rl i 2.2 9 r s � t r�I I , Or oor ll4� 23. � r�.A 1111111(61.11 I i �st- c �illl g 114 r, tillicili: > i 4 ,i 37.25 .5.48 if t��i}rql�u �y, . / lt, �1 i. �° kllll� 1 h 26fi9jIN Ir+ a, u� jki, , I4� ;itIn [r I ;Ir ,l � R G1 p ��5031) 1i a ;� i1e1 �� I x'4.2 h , � �If�,li, ,' �I 1 ' r 4 1 r 30 'i �Ilf�� (� u� a dll � dl 1 �„ i� ISIS I�� Sjiun N > iH� " i)% 19:0 15.5 / 6 ...74 �1' t11'I , ll rIjI 9.1 1t s k h0(.:1111 396 �O n�4j� �,i 4.1 (I�itt. 18 .01 3 4411," l +lq; 23 B: I't 5 l . 'ruN;u(l :I!l 1111f r+ nrld Ir r �,to. -lam' : ,1"kit... ; ��Iliil, �P C i� ,) 31 a6 66 u s{ �+ al r+,i� �I'4ias' llCii' eill- { , 61.24 `fli3` 6�'�'� 20.9; mi 11 : i Milll.`i, / ? , iri, 2528,1 1./ a r r+ 0� tS� li /._ b 1 r :\5'2 1 #5 , {j�t' '�I. IIIIC 18.41 1 * 4:.‘; 4, .,Iti.ilr m //7-7 1,Or *. * 18.74 2p „St I 13 88 I 34.191 13 nyf I (90) W 00 ill •r I ,, fr / ,1 1 lfr r � p { ' th i 4: 11 lll t r 11111,1 l Lia, h Parcel: 462802570040, 9482 BAYLEAF LN 1 in=60ft 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 05/18/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 462802570040 Owner: LEE DENNIS R Parcel Address: 9482 BAYLEAF LN Owner2: LEE SARA BUSHNELL City: SHERRILLS FORD, 28673 Address: 9482 BAYLEAF LN LRK(REID): 802681 Address2: null Deed Book/Page: 2973/1657 City: SHERRILLS FORD Subdivision: NORTH BAY SHORES PH 1 State/Zip: NC 28673-7218 Lots/Block: 2/ null Last Sale: $250,000 on 2005-01-10 School Information: School District: COUNTY Plat Book/Page: 60/88 Elementary School: SHERRILLS FORD Legal: LOT 2 2 PL 60-88 N BAY SHORES PL Middle School: MILL CREEK 60-88 High School: BANDYS Calculated Acreage: .850 School Map Tax Map: null Township: MOUNTAIN CREEK State Road #: null 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: $472,200 Zoning2: null Land Value: $238,200 Zoning3: null Assessed Total Value: $710,400 Zoning Overlay: CRC-O,WP-O,FPM-O Year Built/Remodeled: 2005/null Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: null/null Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2008-03-18 Building Permits for this parcel. Firm Panel #: 3710462800K Building Details 2010 Census Block: 2020 _ . \ — WaterShed: WS-IV Critical Area 2010 Census Tract: 011503 (vim' 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. ©2016, Catawba County Government, North Carolina. All rights reserved. Ter - oo et\.,)YILS of N\ Ch Q)rcJn'` �ro Operate Solex /0% Jh /g afavvegeoUnty crl gYSale ap1/p�irce _re Or pi 4cL e`yejl 28025700408 =-P 5/16/2016 OPERATIONS PERMIT FOR TYPE IV WASTEWATER SYSTEM PERMIT NUMBER WLS#2005-00632 In accordance with the provisions of Article 11 of Chapter 130A, General Statutes of North Carolina as amended, and other applicable Laws and Rules PERMISSION IS HEREBY GRANTED TO Dennis Lee CATAWBA COUNTY FOR THE operation of a wastewater collection, treatment, and disposal system to serve- PIN# 4628 02 57 0040 pursuant to 15 A NCAC 18A 1900 et seq and in conformity with the application, improvement permit, and other supporting data subsequently filed and approved by the Catawba County Health Department and considered a part of this permit. Facilities to be served. (Address and specific type of facility) Dennis Lee 9482 Bayleaf Lane Sherrills Ford, NC 28673 Type 4A The approved wastewater collection, treatment and disposal system consists of: (1) 1000 gal. septic tank (2) 1000 gal. pump tank; Zoeller BN152-A .4 h/p pump (3) Pump to T& J Panel (4)4 trenches; 67ft. x 3ft. The Owner shall be subject to all applicable provisions of Article 11 of Chapter 130A of the General Statutes and 15A NCAC 18A 1900 et seq The Owner is especially referred to Rules 1935(29,31), 1937(d,e), 1938(g), 1945(a,b), 1950(a through i), 1961(a through d), 1965, 1967 and 1968 The Owner shall also be subject to the following specified conditions and limitations as they apply I. GF.NF.RAT.CONDITIONS 1 This permit is effective only with respect to the number and type of proposed facilities and volume and nature of wastes specified. 