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HomeMy WebLinkAboutEHPR-09-2016-24668.TIF sy�A • fHIS IS NOT A PERMIT Case # EHPR-09-2016-24668 �� ► f- t`,e CATAWBA COUNTY HEALTH DEPARTMENT 0 �oVLO U ' ut, Vis{: PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES • /842 sM, Environmental Health Plan Review - OSWP o f'oto IMPROVEMENT- AUTH CONST- EXPANSIONbriEklisttrgt Owner JEFFRY KAUTZ, 5590 CREEK POINT DR, HICKORY NC C:8284550396 NAME TO APPEAR ON PERMIT JEFFRY KAUTZ SITE ADDRESS: 5590 CREEK POINT DR, HICKORY NC 28601 PIN # 373407688805 NAME of SUBDIVISION: CREEK POINT Lot N 4 Section/Block PROPERTY SIZE: Square Feet 20,037.60 Acres 0.46 DIRECTIONS: Springs Road, Left onto Wandering Ln, Left onto Creek Point Dr, House is on the Left. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Public Water DESCRIBE WORK: Septic expansion. Existing home is 3 BdRms Addition 24x16 -Adding 1 BdRm, Full Bathroom & Relocating laundry area. 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, Patio Area EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 85x39, Patio Area 15x15 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 5 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: Addition 24x16 #OF NEW BEDROOMS:: 1 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: 139-ehapplication 09/06/2016 08:33 Page 1 of4 /A \ CATAWBA COUNTY Case# EHPR-09-2016-24668 rigic- Public Health Department Subdivision CREEK POINT +' Y Environmental Health Division PIN# 373407688805 'SWI^ PO Box 389, 100-A Southwest Blvd.Newton.NC 28658 /842W NAME ON PERMIT: (JEFFRY KAUTZ), 5590 CREEK POINT DR, HICKORY NC ( JEFFRY KAUTZ) Site Address: 5590 CREEK POINT DR, HICKORY NC 28601 Property Size: Square Feet 20,037.60 Acres 0.46 Directions: Springs Road, Left onto Wandering Ln, Left onto Creek Point Dr, House is 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 county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that lam solely responsible for the proper identificatipyyand libeling of all property lines and corners and making the site acce-,='ble so that a complete site evaluation can be .-rtormed. Date: `� Gy inSignature of Applicant or Agent am— An Environmental Health Specialist will contact you wit in 5 working days oapplication date. If you need further information or assistance please call 828-466-7291 AREA2 �'--r HIUi•n 'Ti��'�Irt !;j r �l'r" ,�Fn�j��� :1'279 fFEENAME',!;M �.:,. ,;�I 1.I t lu ±q�l� DATE i1j FEE AMOUNT Authorization to Construct Fee (New/Expansion) 09/06/2016 $300.00 Fee Improvement Permit Fee 09/06/2016 $150.00 "gyp,t i' (i"- I!i I i I 1���) ��� 5450 00'01 �i . 1 I��II I llf) TOTAL FEES n n i {i r I ` 'hi Itill�'iiihi� a1u � �II����.u", Jiti !IS��ltII:1', i{�J,IUigiOli „,5+�h .. !.U�,.UIII WIJLlli111la WI' SVI;JIUlllit bl n t@t l Mr UU�,Id�"R•” 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 09/06/2016 08:33 Page 2 of CATAWBA COUNTY HEALTH DEPARTMENT '.1441111101 �.,,,�„�\ 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 ❑ Existing Facility IN Property Address 5590 Creek Point Drive Subdivision Creek Point Hickory, NU 28b01 Lot# Acres .46 Section/Block/Phase Driving Directions to Property Springs Road to Wandering Lane, turn L. on Wandering Lane, turn L. on Creek Point Drive, house is 4th on the left NAME TO APPEAR ON PERMIT? ® Owner ❑ Applicant ❑ Contractor Applicant Contact Information NameJett Kautz Address5590 Creek Point Ur. Hickory, NU 28601 Phone 828.455.0396 Cell Phone828.455.0396 Owner Contact Information Name Same as above Address same as above Phone same as above Cell Phone same as above Contractor Contact Information Name Steve Little Address Phone Cell Phone 828.217.0432 WHO WILL BE THE PRIMARY CONTACT? IN Owner IN Applicant ❑ Contractor Description of Existing,Structures on Site single barmy Hume 5 # of Bedrooms *'( Structure Dimensions X.7C9: #of Occupants 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 10 No Does the site contain any jurisdictional wetlands? Yes INIo Does the site contain any existing wastewater systems? ❑ Yes 0 No Is any wastewater going to be generated on the site other than domestic sewage? ® Yes @ 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 