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CATAWBA COUNTY Case # IMPV-3-10-5345
G Public Health Department Subdivision
Q Environmental Health Division
PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Lot # 1&2
1 PIN# 364809166610
Applicant/Owner BEVERLY ANN BRYAN
Site Address: 2643 S US 321 HWY, Newton, NC
Property Size: SF 1.269 ACRES
Directions: US BUS HWY 321 S/ LOT 1 ON CORNER OF 321 AND DIXIE ST
Improvement Permit
Permit Valid: Expires In Five Years: _X_ No Expiration:
Facility: House
Permit Category: New Septic Bedrooms 3
Projected Daily Flow 360 g.p.d
WATER SUPPLY: Public Water Type: County/City/Township Water
Basement? Yes Basement Plumbing? Yes
Proposed Wastewater System: 25% REDUCTION
Type: RIG - OTHER NON-CONV TRENCH SYSTEMS
Proposed Repair: 25% REDUCTION
Permit Conditions:
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 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
Luke Sears 03/11/2010
AUTHORIZED STATE AGENT APPROVAL DATE
Permit Expiration Date: 03/11/2015
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
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G CATAWBA COUNTY
Public Health Department tt
Environmental Health Division Section/BUPh/Lot#
PO Box 389, 100A Southwest Blvd, Newton NC 28658 PIN#
I g 4 2 SM (828) 465-8270 Fax (828) 465-8276 TDD (828) 465-8200
A licant/Owner
Site Address:
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
Environmental Health Section
Owner/Authorized Representative.Signature
Date
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Date/Time
Method: Fax Email 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.