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HomeMy WebLinkAboutRBPR-07-2022-41631.TIF 4'%i110, THIS IS NOT A PERMIT Case# RBPR-07-2022-41631 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 18 Residential Building Plan Review-Building New EXS SYSTEM Owner *KERRY DAGENHART, 1119 38TH AVE NE,HICKORY NC 28601 H:2823272357 C:8288504567 HOME:2823272357 KSDAGENHART@CAROLINATAPE.COM NAME TO APPEAR ON PERMIT *Kerry Dagenhart SITE ADDRESS: 5096 STARTOWN RD,NEWTON NC 28658 PIN# 362812955553 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet Acres 0.95 DIRECTIONS: Hwy 10 West to Startown Rd,S toward Lincolnton approx 1 mile on Left PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: New 1 story 3 bedroom Single Family Dwelling w/attached garage w/finished bonus room; no basement; Must verify system is sized for 3 bedroom SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is"YES",then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF vacant lot EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 91x71 #OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: ehapplication 07/12/2022 14:22 Page 1 of 3 r,,,,, CATAWBA COUNTY Case# RBPR-07-2022-4 1 63 1 Public Health Department Subdivision �1. M y Environmental Health Division PIN# 362812955553 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 sm NAME ON PERMIT: (*KERRY DAGENHART), 1119 38TH AVE NE,HICKORY NC 28601 (*Keay Dagenhart) Site Address: 5096 STARTOWN RD,NEWTON NC 28658 Property Size: Square Feet Acres 0.95 Directions: Hwy 10 West to Startown Rd,S toward Lincolnton approx 1 mile on Left Completed applications are valid for a period of 2 years.Improvement Permits are valid:with complete site plan=60 months(5 years);with complete plat =without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid.An Authorization to Construct issued for septic repair is valid for 60 months(5 years).Permits may be revoked if the information on this application/site plan changes or if the intended use for the proposed facility changes.Permits may be revoked if site conditions are altered such that they effect permit conditions or installation requirements I have read this application and certify that the information provided herein is true,complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. The undersigned is th owner o the property or legal agent of the owner. Date: Signature of Applicant or Agent If you need further information or assistance please call 828-465-8270 AREA1 FEENAME DATE FEE AMOUNT Existing Tank Check Fee 07/12/2022 $80.00 TOTAL FEES $80.00 FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) ehapplicarion 07/12/2022 14:22 Page 2 of 3 Orl i • a catawba county 31 public health Application for Environmental Health Services THIS IS NOT A PERMIT Application is for: tp New Construction ❑ Existing Facility El Improvement Permit ❑Authorization to Construct ❑ ew Septic El Septic Repair/Malfunction ❑ Septic Relocation ❑ Septic Expansion Existing System Inspection or Reconnection El New Well ❑Replacement Well ❑ Well Abandonment ❑ Well Repair r Property Address F9(9 c-)}o,1'Kw_-)r\ rA 1 \o, n v 453(5 ; Acres SubdivisN .Otmmt3-zzv y r1 Lot#ci -fin(Dri 'ng irections to Pro ek 1 „Arlm/► -ci i--- r •scribe work Applicant Name ' 1g , ; f Applicant Address I ea l r III 31►1 ��673 Phone 81 i... - '1 , gi fj � !� , 1 Emailq joAot4ilinalope/dook___ Owner Name "S Ij �� - . Owner Address Can 1 PQ ij )PA- Phone Email Contractor Name Contractor Address Phone Email Name to Appear on Permit? Owner El Applicant El Contractor Who will be the Primary Contact? Owner El Applicant ❑Contractor gProposed New Construction-Residen ial ' 8 Primary Residence 6 Ne Re ' c& dition to Reside # w B o ( #4ffcct7n r? ' Project Description ,i t ail Structure Dimensions,a o cify imensio decks&porches ,V' (Choose One) ❑Basement kil Crawl Spac Slab If Basemen ere Be Water Usi fixtures ase ent ❑Yes No Retaining Wall>2' ❑ Yes 0 No .