U Individual Well U Community Well U 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) O Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other XAny I�AlAV V l.lA �cou rr CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type ® Primary Residence ❑ New Residence IN Addition to Residence # of New Bedrooms *t 1 Project Description addition of one bedroom, bath, and moving of laundry facilities Structure Dimensions 24 X16' # of Occupants 5 Basement km-Yes No Basement Fixtures � Yes 10; No U Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ® Yes n No Plumbing ® Yes ® No Describe Plumbing Needed [� Multi-Family Residence# Units #Bedrooms per Unitst Total # Bedrooms *t 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.) U Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Church# of Seats Kitchen 0 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 ❑ Drilled ❑ Bored ❑ Dug n Unknown Well Repair Requested 0 Yes 0 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. _ Signature of Owner or Agent Jile.0 . � ..41001109 Date 7( Printed Name of Owner or Agent 19) Catawba County Environmental Health s a PCO 195.a> g a' °i4u fl'i u i!! t :11- ' II k alli In dy t,llu.i, ® �fl�I I1�6 ¢Irrlf��jl. N',,, b pte ® _El � II, `!ill .111r I Iw h �sa>ys ttti o c IJA if -... ........ ,...... ` ^O �It:111:1 d v2yy SPU . \ 't lit. t II " . "I e , ti t, al , / '" 32. � i��: e Parcel: 373407688805, 5590 CREEK POINT DR 1 in=50ft HICKORY, 28601 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 09/06/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 373407688805 Owner: KAUTZ JEFFRY KELLER Parcel Address: 5590 CREEK POINT DR Owner2: KAUTZ JODI B City: HICKORY, 28601 Address: 5590 CREEK POINT DR LRK(REID): 401650 Address2: Deed Book/Page: 2824/1158 City: HICKORY Subdivision: CREEK POINT State/Zip: NC 28601-7089 Lots/Block: 4/ School Information: Last Sale: $160,000 on 2007-03-27 Plat Book/Page: 43/64 School District: COUNTY Legal: LOT 4 4 PL 43-64 CREEK POINT PL 43- Elementary School: SNOW CREEK Middle School: ARNDT 64 Calculated Acreage: .460 High School: ST STEPHENS Tax Map: School Map Township: CLINES State Road #: 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: $140,900 Zoning2: Land Value: $18,200 Zoning3: Assessed Total Value: $159,100 Zoning Overlay: Year Built/Remodeled: 2006/ Small Area: ST STEPHENS/OXFORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel It: 3710373400J Building Details 2010 Census Block: 1059 WaterShed: 2010 Census Tract: 010301 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 held liable tor 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=373407688805&typ=P 9/6/2016 p . 4 • 4 . L OPERATIONS PERMIT FOR TYPE III WASTEWATER SYSTEM PERMIT NUMBER WLS2006-00080 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 JEFFRY KELLER KAUTZ For the operation of a wastewater collection, treatment, and disposal system to serve: PIN V\ 373407688805 pursuant to 15 A NCAC I8A .1900 et seq. and in conformity with the application, improvement permit, and other supporting data subsequently filed and approved by the Catawba c County Public Health and considered a part of this permit. Facilities to be served: (Address and specific type of facility) o1 5590 CREEK POINT DR Type 3B/G The approved wastewater collection, treatment, and disposal system consists of: 0 (1) 1000 Gallon Septic Tank (2) 1000 Gallon Pump Tank (3) Effluent Pump (4) Pump to Pressure Manifold (5) 25% reduction,4 trenches 75' each, chambers 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 (31), .1937 (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: RECEIVED JUL .Z 7 2007 IRNALENVOMENTHEALTH I. GENERAL CONDITIONS This permit is effective only with respect to the number and type of proposed facilities and volume and nature of wastes specified. 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 maybe required by the Catawba County Public Health,such as the construction of or replacement of wastewater treatment or disposal facilities, upon receipt of a repair permit. 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. The issuance of this permit shall not relieve the Owner of the responsibility for damages to surface or ground waters 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. 