Loading...
HomeMy WebLinkAboutEHPR-3-11-9945.TIF � � THIS IS NOT A PERMIT Case # EHPR-3-11-9945 � � CATAWBA COUNTY HEALTH DEPARTMENT U `'C Plan Review Application for Environmental Services Ig�2 SM Environmental Health Plan Review - OSWP +Sc�CI � �f��f� EXS SYSTEM � 1 �/l�(S 3' I�1 NAME TO APPEAR ON PERMIT DAVID M HESS SITE ADDRESS: 1 O95 COLINTRY CLUB RD Newton, NC Pir�: 37101962620� NAME of SUBDIVISION:HICKORY SPTNNERS 3710 Lot # 5 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.5� DIRECTIONS: SOUTH ON 321 BUS/ RT HWY 10/ 3.5 MU RT ROBINSON RD/ 1.8 MIL/ LF ON SANDY FORD RD/ .2 MU LF ONTO COUNTRY CLUB RD/ ON RT APPLICANT OWNER CONTRACTOR DAVID M HESS DAVID M HESS SUNLIFE, INC. 1095 COUNTRY CLUB RD 1095 COLTNTRY CLUB RD 5035 HICKORY BLVDHICKORY NC HICKORY NC 28601 HICKORY NC 28601 28601 828-396-3382 Dave@sun life sunrooms. com PRIMARY CONTACT: Contractor APPLICATIOI��JN��1§��ng Structure DIM EXISTING STRUCTURE: 68 X 34 EXISTING FACILITY TYPE: House NUMBER OF EXISTING BEDROOMS: SEWER TYPE: Septic Tank NUMBER OF EXISTING OCCUPANTS: 1 EXISTING WATER SUPPLY IN USE: Private Well CALCULATED DESIGN FLOW: Public water is **NOT"* available for this property. PUBLIC WATER TYPE AVAILABLE: N/A DESCRIBE WORK: ADDING 11'9" X 20' SUNROOM OVER EXISTING DECK/ ADDING 5' 3" X 12' ROOF OVER EXISTING DECK DESCRIPTION OF 68' X 34' HOUSE EXISTING STRUCTURES ON SITE (IF ANY) PROPERTY EASEMENTS: NONE PROPOSED CONSTRUCTIO PRIMARY RESIDENCE NEW RESIDENCE? Add/Alt to Residence # OF NEW BEDROOMS: 0 # OF STRUCTURE OCCUPANTS: 0 PROJECT DESC: ADDING 11'9" X 20' SUNROOM OVER EXISTING DECK/ ADDING 5' 3" X 12' ROOF OVER EXISTING DECK PROJECT DIMENSION: 11'9°X20 SLJNRM/ 5'3X12 ROOF ON DECK BASEMENT? No BASEMENT FIXTURES? No � I understand that this is a formal application for a well permit, Improvement permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is transferable and may be eligible for a norrexpiring date, but may be revoked if this information, site plans or intended use changes for the proposed facility. A Well Permit and Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or structure location should conform to applicable setbacks. Date: Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 working days of application date. If you need further information or assistance please call 828-466-7291 A�AZ **********+*****+**+**+*+****�*****************************�********************+**+***********+********************** 03/24/11 11:2� j ` C p l THIS IS NOT A PERMIT Case # EHPR -3 -11 -9945 �- CATAWBA COUNTY HEALTH DEPARTMENT U war ` '.,.. Plan Review Application for Environmental Services , 842 9, Environmental Health Plan Review - OSWP EXS SYSTEM NAME TO APPEAR ON PERMIT DAVID M HESS SITE ADDRESS: 1095 COUNTRY CLUB RD, Newton, NC Pin#: 371019626205 NAME of SUBDIVISION: HICKORY SPINNERS 3710 Lot # 5 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.55 DIRECTIONS: SOUTH ON 321 BUS/ RT HWY 10/ 3.5 MI/ RT ROBINSON RD/ 1.8 MIL/ LF ON SANDY FORD RD/ 2 MU LF ONTO COUNTRY CLUB RD/ ON RT APPLICANT OWNER CONTRACTOR DAVID M HESS DAVID M HESS SUNLIFE, INC. 1095 COUNTRY CLUB RD 1095 