HomeMy WebLinkAboutAUTH-3-10-5497.TIF
G~ Anna Jenkins
v 2131 SE 5 Av, Hickory
1842 sM
Owner/Authorized Representative Acknowledgement of Permit Receipt
0~1 I certify that I am the owner or authorized agent (owner's authorization required) representing the owner of
the property described above.
'`P As the property owner or authorized representative, I have received the above referenced permit(s)
as requested in the application for service EHPR-2-10-3963 , by the following method(s):
j Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/ E-mail (Return receipt required)
"?i' 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 AILD110
Owner/A thori ed Representative Signature
Date 3 17 X10
1
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.
~g CATAWBA COUNTY Case # AUTH-3-10-5497
Public Health Department Subdivision
d Environmental Health Division
s PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Lot #
I w PIN# 371212867844
Applicant/Owner ANNA JENKINS
Site Address: 2131 SE 5TH AV, Hickory, NC
Property Size: SF 0.389 ACRES
Directions: FROM HWY 70 TURN RIGHT ONTO SWEET WATER RD, GO TO 5TH AV SE TURN RIGHT. HOUSE IS 1 ST HOUSE
ON LEFT.
Authorization to Construct Permit
Authorization to Construct Wastewater System (Required for Building Permit)
* See site plan and number of additional attachments
Proposed Wastewater System: 25% REDUCTION Wastewater Flow 240 g.p.d
Type: IIIG - OTHER NON-CONY TRENCH SYSTEMS
Soil LTAR: 0.35 g,p.d./ft2
Permit Category: Repairs
Type of Facility: House
Basement? No Basement Plumbing? No Bedrooms: 2
Wastewater System Requirements
Tank Size: Existing Tank 810 gal Pump Tank gal Grease Trap gal
Dosing Volume gal Pump Specs: GPM @ TDH
Pressure Head ft Draw Down in
Drainfield: Total Area: 514 sq ft Total Length: 170 ft Maximum Trench Depth 30 in
Aggregate Depth in Trench Width 3 ft
Minimum Soil Cover 6 in Minimum Trench Separation 9 ft on center
Number of Drain Lines 3
Distribution: Distribution Box
Additional Specifications:
Proposed Repair
System Class: Proposed System: Distribution Type::
Soil LTAR: g.p.d.M2
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
Authorization to Construct Permit is subject to revocation if the site plan, plat or the intended use changes, or if site conditions are
altered. The Authorization to Construct 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.
Megen McBride 03/16/2010
AUTHORIZED STATE AGENT APPROVAL DATE
Permit Expiration Date: 03/16/2015
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
03/17/10 10:01
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DEPARTMENT OF ENVIRONMENT AND NATURAL RESOLMM Shed _ cj
DIVISION OF ENVIRONMENTAL HEALTH PROPERTY ID
ON-SITE WASTEWATERSECTTON COUNTY:
SOIIJSITE EVALUATION
for ON-SITE WASTEWATER SYS~TEM
oWNHR: 1'10 t 12X~ ~hS APPLICATION DATE_24- 1' 0
ADDRESS: DATE EVALUATED:
PROPOSED FACQ.ITY: 2- U PROPO IP DESIGN FLOW (.1949): 2- PROPERTY SIZE: Q.
LOCATION OF SITE: 2f A ue.. t ll cKo r Y PROPERTY RECORDED:
' g other
prin
WATER SUPPLY: Private Public wen S
EVALUATION METHOD:- Auger Boring 0 Pit U Cut
TYPE OF WASTEWATER: ~ Sewage D Industrial Process 0 Iv med
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DESCUPTION SYSTEM P-EPAIIt SYSTEM OTHER FACTORS (.1946):
Available Space (1945) SITE CLASSIFICA.7? (.19A21-
419t= Type(s) EVALUATED BY:
OTHER(S) PRESENT:
Site LTAR .3
COMMENT'S:
LEGEND
use the fo&wink- standard abbreviadons $
SOIL CONVENTIONAL LPP IAU%TSALDGY/
LANDSCAPE POSITION GROUP , TOM ME .I9SS LTAR* .IM LIAR' CONSISTENCE -MUC!'[1RE
a (Concave Slope) • I S (Sand) U-0.8 0.6.O.4 NF.)D' 04=-ncpa O) G (Si gk Gam)
CV (Cnnva Slope) LS (Iaamy Sand) SM (Slightly Egmmi-) M (Masalve)
D (Dune xy) F3~ ) CR (Cmmb)
DS (Dcbms M-p) 11 SL (Saody.Loam) 62-0.6 OA - 0.3 GR (Gm=h4
FP (Food Pbb) L(Loam) SBK (SnbmgdaBlo d y)
FS (Foot Slope) ABK (Anpnlar Blocky)
8 NOW Sk") III SCL (Sandy Clay Loam) 0b - 03 03 - 0.15 PL (Platy)
L (Linmr Sbipe) Sit (SLTt Loam) PR (xiz~)
N (Nme She) CL (Clay Loam)
R (R;dgO SiCL (-lk MY Loam) ZO W"
S (9- ida Slope) Si (SM) .
T (Tc=&=) VFR(VWYF NS0' ~
IV Sc (Sandy clay) 0.4-0.1 02-0m FL M&Mc) SS (99W mdrli
sic (may Clay) FT (Fa-) S (sdda)
C (flay) vat Nay Fm V. Vvy Sdcky) VS (verWWI
O (Org mic) Name EM mz-mdy Fiala riP O~ea plado)
SP MO* Ph9W
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