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 during the operation of the system. Adequate measures shall be taken to divert storm water from the disposal field area and to prevent wastewater runoff. Diversion or bypassing of the untreated wastewater from the treatment facilities is prohibited. Prior 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 materials 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. The designated repair area shall be reserved for the installation of additional nitrification fields and is not to be covered with structures or impervious materials. No addition, expansion, alteration or other repairs shall be made to the wastewater system without first obtaining an improvement permit from the Catawba County Public Health in accordance with GS 130A-336. • 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. In the event that the facilities fail to perform satisfactorily, including the creation of nuisance conditions,the Owner/Operator shall contact the Environmental Health Section of Catawba County Public Health within 48 hrs. of discovering this failure or problem. 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. 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. 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 recommended. 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 Catawba County Public Health 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 Catawba County Public Health for ownership. PERMIT ISSUED THIS THE I 1 DAY OF l'Ltt,1 , 20 t7 . Catawba County Public Health Owner Signature , Environmental Health Section I�/ AarR.S. 4 OPERATIONS PERMIT FOR TYPE III WASTEWATER SYSTEM PERMIT NUMBER WLS2006-00080 In accordance with the provisions of Article 11 of Chapter r-. 130A, General Statutes of North Carolina as amended, and other 2/Ns applicable Laws and Rules. N PERMISSION IS HEREBY GRANTED TO CS Old Hickory Properties ) For the operation of a wastewater collection, treatment, and o disposal system to serve : Pin Number 373407688805 pursuant to 15 A CS NCAC 18A . 1900 et seq. and in conformity with the application, CS 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) 5590 Creek Point Hickory, North Carolina Type III bg The approved wastewater collection, treatment, and disposal system consists of : (1) 1000 Gallon Septic Tank (2) 1000 gallon Pump Tank (3) Effluent Pump (4) Pump to pressure manifold (5) 25% reduction, 4 trenches 75' each, Chambers 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 (31) , . 1937 (e) , . 1938 (g) , . 1945 (a, b) , . 1950 (a throuch 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 . GENERAL CONDITIONS This permit is effective only with respect to the number and type of proposed facilities and volume and nature of wastes specified. 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 . 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 133 . 0100 et seq. and in a manner approved by the North Carolina Division Of Solid Waste Management . 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. 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 during the operation of the system. Adequate measures shall be taken to divert stormwater from the disposal field area and to prevent wastewater runoff . Diversion or bypassing of the untreated wastewater from the treatment facilities is prohibited. Prior 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 materials 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 . The designated repair area shall be reserved for the installation of additional nitrification fields and is not to be covered with structures or impervious materials . 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 . 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 . In the event that the facilities fail to perform satisfactorily, 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. 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 . 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. 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 recommended. PERMIT ISSUED THIS THE 0 DAY OF F' N4(r1 , 207. , 7r,./ �✓ ,TL.