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HomeMy WebLinkAboutEHPR-06-2016-24067.TIF �� \i,,, �I C itt Environmental Health - Division of Public Health COUNTY PO Box 389—100-A South West Blvd.-Newton, North Carolina 28658 minim t tpa......1,11. ,1. li,4 1\ (828)465-8270—Fax (828)465-8276 `.il W� North Carolina wA vVA•.catmA bbaconnt Anc_nov/emironmentalhealth/ AUTHORIZATION OF REFUND Date: 6/24/2016 Case #: EHPR-06-2016-24067 Applicant: Elaine Pritchard-Berkshire Hathaway RE Refund Amount: 300.00 Refund Reason: Site visit was not made. Owner received conflicting info from septic inspector. Tank Only needed to be pumped. Per ' is no longer needed. Authorizing Signature: " Eli Received By Staff: tQ bbiA katT) (/ Date: LP\v-k ,�1P 0,11,CARCO, "Leading the If ,t to a Healthier Community" 5 * �1fw�� 1 4.�� 1$ Rini.` 4j '\, ,a�k \ �j j Public Health k !'}"1 i'� C n"i' r NR e Ai :p ' .'R!ii' �i M U! jll' ( a t �° t 3°ilii ! ,fin s P r -�:!a)! +'h 1 r: tpp , rec i41�i91pI�! r: 7'llohingoti .lVl�al ' t ir+ „ } !�;II ,��IU„r.iC:si l picu'I t 6, to i f kt a ' �� li a��L4 I Catawba xCounty3FNorth',Carotinar Disbursement Vo a cher, J +fylf!` . �ic `d ss e!i i��llir , 6„IMF,lLYil:(U(IY;I!I!fAI L_,Ar'��IIl4h'!U'A v>ASms uIlsLSt NN,Lb;t'.Ir7,�+ `;`�,,�'.rt 34>'ri I! ..,�dih,4!llllslgt, tut t taltilg i itigili ianar: U �h „1III1 but.. Vendor No. Date 06/24/16 C Make Payment To: G Voucher No(s). t Elaine Pritchard E� I 11 i Q .6. ^3 Berkshire Hathaway Real Estate c_,) w Y 110 N Center St 1842 Hickory NC 28601 ATTACHMENT Prepared by: Katherine Harris Description Amount AC-Septic Malfunction - No Site Visit Made 300.00 Sub-Total $ 300.00 Food Tax Sales Tax Total $ 300.00 6 ill Is lllpii 1U , {li'�;;' �h✓[ I1 s(sl n ll,��5jy,I ii i � t11l 11 ■l ∎ rill r I i ` k. l I FO,,..r A c j I 1111,1 cou,.nh t lnl g! luYti e N i!il� : I; . a1 lA ndIjbt CostiCenterr ,jObjectt) 1, Rroject , l flirt „Am ount l all,ii6 use.Onlyule 110 i 58020O . 663000 Total -j The undersigned hereby certifies that the goods or services specified above have been received or performed. Payment has not been previously authorized and this expenditure is a proper charge to the appropriation indicated. The above charge is certified to you for payment. (SIGNATURE-APPROPRIATE OFFICIAL) IA� C CATAWBA COUNTY 11 \G i 00 SOUTHWEST BLVD d�4+� YYY H NEWTON, NORTH CAROLINA 28658 RECEIPT d ' 1Pa PHONE: 828.465.8399 \U it - vas Friday, June 24, 2016 1842 Sri www.catawbacountync.gov PAYOR: Berkshire Hathaway Real Estate Berkshire Hathaway Real Estate(Pritchard, Elaine) PAYMENTS TRANSACTION NUMBER: TRC-701605-24-06-2016 PAYMENT DATE : 06/24/2016 PAYMENT TYPE: DV INVOICE NUMBER FEE NAME FEE AMOUNT 06-16-329234 Authorization to Construct (Repair) ($300.00) Fee TOTAL PAYMENTS : ($300.00) EHPR-06-2016-24067 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 5065 GRAIN CT, CONOVER NC 28613 Contact Person BERKSHIRE HATHAWAY REAL ESTATE, 110 N CENTER ST, HICKORY NC 28601 C:8282441914 ELAINE29@CHARTER.NET ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner RONALD &ASHLEY SKINNER, 5065 GRAIN CT, CONOVER NC 28613 H:8284556562C:8283082569 receipt 06/24/2016 08:14 Page 1 of 1 Katherine Harris From: Megen McBride Sent: Friday, June 24, 2016 7:09 AM To: EH Administrative Assistants Subject: EHPR-06-2016-24067 5065 Grain Ct. I