COUNTRY CLUB RD 5035 HICKORY BLVDHICKORY NC HICKORY NC 28601 HICKORY NC 28601 28601 828 - 396 -3382 Dave @sunlifesunrooms.com PRIMARY CONTACT: Contractor APPLICATIO ing_Stracture DIM EXISTING STRUCTURE: 68 X 34 EXISTING FACILITY TYPE: House NUMBER OF EXISTING BEDROOMS: 4 SEWER TYPE: Septic Tank NUMBER OF EXISTING OCCUPANTS: EXISTING WATER SUPPLY IN USE: Private Well CALCULATED DESIGN FLOW: Public water is * *NOT ** available for this property. PUBLIC WATER TYPE AVAILABLE: N/A DESCRIBE WORK: ADDING 11'9" X 20' SUNROOM OVER EXISTING DECK/ ADDING 5' 3" X 12' ROOF OVER EXISTING DECK DESCRIPTION OF 68' X 34' HOUSE EXISTING STRUCTURES ON SITE (IF ANY) PROPERTY EASEMENTS: NONE PROPOSED CONSTRUCTION I understand that this is a formal application for a well permit, Improvement permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is transferable and may be eligible for a non - expiring date, but may be revoked if this information, site plans or intended use changes for the proposed facility. A Well Permit and Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or structure location should conform to applicable setbacks. Date: - 37 / /< < Signature of Applicant or Agent / /// An Environmental Health Specialist will contact you within 2 working days of application date. If you need further information or assistance please call 828 - 466 -7291 AREA2 Minimum Setbacks: Front: 30 Side: 15 Rear: 30 Side St: Max Height: FEE NAME DATE AMOUNT BALANCE DUE Existing Tank Check Fee 03/21/2011 $80.00 TOTAL FEES $80.00 03/21/11 15:55 /A CATAWBA COUNTY Case # Q G EHPR-3-11-9945 Public Health Department Subdivision HICKORY SPINNERS 3710 Environmental Health Division - Plan Review `7 0; PO Box 389, 100 -A Southwest Blvd, Newton, NC 28658 Lot# 5 \ s4 2 s" PIN# 37101A62V05 Applicant/Owner DAVID M HESS, 1095 COUNTRY CLUB RD, HICKORY NC 28601 Site Address: 1095 COUNTRY CLUB RD, Newton, NC Property Size: SF Q55 ACRES Directions: SOUTH ON 321 BUS/ RT HWY 10/ 3.5 MI/ RT ROBINSON RD/ 1.8 MIL/ LF ON SANDY FORD RD/ .2 MU LF ONTO COUNTRY CLUB RD/ ON RT CHANGE WORK ORDER REQUIRING REDESIGN AND /OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 03/21/11 15:55 THIS IS NOTA PERMIT WLS# I CATAWBA COUNTY HEALTH DEPARTMENT /;/"Pie- t6 Application for Environmental Services r IP r AC (— S.T. Rpr. r S.T. Exp. IX Exist. 5. T. r Well Permit r Replacement Well 1. Name to Appear on Permit: 'David & Marilyn Hess 2. Permit Requested B Inc. - Dave Dunn Business Phone: 1828 -396 -3382 Address: 15035 Hickory Blvd., Hickor NC 28601 Home Phone: 1828 -302 -5735 3. Property Owner: 'David & Marilyn Hess Business Phone: 11095 Country Club Rd., Newton NC 28658 1 828- 294 -7027 Address: Home Phone: (Hickory Spinners 4. Name of Subdivision: Lot #: Section /Block/Phase: 11095 Country Club Rd., Newton NC 28658 Property Address: 'South on 321 Bus., RIGHT on Hwy 10 (WC St.) - 3.5 mi., RIGHT on Robinson Rd. - 1.8 mi., LEFT on Directions to Property: 'Sandy Ford Rd. - 0.2 mi., LEFT onto Country Club., H.O.R. 5. Property Size: Square Feet I Acres 1.55 Date Platted /Recorded (: House C Mobile Home 1 68x34 l 6. TYPE