�. .� CATAWBA CO. HEALTH DEPT. Owner Signature ENVIRRO ENT,L HEALTH SECT. R. S . /1—>� CATAWBA COUNTY Case# WLS2006-00080 Public Health De-pertinent 1 1 1 Environmental Health Division Subdivision CREEK POINT 1/ PO Box 389,100-A Southwest Blvd,Newton,NC 28658 Sect/BL/Ph/Lot# 4 \ 4,_,/ (828)465-8270 FAX(828)465-8276 'PDD(828)465-8200 PIN# 373407688805 Applicant/Owner: OLD HICKORY PROPERTIES LLC Site Address: 5590 CREEK POINT DR HICKORY NC Property Size: SF A6 ACRES Directions: "revised---added AC/paid fee 02/01/06"`TAKE SPRINGS RD TO CREEK POINT SUBDIVISION!TURN LF ON WANDERING LN/TURN LF ON CREEK POINT DR/LOT#4 ON LEFT(Note: see parcel tag) Catawba County Health Department Operation Permit • 7`r( • C -7? 37+ (97 System Code • System Type: 5r710 Description: 0 LA'SV,sr Types V and VI systems expire in 5 years. (In accordance with Table Va) Owner must contact health department 6 months prior to exiration for permit renewal. PERMIT CONDITIONS: 1. Performance: System shall perform in accordance with Rule.1961. • II. Monitoring: As required by Rule. 1961. III. Maintenance: As required by Rule . 1961. Other: Subsurface system operator required? Yes No br If yes, see attached sheet for additional operation conditions, maintenance and reporting. IV. Operation: This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and All conditjp s of he Improvement Permit and Construction Authorization. t. 1 4 . 2-/2-07 System Installer Installation Date ori d tate Agent 0 (5'-7 t Date of Operation Permit Issurance Form�F CATAWBA COUNTY HEALTH DEPARTMENT �5&O ._L • / Telephone: (828)465-8270 Tjyl . (828)465- WLS # 'WO U - 000i JO Improvement Permit VAC / Repair Permit. Operation Permit. System Type Well Permit. Replacement Well Owner/Agent 01 at #, r,fi oru Prpna,+,,t_r LLC.. Phone Address ea /S ur 'S 711 V Subdivision t-c.tt h Peat)- 14;i. - 1 ;c Ear., ./tit. 2 66 0'} Section/Block/Phase Lot# '4 Lot Size U. 14 6 Directions: Jin/fly s-- Al . To ic<+.dari," Ln / Gf on Lrtuek Pi.. Lot on L i% Property Address /.c10 Titai,L/Vuq Facility: House ✓Mobile Home Business Multi-family Other: Pin Number 1-7-)407‘ • (L 0,S* Other . Zoning Approval# # Bedrooms `3 # Seats # Employees . Application Rate n ') GPD Flow 3 6 0 Hot Tub or Spa yes/no Special Fixtures Basement es/no . 100% Repair Area yes/no Basement Plumbing Us/no Water Supply: Private Well Public v' Semi-Public 444444*444**44444444*4444*****4********4444***4****4**********4444********44444*44****44****44444*****4*4****4****444444 Type of System: Trench V Bed Pump V Pump/Panel Panel LPP Other 2--1 % g.(I/Vfr7 ... Septic Tank Size 100 0 Pump Tank Size Nitrification Field: Total Square Feet D D Depth of Stone Bed Size Trench Width .3 4" Total Length of All Trenches 1 0 p Number of Trenches i'1 / Trench Length 2) /77 /75-/75-/ 1 Feet on Center 5 tit t Maximum Trench Depth Distance of Nearest Well *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* ******************************************.**********************************************************4*4**4******4444**444* Topo % Slope Texture Structure Clay Min. Soil Wetness e Hi,n(,J r liuc Soil Depth " ilk Restric. Hoz. at " all I1-ly-vb Available space yes/no p Overall Class S PS U ( c? --' J t Comments: I (1 h H a WI� 1• I V Y\ u r Co "- `P ,y a - L FeB14 v I. Ovt I 1�� IS r 4 �Ja � ' F vl I , t f irvl u `) nra}- -? I t - 5a frt.„ 4.11 Ws t I -1- Oft•vtww 30, I It i c. VX�, 1Oa1 19c 7 ). pc,iv f J / J + t14 ' tJvr.t ✓citn, LI '► I& t/ r- 2U ✓ I Filter Required 4 N+P fir /r h- '1-Ln Riser required when tank is more than 6 l SIX i n ckt; O7 (,dvi✓, inches deep. **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** ***4444***4444**444********4*******4***4*44***4*****44************4***********4*4**4********4**44444**********4**4444444 An Authorization to Construct is valid for(5) five years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. The siting of the well by the Health Department staff is to provide protection from known possible sources of contamination. No volume of water is guaranteed at any site by the Health Department. i n Permit Date 7- l ) O EHS N6 — Owner/Agent � ;�/i. i.