2. In the event that the facilities fail to perform satisfactorily, including the creation of nuisance conditions, the Owner/Operator shall take immediate corrective actions to correct the problem, including actions as may be required by the Catawba County Health Dept., such as the construction of or replacement of wastewater treatment or disposal facilities, upon receipt of a repair permit. 3 The septage generated from this system shall be disposed of in accordance with Article 9 of Chapter 130A of the General Statutes and 15A NCAC 13B 0100 et seq and in a manner approved by the North Carolina Division Of Solid Waste Management. 4 The issuance of this permit shall not relieve the Owner of the responsibility for damages to surface or groundwaters resulting from the operation of this system. Neither does the issuance of this permit exempt the Owner from complying with any and all statutes, rules, regulations, or ordinances which may be imposed by other government agencies (local, state, and federal) which have jurisdiction. 5 This permit may become suspended or revoked if the soils fail to adequately absorb and treat the wastes or if the facilities are not maintained and operated as designed. The system must be operated and maintained in a manner which will not create a public health hazard or nuisance by surfacing of effluent or discharge directly Into ground water or surface water any time dunng the operation of the system. 6 Adequate measures shall be taken to divert stonnwater from the disposal field area and to prevent wastewater runoff. 7 Diversion or bypassing of the untreated wastewater from the treatment facilities is prohibited. 8 Pnor to the transfer of this land to a new owner, a notice shall be given to the new owner that gives full details about the system and the matenals applied or incorporated at this site. At the time of the sale of the property a new Operations Permit will have to be issued. Operations permits are nontransferable 9 The designated repair area shall be reserved for the installation of additional mtnfication fields and is not to be covered with structures or impervious materials. 10 No addition, expansion, alteration or other repairs shall be made to the wastewater system without first obtaining an improvement permit from the Catawba County Health Dept. in accordance with GS 130A-336 11 Failure to abide by the conditions and limitations contained in this permit may subject the Owner to an enforcement action in accordance with North Carolina General Statute 130A-18, 130A-22C, 130A-23, and/or 130A-25 12 In the event that the facilities fail to perform 'satisfactonly, including the creation of nuisance conditions, the Owner/Operator shall contact the Catawba County Environmental Health Section of the Health Dept. within 48 hrs. of discovering this failure or problem. 13 A suitable cover, preferably fescue, shall be maintained over the drainfields. Grassed areas shall be kept mowed and the clippings and other debris removed as needed to prevent thatch build-up No traffic (including parking of RV's, boats, trailers as well as other vehicles) or other equipment shall be allowed on the drainfields with the exception of mowing equipment. 14 Non-biodegradable products (plastics, metals, etc ) chemicals (disinfectants, drain cleaners, acids, alkalies, pesticides, petroleum products, etc ) or grease shall not be discharged into the septic system. 