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HomeMy WebLinkAboutEHPR-08-2016-24591.TIF 1�Y A • THIS IS NOTA PERMIT Case # EHPR-08-2016-24591 i " CATAWBA COUNTY HEALTH DEPARTMENT �g1�e8`�. PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ' • r r 1842 sM Environmental Health Plan Review - OSWP a. Q 12 IMPROVEMENT .4• • - o - o { ❑� �. ti .far. Applicant THE OAKS GROUP, PA (KATHLEEN SAUNDERS), 121 HOLT LN, MOORESVILLE NC 28117 C:704578495I Land Owner CAROLINA CENTERS LLC, 227 W TRADE ST STE 1000, CHARLOTTE NC 28202 Owner BLUESHORE DIRECT INC, 16415 NORTHCROSS DR SUITE B, HUNTERSVILLE NC 28078 C:7048978500 NAME TO APPEAR ON PERMIT Blueshore Direct Inc SITE ADDRESS: 3709 CHEVLOT HILLS RD, SHERRILLS FORD NC 28673 PIN # 460702754550 NAME of SUBDIVISION: Lot# 4 Section/Block PROPERTY SIZE: Square Feet 45,650.88 Acres 1.048 DIRECTIONS: Hwy 150, Left onto Cheviot Hills Rd, Lot is on the Right. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: IP Only* 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? No 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: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF Vacant Lot EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 8 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 60x60x40x70(odd shaped house) #OF NEW BEDROOMS:: 4 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-ehappli cation 08/25/2016 09:21 Page 1 of4 CATAWBA COUNTY Case# EHPR-08-2016-24591 Public Health Department Subdivision G �1 Y Environmental Health Division• IS PIN# 460702754550 �..�.. PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 Lg.2 ,. NAME ON PERMIT: BLUESHORE DIRECT INC ( ), 16415 NORTHCROSS DR SUITE B, HUNTERSVILLE NC 28078 Blueshore Direct Inc ( ) Site Address: 3709 CHEVLOT HILLS RD, SHERRILLS FORD NC 28673 Property Size: Square Feet 45,650.88 Acres 1.048 Directions: Hwy 150, Left onto Cheviot Hills Rd, Lot is on the Right. 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 accessi'le o thatpa complete site evaluation can be performed. Date: ai 1l(<, Signature of Applicant or Agent e p;Q.1A I Lp h7 A.441(,O 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 AREA1 { illi�r i —t ?P (I I i�!Yi���l"u�ll i�igl jdj n�!�li (,^M� ( �t��� I A .iI`.""��Iimir"'' G Illi l l', �ITEENAMEIIIi� �'%%6,rll I • ul Hllf ld�l,l4��1�11 Ikip,DATE�t�r ,tela,2FEE AMOUNT�x ... .uull2�Improvement Permit Fee 08/25/2016 $150.00 AUL SII ii dll„ (����� �� T•o,•••• -Es IIIN41j,, �It hl V1tIJ S150.0,0,1111; i iGltll l Ilu 'I i+,WU�tI�' •. e' tni C v i.i.Isa"a.a• y1,14:101111111; 'CVIlli LL.ltldiiiill" 'd ll FEES ARE NON—REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-ehapplication 08/25/2016 09:21 Page 2 of CATAWBA THIS IS NOT A PERMIT 'v v` t>,,lt�,,tg}1"�0 v SaJE CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permit,,Authorization to Construct❑ Septic Repair ❑ Septic Malfunction❑ Septic Expansion New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction Nt. Existing Facility ❑ Property Address .370G (Jicv101 Hills Rd Subdivision NIP Sher('‘US Ford t 2867 Lot# Nin Acres 2 a,/eaSenent Section/Block/Phase N IR DrivingDuectionstoPtopetty Hwy ISO, Left oyl CnervIoc 1+%lls , /o - On tci NAME TO APPEAR ON PERMIT? Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name '$lu,e s here 'Dived l2ir Address 1(04 is No nil cross n,- Su;tr RMr flier k A/C Phone 10 -Tc3i—?Sob Cell Phone Owner Contact Information Name Sarrrt at ca0PtiCCin 1- Address Phone Cell Phone Contractor Contact Information Name Eai4n\eer, Saurl cierS /Ern rnn Mellott Address 121 Htol# Lel rflooresv lite NC 2$//7 Phone Cell Phone 709-5"Tir s/ WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant Contractor Description of Existing Structures on Site N/n #of Bedrooms *'1 Structure Dimensions #of Occupants Basement 5 Yes 5 No Basement Fixtures Q Yes 4P 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 1No Does the site contain any jurisdictional wetlands? El Yes %LNo Does the site contain any existing wastewater systems? ID Yes Is any wastewater going to be generated on the site other than domestic sewage? Yes jIo Is the site subject to approval by any other public agency? El Yes 0.No Are there any easements or right of ways on this property? Describe Existing water supply in use Jam..Individual Well LI Community Well Li Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** 5 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) 0 Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other ❑ Any cATAg BA THIS IS NOTA PERMIT couhn VY �3 CATAWBA COUNTY HEALTH DEPARTMENT „m,,,c,,,,„„ Application for Environmental Services Page 2 Proposed Facility Type 4 �! Primary Residence �] NewRe Resdenci _ Addition to Residence # of New Bedrooms *t Project Description ! (' � Structure Dimensions szieuDlx sI '1 orbcc% nts- S max Basement 0 Yes 74, No Basetrent Fixtures O'Yes likNo Li Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling Yes ❑ No Plumbing 0 Yes ❑No Describe PlumbingNeeded Multi-Family Residence#Units #Bedrooms per Unit*t Total #Bedrooms *t 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.) ❑ Business Specific Type of Business Retail Floor Space #of Employees,per Shift # of Shifts ❑ Other Facility Type Specify If Church# of Seats Kitchen ❑ Yes 0 No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi Public Well ❑Community Well Abandonment Type 0 Drilled 0 Bored _ Dug FT 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 steeping at the time of construction or for future consideration should be noted as a bedroom and counted on ail 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 pluuibedbut 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/p%e� me performed. eSignature of Owner or Agent "let" Date 0/2 L///o, Printed Name of Owner or Agent Em tinct 14e(+O r1 & NAN C. HENDERSON r. I. L. HILL D.B. 1326 PG. 156uMI-702 1 LOT 0137 P.B. 15 PC. 186 ' Dwc. NO 467-A 3� fig S. �/ l S6\'37• I' 1 \ 0 '` ?Qs - NEW LOT #3 4 Dg (INCLUUDING 0.97TAL AREA7 ACRE IN RAILROAD R Woh.