HomeMy WebLinkAboutIMPV-05-2022-172069.TIF .4v%1.r',. CATAWBA COUNTY Case a IMPV-05.2022-172069
Public Health Deportment Subdivision
- Environmental health Division PINK 369904923630
PO Box 389,25 Co enunent Drive,Nev,ion,NC 28658 1.UTk
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Site Address: 6959 SHERRILLS FORD RD,SHERRILLS FORD NC 28673
Name on Permit: BRANDON BLALOCK
Property size: Acres 3.22
Directions: NC 10,right onto Murrays Mill Rd,left onto Sherrills Ford Rd,go about Smiles property on the right
Owner/Authorized Representative Acknowledgement of Permit Receipt
Idi 1 certil') that lam the of%ner or authorized agent(owner's authorization required)representing the owner of
iv
the property described ahave.
)( As the property km ncr or authorized representative.I have received the above referenced
1 permitfs)as requested in the application for service EHPR-04-2022-40687,by the following method(s):
Received in Person
T Facsimile Transmittal(Return form with signature required)
-. Electronic Image Transmittal/E-mail (Return receipt required)
jAs 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(ISA 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: 05/23/2022
Owner/Authorized Representative Signature
-7 Date -j-27-2Z
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature _ Date/Time f(D7IV
Method: Fax Email US Mail Other
Owner's request to send by the above indicated method of transmittal In lieu of signature
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+. CATAWBA COUNTY Case# IMPV-05-2022-172069
• t 1111 Public Health Department Subdivision
4, .� `1 Environmental Health Division PIN# 369904923630
PO Box 389,25 Government Drive,Newton,NC 28658 LOT#
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Site Address: 6959 SHERRILLS FORD RD, SHERRILLS FORD NC 28673
Name on Permit: BRANDON BLALOCK
Property Size: Acres 3.22
Directions: NC 10, right onto Murrays Mill Rd, left onto Sherrills Ford Rd,go about 6miles property on the right
Improvement Permit
AN AUTHORIZATION TO CONSTRUCT MUST BE ISSUED PRIOR TO BUILDING PERMITS
THIS PERMIT IS NOT FOR SEPTIC INSTALLATION
Permit Category: New Septic Wastewater Flow 360 g p d
Type of Facility: Primary Residence
Basement? No Basement Plumbing? No Bedrooms: 3
Water Supply: Public Water Maximum Occupants: 6
INITIAL SYSTEM SPECIFICATIONS
Proposed Wastewater System: 25%REDUCTION
System Classification: IIIG-OTHER NON-CONV TRENCH SYSTEMS
REPAIR SYSTEM SPECIFICATIONS
Repair System Required? Required
Proposed Wastewater System: 50%REDUCTION VERTICAL
System Classification: IIIE-PPBPS GRAVITY DOSED SYSTEM
Permit Conditions: -The septic tank for the existing house must be properly abandoned before the the new house
can be scheduled for a building final.
-Do not grade drive or fill over system or repair area.
-Lot is on public water. Water line and utilities should be kept near proposed driveway to
meet 10'setback to system.
Landscaping or other site alterations that potentially divert groundwater or surface water toward the septic system, or prevent proper
drainage away from the septic system, including the direction of gutter flows or foundation drains,is not approved and may result in failure to
approve the initial system installation,or the suspension/revocation of existing permits.
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 I 8A.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.
Any permit issued for a conventional system may be used for an accepted system without Environmental Health authorization or permit
modification.Please notify Environmental Health of this change prior to system installation.
1d)— 05/23/2022
Authorized State Agent Permit Issuance Date
5/23/2027
Permit Expiration Date
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
chpemut 05/24/2022 13:20