OF FACILITY: Dimension of Structure Bedrooms* *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 the house plans as a bedroom at the time of building permit issuance. This may prevent the need for system size increase in the future. Basement: C Yes (: No Water Using Fixtures in Basement: C Yes ( No No. in Family: 11 Whirlpool Tub: C' Yes C: No Gallon Capacity: I MULTIPLE FAMILY RESIDENCES: Units I Total Number of Bedrooms I DAY CARE: Number of Children I RESTAURANT: Seats 1 Square Feet Dining Area Square Feet Food Stand /Meat Market Floor Space TYPE OF BUSINESS: I No. of Employees 1 st I 2nd I 3rd OTHER : (Specify) 1 7. Do you anticipate any additions to Facility? C' Yes C No If so describe 1 8. Has any grading, removal, or addition of soil been done to this property? C Yes C: No If so describe L �, 9. Are there easements /right -of -ways recorded on this property? C' Yes C: No 10. Is a public water supply available on or adjacent to the above property? C' Yes (: No Check type that is available: r Community Well r Semi - public Well r County /City/Township water line 11. Well Type Applying For: r Individual Well r Community Well r Semi - public Well r Irrigation Well r Geothermal Well 12. Monitoring Well Request:C Yes C No # of Wells: 1 Name of Site: 1 understand that this a formal application for a well permit, Improvement Permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is transferable and may be eligible for non - expiring date, but may be revoked if this information, site plans or intended use changes for the proposed facility. A Well permit and Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or structure location should conform to applicable set backs. * *IF A PERMIT HAS TO BE REDESIGNED AND /OR RETRIPS MADE TO THE PROPERTY, THERE IS AN ADDITIONAL CHARGE. ** Date: 13/18/11 Signature of Owner or Agent: � i9 "- Print Form 3/21/2011 Print Parcel Map Real ��� �,!* � Estate Search ��� �� � � � �� � ��� _ � � � �� �� �� ' �����; ,y N � ` �v ��, � FM �• . . Y t � ..w a.k 35� �� . � : > � 1 `� � . ,m: . . . . ti .. � � � .} M .:. ' '� fi �... �.� x �. :�.: @r. � �� � `� w # . � � � � �- ` � � � ' . � ... � S y l � � s .,� � ., . � R w t j[�..>;� � .$�. r `' q i . � }:..�.` ,°�� � � � � i < � Y� n .. s ti�" � � . � � � �� � � " � +R � .. � �� .. �,. � ; � � 6.{H7 �� ' 3 .b ,.�-. � ..� � - � '� �� ,�, � �• , ; ` * r � ;.. � -.r . � � �_ �� �,. � �,-� � , �` � � � . � �` � - � � • � � � � ..�,. _ � . q,.. � .�,. �' �. +w . . � � , �.,, � .. � . : �w � � : ,�, .. � � � ..�,.�^�,� - r. � .� � � - �„� �.,,� � �. �•. - �;. � :.�� � '� � ���: � a, . . . . � � � . _. ,� . : 5 �. � � � �"' `� rt� � � �. � "° . s " - �.. � � ".i,. �. , ,. , � �,. - . _ � w � , . �� , �. .�a -�� < � � ; _ •` � . , . ���. � �„�, � r x� . � < a "�e�"` '�' � �� -w� � x � . ib. _ ' � . � �� ' �� � ��� �.�� � � � �� .��� . � � � } � ��� �" ��n � � ; '!�`,.' ` T� �: .. . "�• � M . ,- - :. �.# � r �. ° � - �.. � $�' " �q^ . � . ..� , _, � *� �. x � .. _ . � � .. * . �•' ,. , . �-��. , , ` � '' � �, � � �j . . .RX-� , � 1�.$ �.. �.. �, � ., a .. 