15 The owner shall keep the plumbing system in the facility in good repair and eliminate leaks, drips, or excess flows as they are found. Use of ultra low fixtures and conservative Water use practices are recommened. II. OPFR ATTON ANT) MATNTENANCP REQT 1TRPMFNTS The Owner shall maintain a contract with a subsurface sewage. system operator who is currently certified by the Water Pollution Control System Operators Certification Commission to maintain this system. Verification of any changes to the contract currently on file shall be submitted in writing to the Catawba County Health Dept. This system is required to.be inspected by the certified operator at a minimum frequency of two times per year or as otherwise specified by the Catawba County Health Dept. The distribution device should be inspected during each maintenance visit for proper operation. If needed the pressure should be inspected and set properly at each maintenance visit. Low pressure lateral lines shall be purged of solids at least once a year using potable water directly or added into the dosing tank, If the operator and the health dept. determine purging is needed more or less frequently, then a new schedule shall be implemented. Pressure on the distribution lines shall be checked and adjusted in accordance to design pressures after each purging and at least semi-annually Pump drawdown level (between the on-float and the off-float), approximate dosing volume, and pump delivery rate shall be measured after each purging and at least semi- annually The owner and operator shall be responsible for assunng any broken pipes lateral. end caps or cleanouts are repaired within 48 hrs. of becoming aware of such a problem. The condition of all pipework shall be evaluated during each inspection. Surface and subsurface water shall be diverted away from the tanks and drainfield. Outlets on diversion ditches and tile drainage tubes shall be kept open and free flowing. The septic tank shall be inspected at least annually for leakage, blockage of influent/effluent lines, structural integrity, condition of baffle and tee, condition of risers if present, scum and solids level, and effluent clanty Solids shall be removed from the entire tank before the solids depth exceeds 1/3 of the liquid depth in the inlet compartment, and is otherwise determined to be needed by the operator or the Health Dept. The dosing tank shall be inspected semi-annually for leakage, structural mtegnty, condition of risers, solids level and effluent clarity Solids shall be removed from the dosing tank when solids are removed from the septic.tank or when the solid level is up to the pump or siphon intake level. Solids accumulating on the pump or siphon and floats shall be removed by hosing. Pumps and electrical controls shall be inspected at least semi-annually for pump presence and proper automatic functioning. The floats / pipe / control valves / union / anti-siphon hole are in proper working condition. The control panel / electrical connections are properly maintained and operational. The highwater alarm is present and operating properly Siphons, when present, shall be inspected at least semi-annually to venfy proper automatic functioning, and the highwater alarm is present and properly operating. III. MONTTOR}NG ANT)REPORT-INC; RRQT iIRFMFNTS 1 Any monitoring deemed necessary by the Catawba Co Health Dept. to insure the proper performance of the system shall be performed. 2. A record shall also be maintained documenting each site visit by the operator, including visual observations of all system components, and all maintenance activities It is recommended that the owner be offered a copy of each document for each visit. 