�� & 0.038 ACRE IN SEPTIC EASEMENT) ' PARCEL ID: 4607-0275-3876 ��-- GARY S. TAYLOR & 11 \� a,� �:_8Y kPF1 SANDRA B. TAYLOR c1 D.B. 1765 PG. 645 �� LOT 0136 P.B. 15 PC. 186 = —'— . - - i' N -�P`�.9 pF�'` S\ i., NT 24-I•\9 o S. ` l o. PORTION OF PARCEL 10 4607-1271 AREA = 1.511 ACRI \ PORTION OF PARCEL ID 4607-0275-4550 AREA IN (INCLUDING 0.977 ACRE IN RAILROI e, L34 AREA = 1.080 ACRES SEPTIC (TO SE RECOMBINED WITH POR' Of PARCEL ID 4607-0275-45 RECOMBINED (INCLUDING ACRE IN SEPTIC EASEMENT) EASEMENT C. I (TO BE RECOMBINED WITH PORTION =0.021 ACRE us 01 OF PARCEL ID 4607-1276-6075) a r 12 C`30 30' CMP ,l36 C11 ik I. v T \ • C4 Ll tn N 41 P DUKE ENERGY Z, . S LAKE NORMAN U'' SS VI AREA IN ,C ,..0>: V. r ° "', SEPTIC S, I al-o, o EASEMENT = ,,seI ` f is •.•' L20 0.035 ACRE----70\ o � _ T.E , ' q. N o `ti ♦ ��� 10503(TOTAL.) s �: �� u, til N. (89.98) .0 \ £ \ as -0 (15.04') r n _ / 11 15 ,O� N. Z7G. = a a / N _ it o / L NEW LOT Ij4 ea( ( " II PORTION-OF-PARCEL 10 4507-0275-4550 C (p r 6 • REA ="1-:048 ACRES a ' / �i '- - -11 GAU•. G 0.021 ACRE N�`RAILROAD R/W) pp TO' :E RECOMBINED WITH PORTION ' tO 1 FT ,j5', a nil \ I\r' - •F ?ARCEL 10 4607-1276-6075) ' U 11 7FT vI ., 11 -� C8 �;� p�,;ti) ' r / N77b0 11"{y . ' '82.31'OS'W SJ.IB• r �` ` 225.80' C rli I I I /' PARCEL ID 4607-1574-282B FRANK .L. OWENS, JR. and I N.1 _ ....�.... .. i.urn�m i Department of Environment,Health,and Natural Resources Sheet: Division of Environmental Health Property ID: On-site WasRwater Section Lot#: SOIL/SITE EVALUATION File 4: for ON-SITE WASTEWATER SYSTEM AppiD: Owner: Applicant: Address: Date Evaluated: Proposed Facility: Design Flow(.1949) Property Size: Location of Site: I 0 ki.i' j Vie;-9 _Y"if Property Recorded: Water Supply: [ 1 Public [ 1 Individual [ 1 Well [ 1 Spring [ ]Other Evaluation Method: [-3 Auger Boring [ 1 Pit [ ]Cul Type of Wastewater: [ ]Sewage [ ]Industrial Process [ 1 Mixed P R o SOIL MORPHOLOGY b F .. .1941 PROFILE FACTORS I .1940 .1942 L Landscape Horizon .1941 .1941 Soil .1943 .1956 .1944 Profile E Position! Depth Structure! Consistence Wetness/ Soil Sapro Restr Class # Slope% (IN.) Texture Mineralogy Color Depth(IN.) Class Horiz &LTAR 0-32 (n1-) 3 c. FR. Ss/cp a 2-NS i,uKSerCL i g , r Sc;-p 3 `YS-S14 MA L S0P s .1 0-23 yito Sgv.`C Fka /cc- ria 1 L_ 0. 3 O-14-I inD e1-. C IF F,: ..4-,t P_ 14-412 ux`,, KCL fZ , :lrr 41- p S L „ r 4i Description Initial System Repair System Other Factors(.1946): Available Space(.1945) Soil Evaluation By: System Type(s) Others Present: Site LTAR Site Classification(.1948): Site Evaluation By: Others Present: Catawba County Environmental Health Still: / p :2.7. 0 i iiiii pp 4pit '1t �i1I1I ��! c288.6111t '1)i 114"ri .1 1 i,i i " lt,� 1 (4�) J ;i Ik,�Itd,l 411, Illik.°C3 0..11 lti(i9r,6ii 1 °141hs • • t; all' llt i t ,�I Ili I t ,�}4ti� iI�RF1l�' i �^ n ;joy: i 4„ 1 i 11JIir, a;, � u fi�rl 4 lif i� , iill 1401.P i it" i'1,4111,1!)�i � Ir1i M (h�011111 ,��i� ;'Fl ��i�tl �n ��4`�� � i' �dkttS .. ‘JtS I:1, 1 1II1 .1?tiMMI't63 I I"t+!j r 61"l l i11,7 1 ��,� l ayl �i111 ..„ • 12.43 84 -411 try • '4."