spoke with Elaine Pritchard. She had applied for this repair because the system had failed a septic inspection. She had reason to doubt that the inspection was done incorrectly... so she hired another septic contractor(Gary Leatherman) to do another inspection/second opinion. Per Elaine, Gary found nothing wrong with the system other than it needed to be pumped. In light of this information she does not want to move forward with the repair. She would like to get her money back. I am fine with that. I never made a site visit, I only talked with her on the phone. If you need to talk to her about refund, it's fine to call her. Her number is 828-244-1914. Thanks 1 �1,A CMG THIS IS NOT A PERMIT Case # EHPR-06-2016-24067 •Z 1� L CATAWBA COUNTY HEALTH DEPARTMENT O 0 10 7 t 4.7 :q49 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICESgi /842 s, 84 Environmental Health Plan Review - Septic Malfunction �� — ro' �13- RUTH_ ONST - SEPTIC MALFUNCTION ' ?C 11 ( - i Alin 1 i,�. -1 ., . Contact Person BERKSHIRE HATHAWAY REAL ESTATE (ELAINE PRITCHARD), 110 N CENTER ST, HICKOR` 28601 C:8282441914 ELAINE29 @CI-IARTER.NEL Owner RONALD R. ASHLEY SKINNER, 5065 GRAIN CT, CONOVER NC 28613 F1:8284556562 C:8283082569 HOME:8284556562 NAME TO APPEAR ON PERMIT Ronald & Ashley Skinner SITE ADDRESS: 5065 GRAIN CT, CONOVER NC 28613 PIN # 374414336704 NAME of SUBDIVISION: MILL STONE PH 4 Lot tt 1 Section/Block PROPERTY SIZE: Square Peet 14,810.40 Acres 0.34 DIRECTIONS: North iron Conover on County Home Rd, Right on Lee Cline Rd, Left on Houston Mill Rd, Home will be on the Right odd Houston Mill & Grain St. PRIMARY CONTACT: Contact Person SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: 6/24/16 - Refunded fee. Owner received conflicting info from septic inspector. Tank only needed to be pumped. No need for permit. Per Megen no site visit made. OK to Refund. Septic Inspection reflected drain lines were not draining properly. ' 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 1 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: 53x25 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: 139-chnpplicai inn (16/2402016 08.28 Page I al? �qA THIS IS NOT A PERMIT Case # EHPR-06-2016-24067 6 ,,Q Len CATAWBA COUNTY HEALTH DEPARTMENT 0 = '�bj . 0 ) " odd PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ''+ 1842 sM Environmental Health Plan Review - Septic Malfunction • ei Ain- r del' r AUTH_CONST- SEPTIC_MALFUNCTION •n culpal). o Contact Person BERKSHIRE HATHAWAY REAL ESTATE (ELAINE PRITCHARD), 110 N CENTER ST, HICKOR`_ 28601 C:82824419I4 ELAINE29 @CHARTER.NET Owner RONALD&ASHLEY SKINNER, 5065 GRAIN CT, CONOVER NC 28613 H:8284556562 C:8283082569 HOME:8284556562 NAME TO APPEAR ON PERMIT Ronald & Ashley Skinner SITE ADDRESS: 5065 GRAIN CT, CONOVER NC 28613 PIN # 374414336704 NAME of SUBDIVISION: MILL STONE PH 4 Lot ft 1 Section/Block PROPERTY SIZE: Square Feet 14,810.40 Acres 0.34 _ DIRECTIONS: North fron Conover on County Home Rd, Right on Lee Cline Rd, Left on Houston Mill Rd, Home will be on the Right odd Houston Mill & Grain St. PRIMARY CONTACT: Contact Person SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: Septic Inspection reflected drain lines were not draining properly. 