3 A monitoring report, including all required rccords,signed by the operator, shall be submitted on or before the last day of the month following each 12 month penod after permit issuance to the following address Catawba County Environmental Health Attn. George Pendergrass PO Box 389 Newton,NC 28658 4 Non-compliance notification. The owner/operator shall report by telephone to the Catawba Co Health Dept., Phone No 465-8270, as soon as possible, but in no case more than 48 hrs. upon finding the system is malfunctioning by the surfacing or backing up of effluent, discharge directly into the ground water or surface water, or when repairs are needed. This permit is NONTRANSFERABLE. Once the property is sold or ownership changes hands, a new operations permit MUST be issued. It is the responsibility of the current owner to notify the Health Department of an impending change of ownership. It is also the responsibility of the current owner to inform the potential buyer of the existence of an operations permit and the requirements within. This system will be routinely inspected by the Health Department for ownership. PERMIT ISSUED THIS THE /,rj dh DAY OF l i /t/t/ , 200i2 F Ara / CATAWBA CO HEALTH DEPT Owner Signature ENVIRONMENTAL HEALTH SECT �_ RS rt> ecAISP ftffiz, Ss la loil -1. 1 % CATAWBA COUNTY HEALTH DEPARTMENT f 0 a at/ Telephone (828)465-8270 TDD (828)465-8200 WLS 1 203.5 -0Q32. Improvement Permit z\ AC \ Repair Permit. Operation Permit. System Type Well Permit.$, Replacement Well Owner/Agent ,DEA/M S (_,j_C-- Phone Address gy&a Lay 4.r=A7 4-A-NF Subdivision ✓✓Ott771 day -s-Nc---e-sl ti.,S Fns ,At C'. . .>z 6,'E 23 SeetienlSleek/Phase I Lot# .;z Lot Size D,SS■e?c7 Directions •-O c Mill -,••• . " T -. ora_ /y It AP ' il Po/ t -'VC)-_ a; ,.. .'d' ... C$ A i—s Lilt. . 4* C '- -S Property Address 7 y,.y1 8.,-vzg,9F 44,4...r.- Facility. House )( Mobile Home Business Multi-family _ Other Pm Number 44&,z8 0 2 `c7 0040 Other Zoning Approval# It Bedrooms _ if Seats #Employees Application Rate _, , GPD Flow y •o Hot Tub or SpeP-o Special Fixtures Basemen es o 100% Repair Arc eT o Basement Plumbin y se no Water Supply Private Well X Public_Semi-Public ************************************************************************kd********************************************** Type of System: Trench Bed -- Pump-- Pump/Panel )( Panel— LPP— Other Septic Tank Size /080— Pump Tank Size /ere[, Nitrification Field: Total Square Feet gO b Depth of Stone ,V//9 Bed Size Trench Width %3 Total Length of All Trenches Nu ..tier of Trenches — Trench Length 6s//t-e/07471.—i=Feet on Center er / Maximum Trench Depth -t P's •nce of Nearest Well ..S4 *DO NOT INSTALL SEPTIC WHEN WET* EQIIIR ' AT COMPLETION* ************************,******************************** �*******W:ii *R *.p. ********** ********************* * Topo % Slope iced _� -+ Texture • S • tructure °" Clay Min. ,��. i 7% PNmP Stz,r TO •OE Soil Wetness et \X Pc.E2mg -p 47- Soil Depth ,, l V ' Result Hoz. at " W I' S Mt- LflI dn/ �r \ Available space yes/no %' Overall Class S PS L b, \ 5E4TIG ,/f Ate Comments _y ■ Co/4-iQ/)c?2)2 Td c,„1.LE, GO - • * N.i+s Gv Et.. 101 D Se-vr nits, pis✓ B c=r,.2t- cue ) \ I 4�IMni CC PriO tr.. b�•ti2 SYS S / x y /� �_JI ;-iJ1 * r Dk/Z C.SC� GCi/sec, $?, u, 2-0� o al i F2 d1DO r ri0,-u J* C, ��IC 79C` c� tY �y ' � ] m ii I )N Four sTioN pN.�,P f17 JC Ia't j} T'n G-33 S*vL zottc- oz.- SM-t- ' t '\ at- E 4 LA I E--i.- 1...7 kta Ao la Filter Required F4-o9-r Sul i b1/47.4 Ltx. Riser required when tank is more than 6 ..1/443/40,----.... ' tee' A I us 0.414-i inches deep. �,'+. k **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO TH 1�ANC' OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** \ C C ****************i********i***************************************************** j************************************* 'Mikan^s).