�/ Septic Tank Installed By Cil �w`ave Date 2�jv-07 EHS ,ty Well Installed By Well Grout Approval Date Well Head Approval Date Date Sample Collected Date of Results Results EHS White-Office Yellow-Owner/Agent Pink-Building Inspection Authorization to Construct . I D 11AI:'TitiSr OF ENVIRONMENT AND NATURAL RESOURCES - Sheer of DIVISION OF ENVIRONMENTAL HEALTH PROPERTY ID#: ON-SITE WASTEWATER SECTION COUNTY: SOIL/SITE EVALUATION //'' for ON-SITE WASTEWATER SYSTEM OWNER: "I tY., 1 y+-V APPLICATION DATE ADDRESS: r DATE EVALUATED: PROPOSED FACILITY: - PROPOSED DESIGN FLOW(.1949): PROPERTY SIZE: LOCATION OF SITE: - PROPERTY RECORDED: WATER SUPPLY: 0 Private 0 Public UW,e1 0 Spring 0 Other EVALUATION METHOD: 0 Auger Boring .V Pit 0 Cut TYPE OF WASTEWATER: 0 Sewage 0 Industrial Process 0 Mixed Y: ................... {) SOILIYSORPTIOLOC\ OTHw,R F' • (:1941) PT2OPTLEFACTOFS I: 194[1" ; LAND: 1• )11-: :: 1942 ii ' : SCAPE ZON,. _1441 1941 S011L . 1943: 1954 1945 fi POSITION! DEPTH ..STRUCTC)REJ CONSISTENCE! WETNESS! SOIL: PIY0. SA .. ...RE$.`CR... PROFILE, - SLOPE:% (IN:}:: .;....TEXTURE.......... .......MINERALOG:Y._... .::::COLOR: . ie:DEP.TH ::a CLASS" :::HQRIZ LASSo,;.: .. _. _ i:vQi i�:T.1 ii 0-1 3 G L ,- k fig Fr _ I • 74-31 C ,rd L Loy), r,- 6e ll„,,)4.4 1 (L 4$ L r 3 .J�a'/ Pr cot, 2 j 2 3 1 6-2.7 L L J-Lc :� 1 . .1'r 2?-G& C- ✓)j- t-zno T r 2 v Lig .J I 0-1I CL ,rJ& s„is' rr 9-32 G JJ- rte, FJ 4i 3 3z- iia £ ak "ley, It _ ?Lib,Ft✓y 4 I DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): Available Space(.1945) SITE CLASSIFICATION(.1948): System Type(s) EVALUATED BY: �f.G�j{�/ � OTHER(S)PRESENT: Site LTAR COMMENTS: LEGEND , . :? F use the following standard abbreviations SOIL CONVENTIONAL LP? . _ .:„-” LANDSCAPE POSITION GROUP TEXTURE .1955 LTAR• .1957 LIAR* MINERALOGY/ -C T U CONSISTENCE STRUCTURE CC(Concave Slope) I S(Sand) ' 1.2-0.8 0.6-0.4 CV(Convex Slope) LS(Loamy Sand) S EXP(Non-expansive) G(Single Orrin) D(Drainage Way) EXP(Slightly Expansive) M(Massive) EXP DS(Debris Slump) II SL(Sandy Loam) 0.8-0.6 0.4-03 (Expansive) CR(Crumb) FP(Flood Plain) L(Loam) OR(Granular) FS(Foot Slope) SDK(Subangular Blocky) HQ-lead Slope) III . SCL(Sandy Clay Loam) 0.6-03 03-0.15 ABK(Angular Blocky) L(Linear Slope) SIC(Silt Loam) PL(Platy) N(Nose Slope) CL(Clay Loam) PR(Prismatic) R(Ridge) SiCL(Silty Clay Loam) S(Shoulder Slope) Si(Silt) MOTS' ..F T(Terrace) IV SC(SandyVFR(Very Friable) 145 Noo-avdyl Clay) 0.4-0.1. 0.2-0.05 FR(Friable) SiC(Silty Clay) Fl(F ) SS(Slightly Sticky): C(Clay) '/(sticky) 0(Organic) None VFI(Very v.Very Sticky) VS(Very Sticky) EFI(Extremelymely Firm) NP Non-plastic) *Adjust LTAR due to depth,consistence,structure,soil wetness,landscape,position,wastewater flow and quality. SP lanic)y Plastic) NO TET P(Plamic) HOR/ZONDEPTf In inches below natural sail surface VP(Very Plastic) DEPTH OF FILL In inches from land surface RESTRICTIVE HORIZON Thicknessand depth from land surface ' SAPROLITE S(suitable)or U(unsuitable) SOIL WETNESS Inches Ecom land surface to free water or inches from land surface to soil colors with chroma 2 or less-=cord Munsell color chi desi CLISSIFICATION 5(Suitable),PS(Provisionally Suitable),orU(Unsuitable) P gnadan Evaluation of sapmlite shall be by pits. Long-teen Acceptance Rare(L/AR):gal/day/ft' Show profile locations and other site features(dimensions,reference or benchmark,and North). • 1I I6( :-I smL of j I a ° 4 • DEUR(######) Rc icw(#k#%#) 4,A CATAWBA COUNTY �� .{, 100A SOUTHWEST BLVD t�vl"rk � �' NEWTON, NORTH CAROLINA 28658 d ' " Trapp PHONE: 828.465.8399 RECEIPT VI , Jl®a►o Tuesday, September 6, 2016 1842 sM www.catawbacountync.gov PAYOR: KAUTZ,JEFFRY PAYMENTS TRANSACTION NUMBER: TRC-819040-06-09-2016 PAYMENT DATE : 09/06/2016 PAYMENT TYPE'. Check 3484 INVOICE NUMBER FEE NAME FEE AMOUNT 09-16-332335 Improvement Permit Fee $150.00 TT'.111 � ib3 .. ,�.. 091'162332335 � " " 300;00 ,P+ . � AutHo�ization"to_Cgnstructee� �; (New/Expansion) Fee TOTAL PAYMENTS : $450.00 EHPR-09-2016-24668 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 5590 CREEK POINT DR, HICKORY NC 28601 Owner JEFFRY KAUTZ, 5590 CREEK POINT DR, HICKORY NC C:8284550396 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 09/06/2016 08:32 Page I or I