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HomeMy WebLinkAboutEHPR-07-2016-24336.TIF THIS IS NOTA PERMIT Case # EHPR-07-2016-24336 CATAWBA COUNTY HEALTH DEPARTMENT laraS:( v tEJ .. c �� y PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES � : '• ti � � /842 s�� Environmental Health Plan Review - Repair }'red° n X• % , TJ AUTH_CONST - REPAIR � , o _ a} Contractor *JEFF KING(UNLICENSED) (JEFF KING), 1109 MULBERRY LN, HICKORY NC 28602 8:8286381718 C:828638 17 1 8 REDSKINS0909@ICLOUD.COM ICLOUD.COM Owner RICHARD&JILL NOBLE, 5159 MEADOW PARK LN, HICKORY NC 28602 C:8284093044 NAME TO APPEAR ON PERMIT *Jeff King (Unlicensed) (Jeff King) SITE ADDRESS: 5159 MEADOW PARK LN, HICKORY NC 28602 PIN # 279012875241 NAME of SUBDIVISION: ABERNETHY PARK PH 12 Lot# 88 Section/Block PROPERTY SIZE: Square Feet 16,988.40 Acres_ 0.39 DIRECTIONS: Hwy 127 Sout. Left onto Bethel Church Rd, Right onto Pittstown Rd, Left into Abernathy Park onto Abernathy Park Dr, Right onto Orchard Park Dr, Right onto Recents Park Dr, Left onto Meadow Park Ln, House in the cul de sac PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: Relocating lines to accommodate a pool 42x22 w/concrete. 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? Yes Property Easements Description: Septic Easement off back of property 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: 62x64 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 2 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: E9-chapp licatioa 07/20/2016 14:41 Page 1 of 4 •_1.13 CATAWBACOUNTY Case(I EHPR-07-2016-24336 1 Public Health Department Subdivision ABERNETHY PARK PH 12Ts ,< Environmental Health Division PINII 279012875241 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 i8.g.2 o NAME ON PERMIT: *JEFF KING (UNLICENSED) (JEFF KING), 1109 MULBERRY LN, HICKORY NC 28602 *Jeff King (Unlicensed) ( Jeff King) Site Address: 5159 MEADOW PARK LN, HICKORY NC 28602 Property Size: Square Feet 16,988.40 Acres 0.39 Directions: Hwy 127 Sout. Left onto Bethel Church Rd, Right onto Pittstown Rd, Left into Abernathy Park onto Abernathy Park Dr, Right onto Orchard Park Dr, Right onto Recents Park Dr, Left onto Meadow Park Ln, House in the cul de sac 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 it 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.,ofall property lines and corners and making the site accessibl s that a complete site evaluation can be performed. Date: �'��"// Signature of Applicant or Agent 6 An Environmental Health Specialist will contact you within orking days of application date. If you need further information or assistance please call 828-466-7291 AREA2 n�oimli�ihY rz °St trim"' - !';;;77.77-77: i!th'i ' '?ill 1 • M ..µl LFEENAE_ viii rt)tg). : • �.1 • DDATE!TL�,,.. FEEtAMOUNTi�'f;� Authorization to Construct (Repair) Fee 07/20/2016 $300.00 1l11lV i,,l orils.300.1001.J, . .1.IIIWl1111tl rSlid W illWWLAllird__dG;i1012WI111111 lill.uiii4 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-ehappl icaduo 07/20/2016 14:41 Page 2 or 4 CATAWBA THIS IS NOT A PERMIT ccou�n v v a-.� CATAWBA COUNTY HEALTH DEPARTMENT „wmc.,e� Application for Environmental Services Page I Improvement Permit❑ Authorization to Construct Septic Septic Repair Septic Malfunction El Septic Expansion ❑ New Well Permit❑ Repl'acement Well ❑ ell Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility ❑ Property Address R (cJ t ni b lole_ rq, Subdivision 5159 P'leLduu 415.." PcjL LN Lot# Acres I/4„rot )46 in �� Section/Block/Phase u11/ Driving Directions to Property 1)7 Ant on 4-41c1 6A r) 4, rf13 -Ibun, ft.