-'1,.. II II :t.:}..t„� u�d 1, 3 30.9 5..0..;1_47 2�. Ali Iii "„eit.:^n i , 1 9 il``' 'Inig ;��i�4 '1136'i 0 ei 1 953 i;73dyiG;tia ► 2 "gill 18x3-j1 8.66 �_" � .�54"fir 112 {,t J S 2104 6 • 1 b404 r� N Q taiwiiiiiiiiiiir Lommilia...._ 16.29\ca _11,18T-L1 r"s K In W. o• S ` o VW° rsio 141041151 cli \ 182.46 2l � / J I � ' I Parcel: 460702754550, CHEVLOT HILLS RD 1 in=80ft 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 08/25/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 460702754550 Owner: CAROLINA CENTERS LLC Parcel Address: CHEVLOT HILLS RD Owner2: City: SHERRILLS FORD, 28673 Address: 227 WEST TRADE ST STE 1000 LRK(REID): 803689 Address2: Deed Book/Page: 1898/0427 City: CHARLOTTE Subdivision: State/Zip: NC 28202 Lots/Block: / Last Sale: School Information: Plat Book/Page: 74/164 School District: COUNTY Legal: PL 67-105 Elementary School: SHERRILLS FORD Middle School: MILL CREEK Calculated Acreage: 2.110 Tax Map: High School: BANDYS Township: MOUNTAIN CREEK State Road #: 1985 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoning1: R-30 Building(s) Value: $4,200 Zoning2: Land Value: $59,100 Zoning3: Assessed Total Value: $63,300 Zoning Overlay: CRC-O,FPM-O,WP-O Year Built/Remodeled: / Small Area: SHERRILLS FORD 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: WaterShed: WS-IV Critical Area 2010 Census Tract: 011504 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. Ne 41.' 4-65 ' SQ(Fi C le -111s. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=460702754550&typ=P 8/25/2016 p'A CC CATAWBA COUNTY LT !}+ J� � 100A SOUTHWEST BLVD 3f++'t, 9 7' NEWTON, NORTH CAROLINA 28658 RECEIPT ne a7 H ds�P PHONE: 828.465.8399 U " ia�o,' �C Thursday, August 25, 2016 51842 SM www.catawbacountync.gov \ i, PAYOR: The Oaks Group, PA The Oaks Group, PA(Saunders, Kathleen) PAYMENTS TRANSACTION NUMBER: TRC-799401-25-08-2016 PAYMENT DATE : 08/25/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-331998 Improvement Permit Fee 5150.00 TOTAL PAYMENTS : $150.00 EHPR-08-2016-24591 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 3709 CHEVLOT HILLS RD, SHERRILLS FORD NC 28673 Applicant THE OAKS GROUP, PA, 121 HOLT LN, MOORESVILLE NC 28117 C:704578495I ** NO PEOPLESOFTACCOUNTASSIGNED ** Land Owner CAROLINA CENTERS LLC, 227 W TRADE ST STE 1000, CI-IARLOTTE NC 28202 Owner BLUESHORE DIRECT INC, 16415 NORTHCROSS DR SUITE B, HUNTERSVILLE NC 28078 C:7048978500 receipt 08/25/2016 09:20 Page 1 or I -1.\ CATAWBA COUNTY • 7,Pt�s.a'ublic Health Department 'Case 4 W LS2007-01042 i" eit (1J: Environmental Health Division Subdivision CAROLINA CENTERS LLC \'\� ,/ t PO Box 389. 100-A Southwest Blvd.Newton.NC 28658 Sect/BL/Ph/Lot 4 -- ,,, (828)463-8270 FAX(828)465-8276 TDD(828)463-32011 PIN# 460716832252 Applicant/Owner CRESCENT RESOUCRES. INC. Site Address: CHEVLOT HILLS RD POSICd GC. Property Size: SF 1.173 ACRES Directions: HWY 150 TO CHEVLOT HILLS RD Improvement Permit ,i Permit Valid For: Five years ✓ No Expiration O Facility(Residential): House v House X Mobile Home Multi-Family Bedrooms 4 New? _r"---Addition? Projected Daily Flow %'ifO g.p.d Water Supply Private Well? ✓ Public? Semi-Public? Basement: Y Basement Plumbing: V 1lotTub/Spa: NSpecial Fixtures(explain): Proposed Wastewater Sy emi 2m-_T93S ' ,__11 brs.