7 �, � � � �' t r r � _ .. .. - , . � .. . ` : ' r.. �� ,. ...- " ,:;, '. "�1, ' � �,� _� � *� � 'hcW:u �'� . ���.,{ �.. � � ° ' , } i3�.�o � _ ��, r ;� � . ��.�� , � � , �� , „ . , �, ►„ � � , „�, . . �� ,. _, ,� n , � � . r,; _ _ :�� ����� , � ��� °� �� i i „�,� '` .._ ��} �� `� � q�►� �'��;�!"�� +M�. {� F, , ,. 4 • .�§ �, : � # . I ,, a.. . �< r:� � • . � .: VK. M�• � , ,. - . ��s2 I' ' � Y , .. � `. � � � ��S'��� ��P g � , � P � � . , . , ..., `. . �:�. ,.- . �,,,:.��w.....�.._� �,.�-..,.. ' . � . �• �:, . . _ . _ . . �^ � ., �� , m . a�. � .,,� . . � � - -- " ��, • �w � , � , ._ _ , �• ;:. � . ; _ -, � r �, - � =fi �� M � : �► � � . �' :� � � � ,m � ' `�. . "` ,� : , _ ;� _ .. 1'87.�t0 $� . � � � � � -°,`�a"� �.° . ,! ,� A � . . . . +� ; . � � ` � , �.�.�...,.,., . ,, � � " � ��"" �� _ ��._...... .� . � � > ;� � � � � �a<�� � � � � � � �. . �� � � �, � � ri '� � r.? ; �.�, . z ..� ,�, � , , �. ��, •�M ' �,� _ p, . . ..a+- -. . x ' i t .. .. ?' � `..,t4�,.. 3�� . . . 9 �, r n � ' _� � � ""�r �" �y �,�,\ ...� *� � '� � �. "� �. �,N.� �: " �, � Parcel Summ Printed Ma Scale 1 inch = 31ft Parcel ID: 3 71019626205 Parcel Address: 1095 COUNTR CLUB RD, NEWTON Owner: HESS DAVID M �dress: 1095 COUNTRY CLUB City: NEWTON Owner2: HES MAR ILYN J Ad dress2 : State/Zip: NC, 28658-8317 Building(s) Value: $370,100 Land V alue: $45,400 Total Value: $415,500 DISCLAIMER: 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 ofany 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 www.gis.catawba.nc.us/.../printMap.asp?p... 1/2 Cata�vba County, North Carolina > N This map product was prepared jrom the Catawba County, NC, Ceogrnphic /nformation Systenr. CataN�bn Counry hns made subslantial eJfor[s !o ensure the accuracy oflocation and /aGeling infonnution contained on this map. Catcrwba County p�•omotes nnd recommends 1he independent verifrcation ofany dnta con�ained on thrs map product by the user. The County of Ca�mvba, its employees, agents and personnel drsclaim, and shn// not be held liab/e for any and a!! damages, loss or ]iabi/ity, whether direct, indirec[ or consequentinl whrch arises or mcry m•ise jrom lhis map prodr�et or the vse thereof by any person or entity. Legend Selected Parcel Number: 3710-19-62-6205 1 inch = 100 feet Prepared for: i 2 �k' � j•� �,' j 8�'7� `- 3 0(�.05 �.r! �, j` ! _ / � , __.., �s:so 7s.��o �- t� L _ � -� � ... _� 153.50 � �J � Z69.6 14 __ _.-----_ ---- '� .... + _ +.. . .._, U t Q � , "' � ,_, 1 f ° s �� ! Q U 8551 ; � 650'' ` "' J M = ( ��_ .,� 3 i I ' � 164.G0 I�._. . _, -- . -- � o 0 � j � � 256.80 � � - n � HICKC�RY , � 6309 � C CITY L;iUIIT � ° m � Z �`�' --- I�RA� _ , � 4 , � � � r Y J^ R___ ; `� � A � °� m 'r11C�,K0�_ E W ; ON a � �� � - �t�K'JR ,� �f?AL' -_ �_ .- � - � a -_ �- � - � _ _ �, 1.11 _ _ - — - - RUf� L _ _- ,_ - -- 176.0p p !-.. g d� _ ' NEW-f�O! ,.c� - - - -- - -- - _ . _ _ __ c ir�rrcr� - r � c� , _.�_. �. , �- r u, ; B � o � R.2p � ° U g C - o „�'c� ,-- 62 M � � 233.11 5 �' �- R-2 _ � �° � o ._ , Q �.. _ �. 187.40 _ ��.�,.. � �..,...,,,.�..,,.5,,.,....,,..� __ -� - � — - - -- - a 0 N . � . . � � � �. ' � � �� �r � N % ���_,,\ �o 6 � �, a1 1 3 ° / / ^ � �-..