^.r.7kiD'ri _.',Any f>.ra: r:u y�r 7'+ 'Y�6:weattotritt44,Iottte.RK` aKit'!A . `n GT"`.'TPTy SiS'. � �`Q ccit, Y tt-J{ a'11 '.07 i:.' An Authorization to Construct is va t f nr five years from date issued and is not transferable. Well Permit valid for 5 years d provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be N inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. °r The siting of the well by the Health Department staff is to provide protection from known possible sources of contamination. No volume of . water is guaranteed at any site by the Health Department. , Permit Date ,emu cy r, 4(15$ EHS ts-^� . e.S. W Owner/Agent Air 1911 ft,9gn .1,1 Septic Tank Installed By ,. ){„p;y l,. Date_,51614 U1 EHS C. `�Z e 'Well Installed By Uzt�.. Well Grout Approval Date Well Head (!] Approval Date S^12-06 Date Sample Collected J Date of Results Results EFTS V `j D S • White Office Yellow Owner/Agent Pink-Building Inspection Authorization to Construct tv�S ;ooS-po63 .2 DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES DIVISION OF ENVIRONMENTAL HEALTH Sheer_of ON-SITE WASTEWATER SECTION PROPERTY ID Y COUNTY [ri.'P7t.s/ SOIL/SITE EVALUATION. for ON-SITE WASTEWATER SYSTEM OWNER. PENA1ILS Lt'Lf APPLICATION DATE ADDRESS: 9 yg-0 . era-; Lva{= S j i .S r LD N•G DATE EVALUATED. 7 - A'7-OS PROPOSED FACILITY )ho Sr K PROPOSED DESIGN FLOW( 1949): 450 PROPERTY SIZE. 6 es-4c-err LOCATION OF SITE. 9 Erc a 491-4- - L/!/ PROPERTY RECORDED. WATER SUPPLY ® Private 0-Public 0 Well 0 Spring 0 Other EVALUATION METHOD' 0 Auger Boring Pit 0 Cut TYPE OF WASTEWATER. / Sewage 0 Industrial-Process 0 Mixed SOIL'MORPHOLOGY OTHER 1940' ! PROFILE FACTORS LAND HORI 1942- .... ... .. SCAPE 7ON - .:: 1941 _. -' ���1941 1913 " p' El POSITION/ DEP;T,.H STRUCTURE/ CONSISTENCE/ WETNESS/ SOIL SAPRO RESRR PCLASS :I SLOPE/ : (111)' •TEXTURE.''.... MINERALOGY COLOR ::DEPTH CLASS BORIZ CLASS . :: .. .......... ' 0-3 7jPSa/v I 1 L3- V? ray/ Seytt° �. 1 �l//� tiJ� N/n 3 I • • B-3 ASO/ 2 7/ 3 V( sC.6 • , / Si G P.97500° - S . 3• • o 3 Turco/t, 3-4 5K6/5/e, • P&p/se-too .S 3 • S> ,v/d9 t'r N/n /Woo • 3 • :4 • • • • DESCR1P"RON INITIAL SYSTEM RPPARSYSTEM OTHER FACTORS( 1946): Available Space(.1945) .S SITE CLASSIFICATION( 1948) • SystemType(s) _ T�sPo..<C Tt=‘7-P,y,�Z EVALUATED BY G� C OTHER(S)PRESENT • Site LTAR I .3 3 COMMENTS. - LEGEND use the ollowing standard abbreviations • SOIL CONV ENTIONNA. LPP LP.::.-._._ _.�_ ....:. .< P AlINERALOGY/ LANDSCAPE POSITION GROUP TEXTURE .1955 LTAR* .1957 LTAR* CONSISTENCE STRUCTURE CC(Concave Slope) I S(Sand) 1.2-0.2 0.6-0.4 NEXP(Non-expansive) G(Single Gain) CV(Canvas Slope) LS(Loamy Sand) SEXP(Slightly Expansive M D(Drainage Way) \ FXP(Expnnsrvo ) (Massive) (Debris Slump) 11 SL(Sandy Loam) 0.5-0.6 0.4-0.3 ) CR(Crumb) FP(Flood Plain) L(Loam) 'GR(Granular) FS(Foot Slope) ASK(Angular Blocky) cky)y) II(Head Slope) III SCL(Sandy Clay Loam) 0.6-0.3 0.3-0.15 ' ARK wry)(Angular Bledry) L(Linear Slope) SiL(Silt Loam) PL(Platy) PR(Prismatic)(Nose Slope) CL(Clay Loam) °) R(Ridge) SiCL(Silty Clay Loam) MOIST T S(Shoulder Slope) Si(Silt) ' T(Terrace) VFR(Very Friable) NS(Noo-tky) IV SC(Sandy Clay) 0.4-0.1 0.2-0.05 FR(Enable) 5S(Slightly Sticky) SiC(Silty Clay) Fl(Finn) S(Sticky) C(Clay) VD(Very Finn v.Very Sticky) VS(Very Sticky) 0(Organic) None EFI(Extremely Finn) NP(Non-plastic) SP(Slightly Plastic) Adjust LTAR due to depth,consistence,stnetu re,soil wetness,landscape,position,wastewater flow and quality P(Plastic) NOTES VP(Very Plastic) HORmONDEPTH In inches below natural soil surface DEPTH OF FILL In inches from land surface RESTRICTIVE HORIZON Thickness and depth from land surface SAPROLITE Slsuitable)or U(unsuitable) SOIL WETNESS Inches from land surface to free wales or inches from land surface to soil colors with chrosna 2 or less-record Mansell color chip desighation CLASSIFICATION S(Suitable),PS(Provisionally Suitable),orU(Unsuitable) Evaluation ofsapmlite shall he by pits. • Long-term Acceptance Rate(LTAR),galfday/ft Show i Tonle locations and other site features(dimensions.reference or benchmark,and North). - • C... � <A�C s+ • • • • a ' �..i r°v S.r l 634.11 s. a 1 • • • DENR( aat#4) . Review(4404) t�G2 CATAWBA COUNTY 1P Pubic Health —Environmental Health Division l8.2 SM Inspection of