-., te, A&A)c- 2-<( NAME TO APPEAR ON PERMIT? ❑ Owner ❑ Applicant ❑ Contractor Applicant Contact Information Naive Address Phone Cell Phone Owner Contact Information Name R,cc A 1,4 tAddress S"JSrj 4j,, 4rk Z.A/ h11-(14,� f'L off/p 6.? Phone f�a,�- Vpq - 309q 1 Cell Phone Contractor Contact Information Name Serf k' N`` Address 1/0 /'�J/��y /h AIL) ne )idoiS Phone �l -c39--OA Q, Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant Q cntractor Description of Existing Structures on Site .,li #of Bedrooms 4i' 3 Structure Dimensions CO-( # of Occupants Basement ❑ Yes HNo 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. D Yes 13/No Does the site contain any jurisdictional wetlands? ElYes ICI No Does the site contain any existing wastewater systems? C Yes EiriNo Is any wastewater going to be generated on the site other than domestic sewage? CI y es CNo Is the site subject to approval by any other public agency? Yes C No Are there any easements or right of ways on this property? Describe 10 C-I- Pet-it- B- Or ad. roar Existin water supply in useIndividual Well O- pp y Li ❑ Community Well U Semi-Pu is ell R.County/City/Township Water Line Is a public water supply available? ** Yes n 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) V❑ Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other ny 0ATAWBA THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT „e„ ��,e,— 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 ❑ Yes ❑ No Basement Fixtures ® Yes ® No Accessory Structure(s) Describe �„, y >( i�r t {�fb u� /r r y=4.4 # of New Bedrooms *i if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed Li Multi-Family Residence# Units #Bedrooms per Unit*i Total # Bedrooms *f _ Structure Dimensions LI Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) # Employees per Shift #of Shifts Dining Area (Sq. Ft.) L Business Specific Type of Business Retail Floor Space ft 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 ❑ Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ No Describe Calculated Design Flow, Commercial j 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. 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 f 4 Date O KPrinted Name of Owner or Agent J.-ell Kr,...) Catawba County Environmental Health 14.73 1-.4" I•- (135 V 39. S42> Q a /-`} N. z. 0? ol O ca , z M l� 158.85 W 1 ME400W PgRK CN ci ti `r N a' a 34.74 illhhillict.23211 "_a \\‘,...--'el N� �' �� 3.05 a, ,�4n' tn 41/4.,4 ��'h 711 �I��/ ,. `� a -m 11111111V0 it..01�I11�1llit o .' Ml' o0 • �s , � r It11 IIirl,ii, , i5it. ;1III, iii d , 1. 82 4. �1, ti t ; Iia , _ 7 i ,a, "q oa8/ / i��u ^l ik . II ' Iia ' , l t. CP Iii -- ji Parcel: 279012875241 , 5159 MEADOW PARK 1in=50ft LN HICKORY, 28602 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 Viability,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 07/20/2016 Parcel Report Page I of I Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 279012875241 Owner: NOBLE RICHARD J Parcel Address: 5159 MEADOW PARK LN Owner2: NOBLE JILL R City: HICKORY, 28602 Address: 5159 MEADOW PARK LN LRK(REID): 607017 Address2: Deed Book/Page: 3309/1955 City: HICKORY Subdivision: ABERNETHY PARK PH 12 State/Zip: NC 28602-6018 Lots/Block: 88/ Last Sale: $346,000 on 2015-09-28 School Information: School District: COUNTY Hat Book/Page: 74/59 Legal: LOT 88 PLAT 74-59 Elementary School: MOUNTAIN VIEW Middle School: JACOBS FORK Calculated Acreage: .390 High School: FRED T FOARD Tax Map: School Map Township: HICKORY State Road #: TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: MOUNTAIN VIEW Zoningl: R-40 Building(s) Value: $319,900 Zoning2: Land Value: $22,000 Zoning3: Assessed Total Value: $341,900 Zoning Overlay: WP-O Year Built/Remodeled: 2015/ Small Area: MOUNTAIN VIEW Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: Building Permits for this parcel. Firm Panel #: Building Details 2010 Census Block: 2002 WaterShed: WS-III Protected Area 2010 Census Tract: 011801 Voter Precinct: P23 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/repos 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=279012875241&typ=P 7/20/2016 �ti3T( CATAN B.A COUNTY ❑� !fir `.p: ,f',❑ Case 11 0P-08-20155-063593 ¢���:�� Public Health Department --�• ' :1r Subdivision ABERNETHY PARK PH 12 IC ;'e S IL%, Environmental Health Division r� PINY. 279012875241 r^ 1 PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 F ° 1 L01 88 NAME ON PERMIT: CONSTANTIN BOUREANU, 1475 KENSINGTON PARK CT: HICKORY NC 28602 Site Address: 5159 MEADOW PARK LN, HICKORY NC 28602 Property Size: square Feet: 16,988.40 Acres:0.39 Directions: Plttstown to Abernethy Park/back to new section Catawba County Health Department Operation Permit System Type: IIIG - OTHER NON-CONY TRENCH SYSTEMS (In accordance with Table Va) Description: 25% REDUCTION System Code: IQ4PS System Code Description: Infiltrator Quick 4 Plus Standard Types V and VI systems expire in 5 years. Owner must contact health department 6 months prior to expiration for permit renewal. System Installation Comments: PERMIT CONDITIONS: 1. All maintenance, monitoring, and performance requirements shall be in accordance with 15A NCAC 18.1900, Rule .1961 2, Operation & Maintenance Specifics: Subsurface system operator required? Yes_ No_X_ If yes, see attached sheet for additional operation conditions, maintenance and reporting. This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and All conditions of the Improvement Permit and Construction Authorization. Joey Cothren #1838 08/05/2015 SYSTEM INSTALLER INSTALLATION DATE Mogen McBride 08/10/2015 AUTHORIZED STATE AGENT DATE OF OPERATION PERMIT Form F ISSUANCE ehpennil 0S/10/2015 15:14 Page 1 ora 0? RIM Da-2015-) 76 y 559 Meadow Fait- Imo, Hai t in51alled 815115 � Jeey ter{1ii�h _ eP-�c -460K' GST- 1000 ST BAD, 6. 15 .15 41 1400 -R • of 25,g reahic+cb r\ - b-%Yiv cIvr5 4 +Iovst CoNtVec,44 -to cubkic 4yo4er. or T. „y€:—. 1-04 Norse, (Meadow Pack- l,. : Aii�.� CATAWBA COUNTY O :1�,o`-b. a Case ti AUTH-03-2015-058231 Arit® Public Health Department V. .%1 .r % Subdivision ABERNETHY PARK PH 12 Environmental Health Division r '. �r-r PIM 279012875241 88 PO Box 389, 100-A Southwest Blvd, Newton,NC 28658coir -° ` i • : ° LOTM 88 - u r 2.41074%)....4 : 0 •L _or}° • Pe i 'a)1s' acidiLP NAME ON PERMIT: CONSTANTIN BOUREANU, 1475 KENSINGTON PARK CT, HICKORY NC 28602 Site Address: 5159 MEADOW PARK.LN, HICKORY NC 28602 Properly Sire: Square Feet 16,988.40 AcreS 0.39 Directions: Plttstown to Abernethy Park/back to new section Authorization to Construct Permit Authorization to Construct Wastewater System (Required for Building Permit) • See site plan and number of additional attachments( ) Proposed Wastewater System: 25%REDUCTION Wastewater Flow 480 g.p.d Type: IIIG -OTHER NON-CONV TRENCH SYSTEMS Soil LIAR: 0.3 g.p.d./ft2 Permit Category: New Septic Type of Facility: Primary Residence - house Basement? No Basement Plumbing?No