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: 53x25 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: P9-chap plicat ion 06/09/2016 10:57 Page 1 of7 CATAWBA COUNTY Case# EHPR-06-2016-24067 Public Health Department Subdivision MILL STONE PH 4 ;m�; „`j Environmental Health Division PIN// 374414336704 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 /8•2 .a NAME ON PERMIT: (RONALD& ASHLEY SKINNER), 5065 GRAIN CT, CONOVER NC 28613 ( Ronald &Ashley Skinner) Site Address: 5065 GRAIN CT, CONOVER NC 28613 Property Size: Square Feet 14,810.40 Acres 0.34 Directions: North fron Conover on County Home Rd, Right on Lee Cline Rd, Left on Houston Mill Rd, Home will be on the Right odd Houston Mill & Grain St. 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 completee-evaluationan be performed. 6J Date: 6- '-/./• Signature of Applicant or Agent A 2g ,o jyzA3-2 An Environmental Health Specialist will contact you within 5 working days of applicatioh-date If you need further information or assistance please call 828-466-7291 AREA2 4/F E E I'A M E l j (li A j z i l z I d I I'I ld 1111ti1�11-�ui z(7 !Li1S,��j* DATiR;'.�rlT�i( �If FEE MOIIUNT-;F t DATE`. Authorization to Construct(Repair) Fee 06/09/2016 $300.00 DTI f I IIMr TOTAL FEES1111l111 E�ry� i i il����l�fl f�wl� llf u 1�1�inilltr ll,P G'5300 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-ehnppl icat ion 06/09/2016 10:57 Page 2 of 7 CATk \ \ THIS IS NOT A PERMIT county -"'`,,,, CATAWBA COUNTY HEALTH DEPARTMENT �- � � Pagel Application for Environmental Services b Improvement Permit H Authorization to Construct H Septic Repair n Septic Malfunction Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction n Existing Facility Property Address ,'6)&5 �"I- Subdivision Ali; \\ Sr, vi ��n��tler Ale Lot# Acres Section/Block/Phase Driving Directions to Property N/.W1 Cc, v)Ja 7)v rTl"'/ Nr,m p -PA. Sh t m n M: 11 p-:-,-I /at, NAME TO APPEAR ON PERMIT? wI ier I I Applicant ❑ Contractor Applicant Contact Information Name F l cam. e c r t�) r/0/1/00y f-es_al Address l\D � ,,� 6P � l,la I� un - k-) d os ry 2e ) Phone ¢728- -49 -19) )1 Cell Phone5 ,244-- )914-- Owner rCContact Information n Name ,/,Yvny C7 UG', `n nro r- ( n�rA1� m;nna_ I` Address ,-(:),.5 rA`,� C'�: 00 v. �%{)XG2seo 5.k+ fey Phone E Z 2 '_ % Cell Phoneg b' 3s Contractor Contact Information j Name L fl A'-0.6 r nn An S l Address Phone Cell P one WHO WILL BE THE PRIMARY CONTACT? I Owner • Applicant ❑ Contractor Description of Existing Structures on Site P,9us e- �!! # of Bedrooms *'I' Structure Dimensions ,, ../ #of Occupants S Basement ❑ Yes F No Basement Fixtures Q Yes !I'M I- 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 F�'No Does the site contain any jurisdictional wetlands? "kYes 0-No- Does the site contain any existing wastewater systems? Q Yes ®"No . Is any wastewater going to be generated on the site other than domestic sewage? CI Yes YNo Is the site subject to approval by any other public agency? Yes l Are there any easements or right of ways on this property? Describe Existing ater supply in use I Individual Well U Community Well ❑ Semi-Public Well County/City/Township Water Line Is a public water supply available? ** Yes [ 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 Dy cA / THIS IS NOT A PERMIT COUNTY " f CATABA COUNTY HEALTH DEPARTMENT , . W „e„„o Application for Environmental Services Page 2 Pro osed Facility