� Type:V-c- i 'Proposed Repair: fi L 'f. Dom_. fc._ PermitCon itr.ES �- , TQS /Q��l / p �_ 6w / Owner or Legal Representative Signature: [� M- (Date: 0 9/2'/07 Authorized State Agent: �A-„ Date: 92,e, -e7 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 arid Rules for Sewage Treatment and Disposal Svsterns' (ISA NCAC ISA .1900). Neither Catawba County nor the Environmental Flealth Specialist warrants that the septic tank system will continue to function satisfactorily for any given period of time. Authorization to Construct Wastewater System (Required for Building Permit) See site plan and additional attachments( ). Proposed Wastewater System: Type: Wastewater Flow _ g.p.d New Repair Expansion Soil LTAR: g.p.d./ft2 Type of Facility: Basement: y Basement Plumbing: y HotTub/Spa: N Special Fixtures(explain): Wastewater System Requirements Tank Size: Septic Tank gal Pump Tank gal Grease Trap gal Drainfield: Total Area: sq ft Total Length: ft Maximum Trench Depth in Trench Width ft Minimum Soil Cover in Minimum Trench Seperation ft Distribution: Distribution Box Serial Distribution Pressure Manifold LPP Other Additional Specifications: Authorized State Agent: Date: Permit Expiration Date: I have read and accept the specifications and all conditions of this permit as indicated. Owner or Legal Representative Signature: Date: Form B ann,m„ntv'„r.,„anvrs„,,,,vt .- CATAWBA COUNTY /ft E Case# W LS2007-01 042 \ Public Health Department n 1r,`tj Environmental Health Division Subdivision CAROLINA CENTERS LLC 0,77r.1,7,?/ PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 SeCVBUPh/Lot# \�.,;-% (828)465-8270 FAX(828)465-8276 TDD(828)465-8200 PIN# 460716832252 Applicant/Owner CRESCENT RESOUCRES, If Site Address: CHEVLOT HILLS RD Property Si _ SF 1.17 ACRES Directions: HWY 150 TO CHEVLOT HILLS RD ® Improvement Permit Authorization To Construct El Well Permit A� ����/Z SITE PLAN c�a-✓4/11i 22 4,37y— A / im• / fi . 524- 5AA 100 /sra/r ,9 . • we Ppgro \Arai el� 15' ¢BR • Gott 'C Noun / =So / Scale System components represent approximate contours only. The contractor must flag the system prior to beginning the installation to ensure that proper grade is maintained. Do not install system under wet conditions. This permit is subject of revocation if the site plan or site conditions are altered. Authorized gent • Date Form C cWlJmm�<\FmnnVWLAmn.m� --�_ - / 1/ i C3 / � - Sy31_ J bit --_ -- _ 90-79 0 w /�� zz ' `` o¢ti chi r -i w ,3 lz O I I z 00 • /µh roh W 0 0 asi T arEtnrAL, rp Of I5737 30 v/ ,x SZ/t, Nov' "6- 4 m p p i 5 c �(a mw m I C•- � �• is rr[il�r co _ v- ...-- / O 3J� Nh r. ., t z + J / / Q I' I • ` , a�6 tau: N ` ."-kr, 3 tl'lza Iti h 1_13 • ,o t. tr- - N a Li rr �O •.