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Home My WebLink AboutAUTH-2-10-4436.TIF CONSTRUCTION For Office Use Only AUTHORIZATION `CDP•File Number 3 8 5 6 1 Catawba County Public Health Department County ID Number. EHPR-1-10-3537 t Environmental Health Division Evaluated For: REPAIR ' P.0 Box 389, 100-A Southwest Blvd Township: 4' Newton NC 28658 PERMIT VALID UNTIL Phone: (828)-465-8270 Fax: (828) 465-8276 0 a/ 0 a/ a 0 1 5 Applicant: Beverly Wilkes Property Owner: Beverly Wilkes Address: 4210 Marvin St. Address. 4210 Marvin St. Coy: Claremont Coy Claremont State/Zip: NC 28610 State/Zip: NC 28610 Phone Phone Property Location & Site Information OAddressIRoad Subdivision: Island Ford Park Phase: Lot: 5 210 Marvin St. laremont NC 28610 Directions Structure: MULTI FAMILY # of Bedrooms. 3 # of People: 2 "Water Supply: EXISTING WELL ` ahl 15 tX Mt~ ~v t(44 a SL G ~uti m ecl Ica Ion Minimum Trench Depth: Inches "Site Classification: Minimum Soil Cover Inches Design Flow: Maximum Trench Depth: Soil Application Rate: Maximum Soil Cover: Inches inches 'System Classification/Description: 'Distribution Type: GRAVITY Septic Tank: 1 0 0 0 Gallons 'Proposed System : 1-Piece: ()Yes ()No Pump Required QYes ®No ()May Be Required Nitrification Field Pump Tank. Gallons No. Drain Lines Sq ft 1-Piece: ()Yes QNo Total Trench Length: ft_ GPM-vs-- ft. TDH Trench Spacing: _ Inches O.C. 8FeetOC. Dosing Volume: _ Gallons Trench Width: Inches - Feet Aggregate Depth: Grease Trap: Gallons inches Pre-Treatment- ONSF ()TS-1 OTS-11 Septic Tank Installer Grade Level Required- (9)I ()II 0111 ON Page 1 of 3 CDP File Number 38561 County ID Number: EHPR-1-10 3537 ❑ Open Pump System Sheet Repair System Required:OYeS ONO ONO, but has Available Space epair System Trench Spacing: Q Inches O.C. *Site Classification: - o Feet O.C. Trench Width: Q Inches Design Flow: - o Feet Soil Application Rate: Aggregate Depth: inches Minimum Trench Depth: *System Classification/Description: Inches Minimum Soil Cover. Inches *Proposed System: Maximum Trench Depth: Inches Maximum Soil Cover: Nitrification Field Sq. ft Inches . No. Drain Lines *Distribution Type: Total Trench Length: ft Pump Required: QYes ()No OMay Be Required Pre-Treatment: ONSF OTS-1 OTS-II 'Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. 'Permit Conditions The issuance of this permit by the Health Department in no way guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. Pump out and abandon existing tank. New tank must be no deeper than 36 inches (to the top of the tank). Install risers as needed. Set new tank so that gravity fall from the house is possilbe and gravity fall to the existing drainfields. If tank must go deeper than 36 inches a traffic rated tank will be required. Hook up existing drainfields to the new tank, a new D-Box may be required. Make sure that only sewage is piped into the tank - no gutter drains or foundation drains. Installer is to call this office with questions. Septic tank must be at least 50 ft. from ditch, 50 ft from any well, 15 ft. from basement cuts 5 ft. structures. 10 ft. from property lines. Do not drive, grade, cut, or fill over septic system. This Authorization far Wastewater System Construction shall be valid for a person equal to the period of validity of the improvement Permit, not to exceed five years, and may be issued at the same time the improvement Permit issued (NCGS 130A-336(b)) If the installation has not been completed during the period of validity of the Construction Permit, the information submitted in theapplication for a permit or Construction Authorization is found to have been incorrect, falsified or changed, or the site is altered, the permit or Construction Authorization shall become invalid, and may be suspended or revoked (.1937(8)). The person owning or controlling the system shall be responsible for assuring compliance with the laws, rules, and permit conditions regarding system location, installation, operation, maintenance; monitoring, reporting and repair (1936(b)). Applicant/Legal Reps. Signature Required? ()Yes ONO Applicant/Legal Reps. Signatures 1 c? Date:. % s " 1 /0 . *Issued By: 2246 - Megen McBride Date of Issue: 0 a 0 a / a 0 1 0 Authorized State Agent: VVIA Malfunction Log Oyes &Hand Drawing Oimport Drawing TotalTime:(HH:MM) **Site Plan/Drawing attached.