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~g CATAWBA COUNTY Case # IMPV-3-10-5499
Public Health Department Subdivision
d Environmental Health Division DEERFIELD 4
? PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Lot # 49
~s PIN# 268902798192
Applicant/Owner CALIN SERAZ
Site Address: 1347 SHADOWFAX WYND, Hickory, NC
Property Size: SF 1.07 ACRES
Directions: HWY 127 S - TURN RIGHT INTO DEERFIELD - TURN RIGHT ONTO SHADOWFAX WYND - PROPERTY ON LEFT
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: Well Type: Individual Well
Basement? No Basement Plumbing? No
Proposed Wastewater System: 25% REDUCTION
Type: IIIG - OTHER NON-CONV TRENCH SYSTEMS
Proposed Repair: 25% REDUCTION i P u m P f Qqu~~ t'd
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
Megen McBride 03/17/2010
AUTHORIZED STATE AGENT APPROVAL DATE
Permit Expiration Date: 03/17/2015
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
03/17/10 10:59
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Calin Seraz
V 1347 Shadowfax Wynd, Hickory
I84 sM
Owner/Authorized Representative Acknowledgement of Permit Receipt
63 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 EHPR-3-10-4101, by the following method(s):
CS 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 .34-711D
~--Owner/Authorized Representative Signature CffG~~Ci SERA6 i
(-/Date3 17 a o t'o
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.
DEPARTMENT OF EN UONMENI' AND NATURAL RESOURCES Sheet _ oj•_
DIVISION OF ENVIRONMENTAL HEALTH PROPERTY ID
ON-SITE WASTEWATER SECTION COUNTY: t.
SOMSTTE EVALUATION
for ON SITE WASTEWATER SY M
8 L~~ I w `~rJ4ra2. APPLICATION DATE ID
ADDRESS: DATE EVALUATED: i3 ` ' a
PROPOSED FACII ITY: o'J'L PROPOSED DESIGN FLOW (.1949): 10D PROPERTY SIZE: ( •57 lw
LOCATION OF SITE: 13117 S6')) , - I t-,c2y W 1iryl PROPERTY RECORDED:
WATER SUPPLY: 0 Private 0 Public V Well Spring d Other
EVALUATION METHOD: 0 Auger Boring Pit 0 Cut
TYPE OF WASTEWATER Sewage 0 Industdd Process 0 Wixe:d
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DESCRErMN DMIAL SYSTEM KWAIR SYSTEM OTHER FACTORS (.1946):
Available Space (1945) PS SITE CLASSIFICATION (.19488)):,
Tys) f J EVALUATED BY: I '~Pf`l f ' ~`1
Syst= OTHER(S) PRESENT,
She LTAR . 3 3
COMMENTS:
LEGEND
use the bHowin,L., standard abbreviations
LANDSCAPE POSITION SOIL, CONVENTIONAL LPP 1dIA(ERAIAGY/
GROUP .1955 LTAR* .1951 LIAR' CONSISTENCE
STRUCILRF
CC (Concave Slope) 1 S (Smd) 12'• 0.8 0.6-0.4 NFXP
(Ilan ezpaa an
D G (Singk Cmm)
(Guava Slope) ve) M (~+ve)
~e Way) (may F.~ SEXP (Stigbdy l?si ri
l) II LL( a) Loam) 0.9-0.6 OA-03 ( ) GR(~
FS (Foot SITC) SRK(SrrbaWd_131oc>;y)
H (Heed Slope) III SCL (Sandy clay Loam) 0.6-03 03 - 0.15 (Angd may)
L gin- MW) SS (Silt Loam) moo) (Platy)
N (Nose Slope) CL (Clay Loam)
S (Shoup Slope) ~ ( Clay Loma) O S W_ FT
T (Terrace) &I )
IV Sc VFR(V=yFriebk) DtS(Y)
(~d9 ~Y) 0.4-0.1 02- o.OS Flt (F&WC) ( ~I
Sic phy Clay) R (F-)
c (Clay) VFl (Vary Fum V. Very Sticky) vs (Vary Sri ft)
O (Organic) Nose EF1(EmmmdY Fam) iP tbPUgdc)
SP ('SEO* Phaio)
*Adjutt LIAR die to depth, Cow t m dimetare, to wetaesc, kndseape, position, wastewater now and yeardy. P (Pimio)
XXORl1.ONDEPTX h mchm brow mtuml soil sntface Nmy Plmef6c)
DEPTX OFRU la inrha from land su6m
RE4PBI=T HORIZON Tbictaea and depth fmm land cmfa
SAPRO1 m S(suit or U( )
SOIL fl''TAW hchet fmm hmd stab to fix water aT IDchs fmm land sa¢ace to soaS colors with chmmn 2 or lass - rxfud lsell color chip designation
CLrlSSZFICATION S (S%*614 PS (Provisionally Suimblej or U (Unsuitable)
Evahzdm of uprolite shall lX by pits.
Loog4= Aaxpt m= Rase (LTARr 6ya '
ro l0 6onc and other site features (dimensions, reference or benehmsrk and Nemthl.
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