Bedrooms: 4 Wastewater System Requirements Tank Size: New Tank 1,000 gal Pump Tank gal Grease Trap gal Dosing Volume _ gal Pump Specs: GPM © TDH Pressure Head ft Draw Down in Dralnfield: Total Area: 1,200 sq ft Total Length: 400 ft Maximum Trench Depth 30 in Aggregate Depth in Trench Width 3 ft Minimum Soil Cover 12 in Minimum Trench Separation 9 ft on center Number of Drain Lines 6 Distribution: Serial Pre Treatment: NONE Additional Specifications: 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. _ >>>>> DO NOT INSTALL SYSTEM UNDER WET CONDITIONS ««< Proposed Repair System Class: IVA Proposed System: 50%REDUCTION Distribution Type:: LPP Soil LIAR: 0.3 g.p.d.ift2 PUMP REQUIRED ***** OPERATOR REQUIRED chpermii 03/0412015 09:41 Page 1 or 4 �. CATAWBA COUNTY Case H AUTH-03-2015-058231 �� Public Health Department Subdivision ABERNETHY PARK PH 12 n. at Environmental Health Division PIN!! 279012875241 �.' PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOTH 88 NAME ON PERMIT: CONSTANTIN BOUREANU, 1475 KENSINGTON PARK CT, HICKORY NC 28602 Site Address: 5159 MEADOW PARK LN, HICKORY NC 28602 Property size: Square Feet 16.988.40 Acres 0.39 Directions: PIttstown to Abernethy Palk/back to new section 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 Authorization to Construct Permit is subject to revocation if the site plan,plat or the intended use changes,or if site conditions are altered. The Authorization to Construct 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 RPMs farSewaee Treatment and Disposal Systems' (ISA NCAC 18A .1900). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function,ntidnetnrily for nay given oeriod of time. Megen McBride 03/04/2015 AUTHORIZED STATE AGENT APPROVAL DATE Permit Expiration Date: 03/03/2020 No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department. ehpermit 03/04/2015 09:41 Page 2of4 IP. AG P-&PK o)-30(5-)t' 7i, 5151 Mecdovi Qa{Icln, Hic;:nri t Y,,slall (o00yi1 setAi&\tk"K and 40o{1. c4 )5), Suction; 6-67j4.4rehcL,rc. I' 7.ns1cl\ avui r4icld or. tok}ovr 11 ,p . SSr AAA c. olean D{�• ksrom \$t S, lof4. firer. c✓tires, rr v inducing) th, I ofzt . har. propex1 IirtS , and OA of r �1- 4- wogs ci4 eostnker,}5. * Qo 1104 &tee, goat, c,-1, of -611 (rev se c odea of (reit( off, . + ikousa w+ll Conned it, r101ic *Ate. .tis r G sktoolcd FAst+ r _ _ eft: _ _ Stie o.fret . p' Digo �� ; I yS s' 1c ProloSti Qom' 9&drooM lime, 13% 654: Is 's- - Mwdow Parc Ln. "Io. L4 g g DEP A87MF TOPENVIRONMENrAND NATURAL RESOURCES Sheet /___ DIVISION OFENV1RCEME J AL HEALTH PROPERTY ID N:_ .ONSITE WASTEWATERSECTON COUNTY: SOIL/SITE EVALUATION for ON-SITE WASTEWATER SY Di OWNER: Akvn4%1 Qevd�- Iii r APPLICATION DATE 12 31 �3 �H�R Ct^2013 1 3(2 ADDRESS: DATE EVALUATED: 20/114 PROPOSED FACQiiy: 4 PROPO (.1 : • PRAPERIYSIW 0.NOCrrs LOCATION OP SUE S-��g�W rade- I l tIIL R PROPERTY RECORDED: WATER SUPPLY: 0 ?draft (-4 Pub& 0 wen 0 SiDdIY other EVALUAEONMETHOD 0 Augur Bating Q ?if L1 Cut - MEOP WASIfwATFR: Q Sewago 0-Indus—SI Ptz 0 t.'f ._'71: -.--C-I=r,ra C_:6 c:::_L':..:_i___�i._ .. •tc. ct�'SCT:f��:n^ C..4_•.....__—JiL'J:G:'��c�.::l-. 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CPT y5 FS 3 — — 0.3 • . 4 _ , Daatm—n DCIIAC SYSTEM *YAM SYSTEM OTHER FACTORS(.1946): 1 A4u3ble SP=I-�� STTE CLASSIFICATION(.1c1948k )�� I -� Sym Tyro 1E -S. c EVALUATED Wit Mc,- Mer [r`(.1?n UL A , �^ OTHER(S)PRESET: J/ • • SBaLIAR 0,3 0.3 • COMMENTS: ?ups pi/ be regiid • L. et CATAWBA COUNTY Qe ir,a`cr, s Case a IMPV-03-2015-058230 1, Public Health Department Subdivision ABERNETHY PARK PH 12 �'/t�(��� Environmental Health DivisionIa. moi ' ,!