** Hours tiinutes Page 2 of 3 CDP File Number: 38561 County ID Number: EHPR-'-'0-3537 Drawing Type: Construction Authorization Date: 0Inch Drarvin~ Scale: QBiock = ft. NIA C u i re, i JA'j(A w OA f(eqlof) ~alx(_ UK jtIv T~~S tvV+~i ~4 ~o e (cm, co16rtl st. ~c +aKv, '04~ C, hey I~oo ~,1. X11 3~drboIn Se' ie~ new v tSFb'S~~ Page 3 of 3 CATAWBA COUN'TY HEALTH DEPARTMENT 05ko Teleph (828) 465-8130~DD (828) 465-8200 WLS# O 2 IP AC Rpr Prmt. Opr rmt. Sys. Tye (4 Well Print. Replacement Well Well Rpr Prmt. Owner/Agent Phone Address Subdivision ~rj Of S ctio Block/Phase Lot#_ Lot Size Direc 'o Tlr V ,4- Prop rry Address Facility- House Mobile Home Business Multi-family Other- Pin Number :-3:27301 Z.S`D V Other Zoning Approval # # Bedrooms # Seats # Employees Application Rate GPD Flow I-lot Tub or Spa yes/no.Special Fixtures Basement ye{ o 100`7 Repair Area yes/no Basement Plumbing yes/no Water Supply Private Well Public Semi-Public Type of System. Trenci~/%7pmp BedY Pump Pump/Panel Panel LPP Other Septic Tank Size/C Tank Size Nitrification Field. Total Square Feet Depth of Stone D /i1 Bed Size 5K 6 Trench Width Total Length of All Trenches 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* Topo % Slope Texture Structure Clay Min. Soil Wetness Soil Depth Restric Hoz at _ Available space yes/no Overall Class S PS U Comments Filter Required l1~ ~ 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 pr ction f tmi k 27n possible sources of contamination. No volume of water is guaranteed at any site by the Health Department. Permit Date._ - O EHS(-,-!D A,~ Owner/Agen i Septic Tank Installed` • M Date-/- -b EHS Well Installed By ,IU Well Grout Approval Date Well Head A6 oval Date Date Sample Collected Date of Results Results EHS White - Office Yellow - Owner/Agebt ` Pink - Building Inspection Authorization to Construct ~14'A "l O - CATAWBA COUNTY Case # Subdivision Public Health Department Section/Bl/Ph/Lot# Environmental Health Division PO Box 389, 1 OOA Southwest Blvd, Newton NC 28658 PIN# 18 42 sAa (828) 465-8270 Fax (828) 465-8276 TDD (828) 465-8200 Applicant/Owner Reyead W; lka Site Address: vic aw, , Property Size: Directions: Owner/Authorized Representative Acknowledgement of Permit Receipt I certify that I am the owner or authorized agent (owner's authorization required) representing the owner of the property described above. _ As the property owner or authorized representative, I have received the above referenced permit(s) as requested in the application for service, by the following method(s): Received in Person Facsimile Transmittal (Return form with signature required) Electronic Image Transmittal/ E-mail (Return receipt required) As the property owner or authorized representative I have reviewed and understand the specific conditions of the permit issued, and further understand that all applicable regulatory requirements specified under the North Carolina Laws and Rules for Sewage Treatment and Disposal Systems (15A NCAC 18A.1900), and/or Well Construction Standards (15A NCAC 2C.0100), shall apply to the issuance of this permit and the construction of the wastewater system and/or water supply well permitted. Permit Issue Date Received Date Catawba County Public Health Enviromnental Health Section Owner/Authorized Representative Signature Date Documentation of Permit(s) Transmittal s (per it transmitted by electronic or other means) Permit transmitted b 14L1 djv (name ofperson sen ing permit) Signature Date/Time D. L_,>11,0 x-30 Method: Fax _ZEmail US Mail Other Owner's request to send by the above indicated method of transmittal in lieu of signature acknowledges the conditions and statements above. j(t~r,e•powctt 6OP109.0ri