� • -mom�O �? '� O - I - 3 0 W 0" e��'''.. � • II�mr , 1Y b 3 w Z G��+ _w id�raza f „' M • • a'K0 FEW 6l b Sac , I , urn bo Z'f 4.1 P \/ w z 01ei H: 5 L ' ' 10 II - VSA I GRa� � i 0 2pQ CO I " `' cv �J�O�� Ngo �N 1 p v r V–Y _ Ilk _ �• ; Fes- fl !i TJC .v f N� QG�� y 6 laQ\h zzm . • • 6 N a6 rV .- N h r, 3 . C,9FQ-agz Z-s- rt .`A ' 30 WI'a CO co in 1 it-ami s.� .., / a f1 to J[O i • a U vma �o L32r . •i zW tz. c " IX ti ' . .. . .. _ - - a� i \ r NpT3T19 W v 209:59 / 80011 - r: �w ie-ME!* =� iii L? ?? Fs •DTA MbKh� � Dco`n m,p ( 0 . • 40 • oao i� j ', I ® o`nhc)iz --- I - - z ^rcNedz m 1 - Um a.vW - 226 Z,: Ts, aw Q co m to n m t~ a, ' N crri N cn c, in n n " oINIm –en n n m v m n (0 in nm y '—__ . N Nat N N m m h Q .- -- — N N , m CO N ^ N r"l N N ♦ Q .- N r) 0 LJ LOLi m U c„. o r'l`m co <o�')1- N m in Ol t-.o m < 17 to N m 10 tram N to .-m h can h o �- Z Qr[} r1 O N ,7O rl m 'Orr- .- a r? r} � N _ ll') h in -- - r) N O .-{fa _ . . d 4- rl 10 M1-CO ^ M1 m N in N a m r In r. p Q: O 1` t Win i r e.�1 re; rm] E PART r'OF ENVIRONMENT AND NATURAL RESOURCES - Shen of �OFIItO1 rALHEALTH. PROPERTY ID t ffidVWASTBWATER SECTION COUNTY: ' . SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM 'wpm O0 n cep _ APPLICATION DATE tDDRESS: DATE ROPOSED FACII.TIY: 3 DESI@,I,FLOW(.1949): .1'}5 0 Ca pD FROFBRTY SIMEVALUATED: ocATTON OF SITE: L6 t e, C V[¢b fiB I 1114-) PROPERTY RECORDEDe VATBR SUPPLY:'O Assn 0 Public Xi/ell 0 Spring 0 Other r VALUATION 1011140Th ginger Baring s$t 0 Cat TYPE OF WASTEWATER: 0 Sewage 0 Indossial Process 0 Awed P D5 .�� D musk s OM) PEONES FACTORS s aa0 iL�CAFS cps • SUM% WO• .wa ...LM - sae: .no ,S ,gsw cum STHUClJflI CONSNIENCTI WZJNISW SOS. SMIRO DWI" a ILTAIR Tf;J(7UDi aanaatATOGY CW.ca DMH masa BOWE p - 6 wk,5bk�52 5-/Fri SS�5P 41 :•w^,) - Q5 6 -30 n/wk 40K 5C / ,555!C8ro -Rea) 0, 30 1 /6_14/,° 4, 30 -Y.0 wit, %iKi c Fri csiSP Cur ;,s,) Lis- 4' Massa 5-A. Sot, Cr/SS/Ni Mw40 L 0- /6 mo5k*S61. FFA5.55PC& 4 ) Per ° . iG -y8 -wk51A/s` c h St$r CI n� wy 5Rp t, elu.s, 01 30 _` 9- i8; 0, 3S- c5- L a- t' . Mo/Grp 5L VF-fl 55/146, ;Brw�n,) B/ 6 - .3-s` wlc�sbk/yc t 5.559 (5; „) wiF. 54p, gn -lus, 30 )2-/ /:. yc- 9 ' �,,�' 0 - )41 Mo,/°rl ,5L- Fri X15,PI P C%oW..). Cf )4- 34 Pio/5 <, C Fr;sS/ 5Q lick) vs/ F - sap, IAr-lu4, 30 t 34--54I wkJ5h�(j`yt � 55, 5P (',', Ow/ C- .Sap,tT-.:n ,hire n84CRIVO0NN INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): a_,,,Space(1 SITE CLASSIFICATION(.1944 arm Type(s) EVALUATED BY: OTHER(S) ENT. y��<�j���.9 '/ /�c� p •LTAR ILCu//'PGl:.�'�`(./C.e/!'`*.-s 2r---2i---67 ti C; -I UU O [T t!• hS � t.r A U ISS jN Ot.. � A A N A U3 � N nS -2NU D r Y O V�A U> •O V 0 (la {I A' V O t0 O -• 0 V to V N IX N m V CO V co U -P TI m O a O Allllll-- ONt/ '— tJ c. tri U. Vi di tri Ut.' A A — - tw l.. c U 0 t;to-6 U to o Z iin O U •.U —; iT W CO CO N (4 cp to A 0 0 V +) CJ. JD N V U U. A 0 CO U r0 V n D f•f f f ri ri rim g ri ri f m f f m rpm m . m O U N A A N U N -. N N N A U N N A N W m cot" I it it O O r 0 m m m N U Uoc, 0 O. V U 0 co- 0 N tO U -. ia 03 m V .. CO CO O1. ? 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