} PINI 279012875241 PO Box 389, 100•A Southwest Blvd, Newton,NC 28658riga :ti `fti LOTb 88 Yff •:•;e1-440 ❑ : Or};. - NAME ON PERMIT: CONSTANTIN BOUREANU, 1475 KENSINGTON PARK CT, HICKORY NC 28602 Site-Address: 5159 MEADOW PARK LN, HICKORY NC 28602 Property Size: Square Feet 16,988.40 Acres 0.39 Directions: Pittstown to Abemethy Park/back to new section Improvement Permit Facility: Primary Residence - house Permit Category: New Septic Bedrooms 4 WATER SUPPLY: Public Water • Basement? No Basement Plumbing?No INITIAL SYSTEM SPECIFICATION S Permit Valid: Expires In Five Years: _X_ No Expiration: Projected Daffy Flow 480 g.p.d Proposed Wastewater System: 25% REDUCTION Type: 111G -.OTHER NON-CONN TRENCH SYSTEMS Permit Conditions: REPAIR SYSTEM SPECIFICATIONS Repair System Required? Required Proposed Wastewater System: 50%REDUCTION Type: IVA-ANY SYSTEM WITH LPP DISTRIBUTION PUMP REQUIRED ***** OPERATOR 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 pot aooroved,and may result in failure to approve the initial system installation,or the suspensionfrevocation of existing permits. Theissuance 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 arc 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 Sewafe Treatment and Disposal Systems' (I 5A NCAC I8A.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 03/04/2015 AUTHORIZED STATE AGENT APPROVAL DATE Permit Expiration Date: 03/03/2020 No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department. chpermil 03/04/2015 09:41 Page l of3 IP, Ac. ItgPR 0o-1o15-Zo+S76 5151 Meadovr ?a(lc lr►, 4-lickor1 4' Y,scull (00011 seei(' k(""K and 400{g. o{ )5% rtc Ucior 16-67 f{. Irma,es. 1 iss{c,I\ avvinefsttrl. or Cor.{OJC 'v SeQkrc, S,s1er- rKu t c } ‘"Si. 10041. 4vm W . r 1 o <llS, 1o14. .. v edirrs, 54 . frt sk,nukv S , rud, , OA. -crow. FroPerh ki s I and oAr of riohk• o{- lot, Q4 eosev.e.411. 3, Do not dive, rot,ot, CA, 00 cit. Nev sc�c ares• or repair area. 4 itkwse WAk (onned i rblic vygAtr, II). 1S Ru &t? iSotrAtrA (.._ 'P 10. o,yo 10 `c - roVoSed Q... 9Be4roor, time, 1,3x 1,5 '~ moo''' y. 9 NM ow Pant Lit d r r.go. ew Z 8 11 ' 8 2 ad Mc" 3 •:1 r g :142 g III "&,)_; i g rici z . 3 :',..1 :: cii 2 E E^ .%thl^ Cs. E . 1,,ill hi ill 1 „ 3 7-2- ' g.8 2 Sg5 d i' = r 7 •.! .9- 1 T't 1 ? 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PIM/ 279008974976 s¢2 a PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 . a+ LOT# 88 ■ NAME ON PERMIT: ABERNETHY PARK LIMITED, 2850 SAINT GEORGE RD, WINSTON SALEM NC 27106 Site Address: 5159 MEADOW PARK LN, HICKORY NC 28602 Property Size: Square Feet 16,988.40 Acres 0.39 Directions: BETHEL CHURCH RD TO PITTSTOWN RD TO ABERNETHY PARK DR TO ORCHARD PARK DR TO REGENTS PARK DR TO KENSINGTON PARK DR TO MEADOW PARK LN Improvement Peiniit Facility: Primary Residence - house Permit Category: New Septic Bedrooms 4 WATER SUPPLY: Public Water Basement? No Basement Plumbing? No INITIAL SYSTEM SPECIFICATIONS Permit Valid: Expires In Five Years: _X_ No Expiration: Projected Daily Flow 480 g.p.d Proposed Wastewater System: 25% REDUCTION Type: 1110 -OTHER NON-CONN TRENCH SYSTEMS Permit Conditions: REPAIR SYSTEM SPECIFICATIONS Repair System Required? Required Proposed Wastewater System: 50% REDUCTION Type: IVA-ANY SYSTEM WITH LPP DISTRIBUTION PUMP REQUIRED ***** OPERATOR 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 Rules 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 03/10/2014 AUTHORIZED STATE AGENT APPROVAI.DATE Permit Expiration Date: 03/06/2019 No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department. E9-ehper,ni i 03/12/2014 09'52 Page I of 3 IF L✓. , . - 12- 2013- 1g3(2 5159MCRovw •p .. Lb !' �;, • ri^�tPi /2 Lpi `gz f tk• U 6..C.G 1 . 