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Home My WebLink AboutCASE-3-10-1534 PERMIT.TIF CATAWBA COUNTY Public Health P~epartmen* Case # WLS2008-00I00 Environmental Health Division Subdivision FOREST PARK DEVELOPME: PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Sect/BL/Ph/Lot # 3-4 (828) 465-8270 FAX (828) 465-8276 TDD (828) 465-8200 PIN# 364913033036 Applicant/Owner: MICKEY SHEPPARD Site Address: 1998 BROOKSIDE AV NEWTON NC Property Size: SF I ACRES Directions: '"Revised 1/9/08: Need well/ Cannot hook onto city water"' / 321 S TO LT ON LAKEVIEW DR/ LT ON BROOKSIDE/ LOT ON RT Catawba County Health Department Operation Permit ,0'0 ~p AML t o~' ion' too' PLOW Y ~CA System Code System Type: TCIA Description: ~L IKj n ~~GLQV✓ 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 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 conditions of t fie Improvement Permit and Construction Authorization. System Installe installation a e u onze 5rale /~nT- g Date of Operation Permit Issurance Form F r\Tidernrrrk\ForrnaVWLSnno. mr CATAWBA CQUNTY Case # W LS2008-00100 Public Health Pepartment Subdivision FOREST PARK DEVELOPME\ Environmental Health Division J\`. ' y I PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 SecUBUPh/Lot # 3-4 (828) 465-8270 FAX (828) 465-8276 TDD (828) 465-8200 PIN# 364913033036 Applicant/Owner MICKEY SHEPPARD Site Address: 1998 BROOKSIDE AV NEWTON NC 6~ Property Size: SF 1 ACRES Directions: **Revised 1/9/08: Need well/ Cannot hook onto city water** / 321 S TO LT ON LAKEVIEW DR/ LT ON BROOKSIDE/ LOT ON RT Improvement Permit Permit Valid For: Five years No Expiration Facility (Residential): House House X Mobile Home Multi-Family Bedrooms 4 New? _ Addition? Projected Daily Flow g.p.d Water Supply Private Well? Public? Semi-Public? Basement: N Basement Plumbing: _N HotTub/Spa: N Special Fixtures (explain): Proposed Wastewater System: Type: Proposed Repair: Permit Conditions: Owner or Legal Representative Signature: Date: Authorized State Agent: Date: 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 sub,iect 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 18A .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. Authorization to Construct Wastewater System (Required for Building Permit) See site plan and additional attachments ( Propose Wastewater System: 2 S `lam i-,-- t yr. Type: 3RG Wastewater Flow PC) g.p.d New Repair Expansion Soil LTA W •'Z g.p.d.= Type of Facility: k ~^a i s e- Basement: N Basement Plumbing: N HotTub/Spa: N Special Fixtures (explain): Wastewater System Requirements Tank Size: Septic Tank ~ CCU gal Pump Tank gal Grease Trap gal Drainfield: Total Area: ~7CXC) sq ft Total Length: ~400 ft Maximum Trench Depth -'tom in Trench Width 3 ft Minimum Soil Cover r in Minimum Trench Seperation ft Distribution: Distribution Box Serial Distribution Pressure Manifold LPP Other Additional Specifications: Authorized State Agent: 2G~n Date: , Permit Expiration Date: 1/2-3/2013 I have read and accept the specifications aMconditions tas in 'cater Owner or Legal Representative Signatur Date: a Form B r':\ridem... kV.muVWLSunn. mr 1 / CATAWBA COUNTY 3yn- Case # WLS2008-00100 Public Health Htment Subdivision FOREST PARK DEVELOPME. Environmental l He.ililth Divi§ion 3-4 W-1 PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Sect/BL/Ph/Lot # ' (828) 465-8270 FAX (828) 465-8276 TDD (828) 465 8200 PIN# 364913033036 Applicant /Owner: MICKEY SHEPPARD Site Address: 1998 BROOKSIDE AV NEWTON NC Property size: SF 1 ACRES Directions: "Revised 1/9/08: Need well/ Cannot hook onto city water" / 321 S TO LT ON LAKEVIEW DR/ LT ON BROOKSIDE/ LOT ON RT WELL PERMIT Proposed Use: Private Public Semi-Public Other GROUTING DEPTH: MINIMUM 20 FEET SETBACKS: I. BUILDNG FOUNDATIONS 25 FT. 5. UNDERGROUND STORAGE TANKS 100 FT. 2 EXISTING & PROPOSED SEPTIC SYSTEMS - MIN. 50 FT. 6. STREAMS/BROOKS/CREEKS 50 FT. 3. EXISTING & PROPOSED SEPTIC REPAIR AREA - MIN. 50 FT. 7. LAKES/PONDS RESERVOIRS 50 FT. 4. SEWAGE PUMP SUPPLY LINE 50 FT. ALL OTHER POSSIBLE SOURCES OF GROUND WATER CONTAMINATION 100 FT. The well driller must verify all sepearations are adhered to before drilling the well. If the well driller is unable to maintain any of the above separations, contact the Health Department at (828) 465-8270 before drilling the well. SEE SITE PLAN FOR PERMITTED WELL LOCATION By. Permit Issuance Date: Customer Signature: WELL INSPECTION: GROUTED DEPTH: 20 DATE: 13 INITIALS: ^ APPROVED CASING: PVC ✓ STEEL / DATE: I /of( INITIALS: 'L CASING HEIGHT 12" ABOVE LAND SURFACE ✓ DATE: :7 <2 -O'b INITIALS: Ern WELL COMPLETION REPORT RECEJ.VED DATE: INITIALS: WELL HEAD APPROVED DATE: '7 -,;4-0f) INITIALS: CiM 4~: Well Driller Date Drilled Weil permits are valid for 5 years from the date of issuance and are subject to suspension and/or revocation fro non-compliance with appropriate state and local rules and regulations, or if false information was given in order to obtain a permit. Wells shall be constructed in accordance with all state and local regulations and rules. The Well Completion Report must be submitted to the Health Department within 30 days upon completion of a well. A I 1A , kll_ -1 - d- 0 -0,6 Authorized State Agent Final Approval Date Form D r.\Tidet?ici/(.'\FonnsVtVLS(IUU. mi CATAWBA COUNTY Case Health Drparunent # WLS2008-00100 Environmental Hcalth Division Subdivision FOREST PARK DEVELOPME. PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Sect/BUPII/Lot # 3-4 \J ~ i' (828) 465-8270 FAX (828) 465-8276 TDD (828) 465-8200 PIN# 364913033036 Applicant/Owner MICKEY SHEPPARD Site Address: 1998 BROOKSIDE AV NEWTON NC Property Si SF 1_ ACRES Directions: "Revised 1/9/08: Need well/ Cannot hook onto city water" / 321 S TO LT ON LAKEVIEW DR/ LT ON BROOKSIDE/ LOT ON FIT ® Improvement Permit ® Authorization To Construct 0 Well Permit SITE PLAN Wlo t~ 1 F2 it Y\e 7ZS, ` L \ >e 0 ~j~- m v57 rJ ~r I e-cz \00 IC)` weA ~G/~t 5or~ - Sot w~ a~t~ SeP~Z arecc -5' gr-ov -t f r-o.e - r IrK c 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. 1-130 Zo 83 Z-9-- ya'o Authorized State Agent Date Form C rATidenmrAFornuNIVLSmm. r'nl