� o CL �--~ —` -,� 6 ^ . 5181 �, I ^ � ,� �� �_ � � �� �� �� � � 1$s �0 40 213.27 _ 5A.40 3D7.67 4 . .... . .. .. . .. . . ��.�. .. � . . . � � .. . ' . . .� � .�� � f .... � � � . � . . � � .. �.. . . � 1 � � � . � � . . . � � � � (�' . �'.,�' � ' ,,,� r ' C � . _ � . � , . _ , �_, �_ � � �. y � _ � . . .. _ �� . _�.�u . . . � : . . , . :_ . _•. _ . TFIIS IS NOT A LEGAL DOCUMENT Monday, March 21, 2011 03:47 PM i �� � �, �--_•�.,,�, .. � CATAWBA COUNTY NC - Parcel Report • Information Regarding Selected Parcel(s) Parcel ID: 3710 -19 -62 -6205 Name: HESS DAVID,M Name2: HESS MARILYN J Address: 1095 COUNTRY CLUB RD Address2: City: NEWTON State: NC Zip: 28658 -8317 Account: 140226 Calc Acreage: 0.55 Tax Map: 072N 02005 LRK: 38087 Deed Book: 2224 Deed Page: 0457 Subdivision Name: HICKORY SPINNERS 3710 Subdivision Block: A Lots: 5 Plat Book: 13 Plat Page: 45 Building Number: 1095 Street Name: COUNTRY CLUB RD Site Zip: 28658 Township: NEWTON • Fire Code: NEWTON RURAL City Code: COUNTY State Road: Total Bldgs Value: $370,100 Land Value: $45,400 Total Value: $415,500 Year Built: 2002 Year Remodeled: Last Sale Date: 9/7/2000 Last Sale Amount: $34,000 Neighborhood: 96 Watershed: Watershed Split: Voter Precinct: P34 E911 District: COUNTY Zoning: R -20 • Zoning2: Zoning3: Zoning Split: N Zoning Overlay: ED -O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: BLACKBURN Middle School: JACOBS FORK High School: FRED T FOARD School Split: NO P &Z Case Number: Census Tract 2010: 011701 Census Block 2010: 2028 Small Area Plan: STARTOWN Agricultural District: Printed: Monday, March 21, 2011 03:48 PM 1 (.a W �,CL� aL C ' 1' AW BA COUNTY' "HEALTH DEPARTMENT O P • Telephone (828) 465 -8270 TDD (828) 46 1-8200 WLS # 01-1)0 9 S' 1 IP AC' Rpr Prmt. Opr Prmt. Sys Type Well Prmt. Replacement Well Well Rpr Prmt. Owner /Agent vi D FlEt.,\ Phone yid - 7ov Address L Cl„ 92 "; l..cf:_k .• . ' Rcot-t-, Subdivision Ni�,jt.t,c..-.l ( ,Q ‘ �,, , ,es 2 Section/Block /Phase Lot# S Lot Size SS Aj iEt Di rections Sl - c...,,,, IZ.;a © c y.,,, � `1 ' ? n Zp . (c (°_ ,� -, c,----,,-1 rho. " &."-- j Eavtitr Property Address / C C, ("j.-.+t. eo. Facility- House )( Mobile Home Business Multi- family Other Pin Number 3? to iG (,2(, zdC Other (cu. b 1 LAE° jt>, (2..9-14 , -, Zoning Approval # # Bedrooms # Seats # Employees Application Rate GPD Flow Hot Tub or Spa yes /no Special Fixtures Basement yes /no 100% Repair Area yes /no Basement Plumbing yes /no Water Supply- Private Well Public Semi - Public ******************************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** of S stem. Trench Bed Pump Pump /Panel Panel LPP Other Septic Tank Size mp nk.Size Vitrification Field. Total Square Feet Depth of Stone Bed Size Trench Width Total Lengi • , ' - • , hes Number of Trenches Trench Length / ^ // / / Feet on Center Maximum Trench Depth - Distance of Nearest Well *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* ******************************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** po % Slope Te ture `�� Stru re Clay in. — — % I' S t w �1 t SEEktk Soil W ness /, [,��•�- y (y . Soil Dep '-�/ P� i Restric H at R j--� / / Available sp ce yes /no / / Al O verall Clas S PS U Comments K 0 E A 1 e C pt.,. ,'\ C p u i C 6 :).