1j.Y`, r'. Q I,-. 1 it Ie J;-01 • ..IDV 5 - 'ALJ V/' ? b.,„- , r'', J✓ y n r'N ?Y.”4:'.' r7 I �. ti 1.::�1j an.C.t - J..(5-{,:: of .pvkJ i41 i 1 '�- /a°... -L.) --- p i Qo', u� ' cm 0. III' r� 150:10 XTa• \ND\ vq" is �''�i• • ' �;; i, �C C' 1 —Ti\ 1a i -- s��\ IVy,? '.a , tiiii,il ,;r :, 1,o • • \"T'SO D .ARI'MEM'OFENVIAONMENT AND NATURAL RESOURCES Shed— DIVISION OF ENVIRONMENTAL HEALTH PROPERTY ID#: ON-SITE WASTEWATER SECTION COUNTY: SOIL/SITE EVALUATION A y n for Oys SITE WASTEWATER SYSTEM OWNER: titiirk4 -1YP\If - ILMI-f(6t APPLICATION DATE 1231Ii> EIIiR-ic.'2( -11,3G2_ ADDRESS: DATE EVALUATED: 214 I N PROPOSED FACILITY: 41W t1 o\BP, PROPOSED DESIGN FLOW(.19r49): 410 PROPERTY STtt: ()i 3fl 0 Grrs LOCATION OFSITE 5!Sii I\1FGtdoW fa(1 - Lr i-I I C?-074 [SA RR PROPERTY RECORDED: WATER SUPPLY: o Private q Public 0 Well O Spring a Other EVALUATION METHOD: 0 Auger Baring Q Pit 0 Cut TYPE OF WASTEWATER: Q Se-wage 0 Industdol Ptoss 0 NI'ucd • !Rv114 =`r=_EatFaF ila:3E,1!s -:...._:,;--i Thrt ...._ ..._..._ __ ::::_._::.5.(STIIMC3$£$O bG :-: _::r....... 31 eR-::.-.... :.. .... . .........._......_.........._.....:::::::::::::::..._:::- :: ::::::::__- °°=i3 ii`i:=iiii5;;'_i:(i]941 .:......::::::::::::.-_=.__:_::::::::_:::_:: iY:RO . ' 'rAGTO :c:_::-'_-_...._........_. --...............__.-...... =a_R9lAls__: i€'iii':_- :_::z:Eh_:-::__::_.:: ::::::::::::::::::-:_.::___........-_..._.__..-.:.......-........_._... ..---........_._. .._....._._:...._+.'---:..._- - °i - ' 75E-CYC 3 ::ZAN . 19a! SOIL i! 194T .- -;;,i:.1g5K:.7. 49.64pxoFu;L'� iu :Posrnow DEerx ..... snurruttn t_oNSISTENcEi 9,trr ESSi $Q11..:- '::'sena.: 1.:.:.:_::::.::.::.:rit Ei :Stop&le .{A}, -... T:F "TLR6 .::`::.::::_'MurE1tAtocr , COLOR _ ::.DEEra: CLASS HOAR: $ra .. --f TAR D-/U St- ,",t, -IV,Cc. SO,u L. 10-41 r r, Qs 6' . . 'Cass. SN? • P 1 2- - - iiii3, — _ 03 t I - . p-(D. I. Si : oif ' I r.cs. sell, 16-'V CC-, 5614- I-F✓5s. SCYV PS 2_._ — 3 — 6.3 I i0- !o si=. 4 r I-�., SS. sett, 3 I Yo 3 !I — • 4 I . DEflIP IOP I A'ITIAL SYu rM REPADt SYSTEM OTHER FACTORS(.1946): Mei-toile Spate(.1945) I 5 PS SITE CLASSIFICATION(.1948): ^ -111 .l-TT EVALUATED BY: '\elePI, llii(i-''r! System TYPXr) Eel 'Igo, OTBER(S)PRESENT: J • . Site LIAR 0,3 \ 0,3 COMMENTS: \ \Dv(fte 1 \a/ brevid 1 f 1 I I 1 Y'ACATAWBA COUNTY !s , G 100A SOUTHWEST BLVD ;'1 ` 2 NEWTON, NORTH CAROLINA 28658 RECEIPT rte,—A,rap;pi.__. t, a, U w�!1ru �,ij��PQW �C PHONE: 828.465.8399 \LLQ; a> '� Wednesday, July 20, 2016 842 sm w�ew.catawbacount nc.gov PAYOR: *Jeff King (Unlicensed) *Jeff King(Unlicensed)(King, Jell) PAYMENTS TRANSACTION NUMBER: TRC-743001-20-07-2016 PAYMENT DATE : 07/20/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 07-16-330709 Authorization to Construct(Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-07-2016-24336 CASE TYPE: Environmental Health Plan Review WORK CLASS: Repair SITE ADDRESS: 5159 MEADOW PARK LN, HICKORY NC 28602 Owner RICHARD& JILL NOBLE, 5159 MEADOW PARK LN, HICKORY NC 28602 C:8284093044 Contractor *JEFF KING (UNLICENSED), 1109 MULBERRY LN, HICKORY NC 28602 B:8285381718C:8286381718 REDSKINS0909 n ICLOUD.COM ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 07/20/2016 14:41 Page I of 1