Type 4 Subsurface Wastewater System Catawba County Dennis Lee WLS 2005-00632 Health Department Name of Establishment Permit No. 9482 Bayleaf Lane NC 3BR Home 480 gpd Location Type of Establishment Design Flow Owner Address Phone N/A Certified Operator Address Phone Legend S-Satisfactory M-Marginal U-Unsatisfactory N-Not Evaluated N/A—Not Applicable SEPTIC TANK AND PUMP TANK S Riser Accessible End N U Signs of Infiltration Begin N N Structurally Sound In N U Landscape position GPI N Gal N PUMP Time N N Present and operating GPM N N Design GPM Actual GPM %Efficiency DGPM N N High Water Alarm Operating Properly X 100 S Control Panel Condition N Control Floats Operating Properly %E N N Straps and Float Tree Condition N Effluent free and Clear of Solids DRAINFIELD S No Effluent Surfacing S Repair Area Reserved S Surface Water Diverted U Turn ups, Cleanouts and Valves Located and S Line Cover Maintained Properly Protected S Protected From Traffic N Laterals Appear to Be Flushed N Distribution Devices Operating Properly N Pressure on Highest Line TOMMFNTS No certified operator reports on file since 2006. Operator is required as a condition of permit for Type IV systems. System is to be maintained by a certified operator at least every 6 months. Unable to locate turn ups at distal end of drain field. Drain lines need tto be flushed periodically to avoid clogging and possible premature failure of system. Retaining wall in place within 5' of septic tank. Compliant Noncompliant X Jason Boyd,RS 01/19/10 Environmental Health Specialist Date CATAWBA COUNTY u 1g0 Pubic Health — Environmental Health Division Ig 2 :.1 Inspection of Type 4 Subsurface Wastewater System Catawba County Dennis Lee WLS 2005-00632 Health Department Name of Establishment Permit No. 9482 Bay Leaf Ln Sherrills Ford NC 4BR Home 480gpd Location Type of Establishment Design Flow Owner Address Phone None Certified Operator Address Phone Legend S-Satisfactory M-Marginal U-Unsatisfactory N- Not Evaluated N/A—Not Applicable SEPTIC TANK AND PUMP TANK S Riser Accessible End N U Signs of Infiltration Begin N N Structurally Sound In N U Landscape position GPI N Gal N PUMP Time N S Present and operating GPM N N Design GPM Actual GPM % Efficiency DGPM N N High Water Alarm Operating Properly X 100 U Control Panel Condition N Control Floats Operating Properly %E N N Straps and Float Tree Condition N Effluent free and Clear of Solids DRAINFIELD S No Effluent Surfacing S Repair Area Reserved S Surface Water Diverted U Turn ups,Cleanouts and Valves Located and S Line Cover Maintained Properly Protected S Protected From Traffic U Laterals Appear to Be Flushed S Distribution Devices Operating Properly S Pressure on Highest Line COMMENTS There are no certified operator reports on file since 2006. An operator is required for this system. The riser on the outlet end of the septic tank needs to be replaced because it has a hole in it that allows surface water infiltration. The control panel is partial buried and needs to he raised to above ground level. Unable to locate turn ups and valves. 'omphant Noncompliant X Robbie Phelps 17/5/13 Environmental Health Specialist Date yy'A •� CATAWBA COUNTY =7 !}± I OOA SOUTHWEST BLVD rra%x NEWTON, NORTH CAROLINA 28658 RECEIPT v \ vvPa PHONE: 828.465.8399 as Wednesday, May 18, 2016 /842 set www.catawbacountync.gov PAYOR : Lee, Dennis PAYMENTS TRANSACTION NUMBER: 1RC-674900-18-05-2016 PAYMENT DATE: 05/18/2016 PAYMENT TYPE: Check 1003 INVOICE NUMBER FEE NAME FEE AMOUNT 05-16-328479 Existing Tank Check Fee $80.00 TOTAL PAYMENTS : S80.00 EHPR-05-2016-23900 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 9482 BAYLEAF LN, SHERRILLS FORD NC 28673 Owner DENNIS LEE, 9482 BAYLEAF LN, SHERRILLS FORD NC 28673 H:828478946IC:7046585288 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 05118/2016 12:25 Page 1 of 1