„... L , P Q..? L., c ` q v � N r, cb t — cc.? `� 4 E h G Spa` C.c.s E P es. a, Az ri- i t: ( o o Z C / A„- n'.. f _c),._._ it ';) v■.. -,O •.,b �0 ,p ��csJ i7ztva. -......k ' Filter Required I d 7 Li. Riser required when tank is more than 6 inches deep. * *NO GUARANTEE OR ARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION ** ******************************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed Q facility An Authorization to Construct is valid for (5) five years from date issued and is not transferable. Well Permit valid for 5 years ✓• if 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. k Permit Date (p 17 0 EHS et._ .am 0 Owner /Agent N�p.^SZ°` -'-' Septic Tank Installed By Date EHS Well Installed By o.K�.9.1\ Qta,Bc Well Grout Approval Date () Ll lot Well Head Approval Date 7 Z. oZ Date Sample Collected EHS )0E7=; � _. Date of Results Results White - Office Yellow Owner /Agent Piiik Building Inspection Authorization to Construct CATAW C 6 TY HEALTH DEPARTMENT V Teleph (828) 465 8270 1'DD: (828) 465 8200 A� 9sCs- IP !� AC Rpr, Pr t. Opr. Prmt. Sys. Type 3 6-- Well Prmt. Replacement Well Well Rpr. Prmt. Owner /Agent ,t 77 Phone Address % n ,.-6 Subdivision ' Section/Block /Phase ' L,t# s Lot Size Directions: 4 'J / ir.="it' --� fi� au .:u,A..o. r � . Property Address 0 S :. MO I ____ Facility: House t- Mobile Home Business Multi - family . Other: Pin Number : /B - f, . --. , i, o ' Other • . Zoning Approval # # Bedrooms 1-{ # Seats # Employees . Application Rate • 3 GPD Flow 1? U Hot Tub or Spa yes /no Special Fixtures Basement yes /no . i00 %a Repair Area Ono Basement Plumbing yes /no Water Supply: Private Well Public r emi- Public Type of System: Trench Bed Pump Pump /Panel Panel LPP Other �' 0 Septic Tank Size Pump Tank Size Nitrification Field: Total Square Feet /a0 0 - Depth of Stone g Bed Size Trench Width .___3 Total Length of All Trenches VQC Number of Trenches 7 Trench Length /Ot1 / /OV 1/00 / 76O/ Feet on Center 9 / Maximum Trench Depth 3c17. Distance of Nearest Well /Oa *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* ******************************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** .2 Topo -. Slope Texture ,,� • Structure _ 44/ 17 Q Clay Min. / ^� ��— � � .4 Soil Wetness , • j.� x " 9 " " r Soil Depth • I i '� ` I � Restric, Hoz. at Available space d no 16 � a Overall Class S a* U " 1 + � - . j Continents: 6 0 __ . i -A � J I i rel' 1 lo Filter Required O� Riser required when tank is more than 6 • inches deep. * *NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION ** ******************************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility. 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. Permit Date 1 1- -- -- 0 ` EHS 47,..C7;, Owner /Agent U3 `k� `mow -'� Septic Tank Installed By 4, =, A ,,,,t ;. S FP1 L Date j • tq .p EHS' .,, -:- -• 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