Type Primary Residence ❑ New Residence { I Addition to Residence # of New Bedrooms *t Project Description 5 ) city'ea ,Ara YV W c n )',t-,e Structure Dimensions #of Occupants Basement U Yes [7-No Basement Fixtures Yes 05-No ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable _ Structure Dimensions #of Occupants Accessory Dwelling n Yes ❑ No Plumbing n Yes No Describe Plumbing Needed I Multi-Family Residence#Units #Bedrooms per Unit*t Total#Bedrooms *I. Structure Dimensions U Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) # Employees per Shift #of Shifts Dining Area(Sq. Ft.) n Business Specific Type of Business Retail Floor Space # of Employees per Shift #of Shifts ❑ Other Facility Type Specify If Church # of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type I Individual Well ❑ Semi-Public Well n Community Well Abandonment Type [ Drilled ❑ Bored ❑ Dug IT Unknown Well Repair Requested _ Yes ❑ 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 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. 3 Signature of Owner or Agent /O��a- xa�� Date /)9�/4, Printed Name of Owner or Agent Catawba County Environmental Health 'Y A Ift, ylllnv .,l ' `O tbb a• H L}AI� 4 It *;4,,.._ 4 i' ., s 1 I me a N tp, co V IJ <D IIWI ei ---- -lor '�N,IIpiIIINiI,II„„,��6111111% ill f I., 111i111Ilp11pi. , 111111111111111111t, aft. a 45 HO[/o,ut pfy.Ml«►t0 100 pr. .---'-g""'"'"■,,,............................................„......................„......... 100 100.00 ' IL4' oso ar to 11: 1 SIIIIIII Parcel: 374414336704, 5065 GRAIN CT 1 in=50ft 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 06/09/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 374414336704 Owner: SKINNER RONALD D Parcel Address: 5065 GRAIN CT Owner2: SKINNER ASHLEY M City: CONOVER, 28613 Address: 5065 GRAIN CT LRK(REID): 403014 Address2: null Deed Book/Page: 3100/0113 City: CONOVER Subdivision: MILL STONE PH 4 State/Zip: NC 28613-7135 Lots/Block: 1/ null Last Sale: School Information: Plat Book/Page: 53/41 School District: COUNTY Legal: LOT 1 MILL STONE 4 PL 53-41 Elementary School: LYLE CREEK Calculated Acreage: .340 Middle School: RIVER BEND Tax Map: null High School: BUNKER HILL Township: CLINES School Map State Road #: 3028 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: ST STEPHENS Zoningl: R-20 Building(s) Value: $121,500 Zoning2: null Land Value: $11,800 Zoning3: null Assessed Total Value: $133,300 Zoning Overlay: null Year Built/Remodeled: 2002/null Small Area: ST STEPHENS/OXFORD Current Tax Bill Split Zoning Districts: null/null Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710374400J Building Details 2010 Census Block: 1034 Watershed: null 2010 Census Tract: 010201 Voter Precinct: P33 Agricultural District: Proximity Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be hold liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. ©2016, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=374414336704&typ=P 6/9/2016 s ° CATAWBA COUNTY-HEALTH-DEPARTMENT pogled �Q Telephone. (828)465-8270 TDD (828)"465-8200 WLS,7/ CZ-Cl/e¢ 'IP -AC X. Rpi. Punt: i0pr. Prryw�t�:�/'j����Sys:"hype __3i Well Print Replacement'Well Well Rpr.Prmt. Owner/Agent CTi i4eS U GrifBv if—' Phone Address Subdivision f7)t/J$ yt, Section/Bl■- P.. e t / Sii_e Directions. :7j 7A!* OICTIC�g' ' �fl1 - - ` CO N ?' / Eal Property Address ,S6 65 - eir „ . Facility: House X. Mobile Home _.Business Multi-family • . Other: Pin Number 3744' 1133 676¢ Other. - . Zoning Approval It tej 2— OOESY7 //Bedrooms 3 N Seats N Employees . Application Rate Q,' S GPD Flow 36 C`) Hot Tub di Spa yes(pSpecial Fixtures Basement yes f�)g . 100%.Repair Area Yno 25 * SO f'c ...- Basement Plumbingyes/no Water Supply: Private Well .`Public x, Semi-Public ********************************************************************************************** * *** *** ******** Type of System: Trench Bed Pump Pump/Panel Panel'. : LPP Other Septic Tank Size 10(30 Pump Tank Size Nitrification Field: '.Total Square Feet. 770 0 Depth A of Stone di di Size Trench Width 3 :-I'/r+ Total Length of All Trenches 157 Number of Trenches z 6C Trench Length 135/Ii7/`/_/. / Feet on Center 7 Maximum Trench Depth S6 Distance of Nearest Well' DO NOT INSTALL SEPTIC WHEN WET* *WELL,RECORD•REQUIRED'AT COMPLETION* *************************************i************************************************************************************* Topo -2- % Slope Texture Structure /S Clay Min. It,( • • Soil Wetness " .Soil Depth ¢,Q • . - Restric;Hoz. ate- " Available space_y_u/no - Overall Class S P Comments: _ - ._ _ _ __ a3 _ _ . �� Il a J35 _ __ 1�. V � \ c „ ■ d Ia- . Delo` ' I . _ ..3 J FtlterRequiredl _ X36 Riser.r`equired-when — �n tank is,more than 6 JkiJ j� /W// l inches deep: - - -**NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** *******************************************************************************************s******************************* *Iinprovement.Permit has no expiration date and is transferable, but may,be revoked if site plans or.intended use.changes for,the proposed: facility.,;An:AuthorizationtoConstruct is valid'for(5)live years from date.issuedland isnotitransferable.-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•tie 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 fr.t Aim p sib sourcts,ofcontatnination. No volume of water is:guaranteed at any site by the.Health-Department. - Air Permit Date 7}�-p 5- z- EH Owner/Agent c_b7 6 �e. Septic\Tank Installed' Date EHS 4 Well Installed By /Y1A-)C /n i a Well Grout Approval Date ,3..-6`- Well Head Afproval Date Date Sample Collected - Date of Results Results _ EHS Wiiite-Office Yellow Owner/Agent - _PinkBuilding:Iii pectidit Auttioriiltion to Construct �A CATAWBA COUNTY � 4 � 100A SOUTHWEST BLVD �' NEWTON,NORTH CAROLINA 28658 RECEIPT vmsc 1Pe PHONE: 828.465.8399 U 'ra - ,odw� `'C Thursday, June 9, 2016 184'1 sm www.catawbacountync.gov PAYOR: Berkshire Hathaway Real Estate Berkshire Hathaway Real Estate(Pritchard, Elaine) PAYMENTS TRANSACTION NUMBER: TRC-688592-09-06-2016 PAYMENT DATE : 06/09/2016 PAYMENT TYPE: Check 1158 INVOICE NUMBER FEE NAME FEE AMOUNT 06-16-329234 Authorization to Construct(Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-06-2016-24067 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 5065 GRAIN CT, CONOVER NC 28613 Contact Person BERKSHIRE HATHAWAY REAL ESTATE, 110 N CENTER ST, HICKORY NC 28601 C:8282441914 ELAINE29 @CHARTER.NET ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner RONALD&ASHLEY SKINNER, 5065 GRAIN CT,CONOVER NC 28613 H:8284556562C:8283082569 receipt 06/09/2016 10:57 Page 1 of 1