-a 416(1)1(1. Accessory Dwelling #of New :edrooms*t #of Occupants Structure Dimensions (Choose One) El Basement 0 Crawl Space 0 Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' ❑ Yes 0 No Accessory Structure(s)Describe Structure(s)Dimensions Plumbing El Yes El No Describe Plumbing Needed (Choose One) El Basement 0 Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement El Yes ❑ No Retaining Wall>2' 0 Yes El No Multi-Family Residence #of Apartments #Bedrooms per Apartment*t Total#Bedrooms in Structure*t #of Occupants Structure Dimensions (Choose One) ❑Basement ❑Crawl Space El Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' ❑ Yes ❑ No Well Construction/Abandonment/Repair Proposed Well Type El Individual Well El Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored El Dug El Unknown Well Repair Requested ❑ Yes ❑No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank?El Yes ❑No Environmental Health Catawba County Government Center, 25 Government Drive I PO. Box 389, Newton, NC 28658 Phone: (828)465-8270 I Fax: (828)465-8276 I EHAdmin@CatawbaCountyNC.gov Existing Structures on Site Describe e(4\O1 uJ Structure Dimensions - #of Bedroom * #of Occupants Basement ❑Yes 0 No Basement Plumbing 0 Yes ❑ No Existing Water Supply 14 Individual Well 0 Shared Well—Number of Connections ❑Community Well ❑County/City/Township Water Line Is a public water supply available?** grYes ❑No Commercial ❑Proposed New Construction ❑Existing/Change of Use ❑Repair Food Service Specify Type #Seats Dining Area(Sq. Ft.) #Employees per Shift #of Shifts Church #of Seats Daycare 0 Yes 0 No #of Children #of Employees per Shift #of Shifts Commercial Kitchen ❑Yes 0 No Residential Kitchen ❑Yes ❑No Daycare#of Children #of Employees per Shift #of Shifts Business/Other Specify Type Structure Dimensions • Retail Floor Space #of Employees per Shift #of Shifts • Other Information Calculated Design Flow,Commercial t (This value will be determined by EH staff) The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in question. the answer to any question is"yes",applicant must attach supporting documentation. 0 Yes No Does the site contain any jurisdictional wetlands? Yes 0 No Does the site contain any existing wastewater systems? 0 es No Is any wastewater going to be generated on the site other than domestic sewage? , Yes No Is the site subject to approval by any other public agency? Q Yes �l No Are there any easements or right of ways on this property? Describe. ' f applying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s): • '(systems can be ranked in order of your preference) ❑Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other 0 Any *Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as a bedroom and counted on all applications.The number of bedrooms will be confirmed by rooms identified on floor plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system expansion in the future. t If structure is plumbed but has no bedrooms,calculated design flow will be determined by EH Staff. ** If No,a well permit must be issued with the Authorization to Construct. RETRIP TO THE PROPERTY AND/OR SYSTEM REDESIGN WILL INCUR AN ADDITIONAL CHARGE(SEE FEE SCHEDULE) Environmental Health soil/site evaluations require digging,augering, and/or probing into the ground.Property owner/applicant is responsible for marking all underground utilities,including but not limited to:underground power,cable,telephone,gas, water lines,and irrigation systems/sprinkler systems.Catawba County Environmental Health is not responsible for damage to unmarked utilities. Completed applications are valid for a period of 2 years. Improvement Permits are valid: with complete site plan=60 months(5 years); with complete plat=without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid.An Authorization to Construct,issued for septic repair is valid for 60 months(5 years).Permits may be revoked if the information on this application/site plan changes or if the intended use for the proposed facility changes.Permits may be revoked if site conditions are altered such that they effect permit conditions or installation requirements. I have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. The undersigned is the owner of the property .r legal agent of the o ner. 6. Signature of Owner or Legal Agent A � Ali A . _8 a 'a � I 1 !� Date Printed Name of Owner or Legal Agent MaNIME111 , lair 4 Ri I I VN N 'I i3I qq fit0 C H N N N 3 O -0 II) G Z It, V = a = m goy C W a °`t 01 = C o c� A - C A z r z 5 3 g ce o 2 0 0 0 - o 0 A N / \ S� Zf / UO // \\ aZ- 8 <� z zU 1/ \ rO Q�Q c QZ a O \ zNCcw z zN /� \ to N W w NN P Z - QOi ¢p w E •¢pga / \ Zaaz >`��pp[[m / \ “ J F O ^ s. g&- / \ 9OzzLL �V c74a z�^LL / 00:) \ a,paw (2gcs r 8 r qF- w 44 Wino y/I■'w,■ 2 aF r a,z *61 w o a N / U• O VI¢ rq 0 \ •£fB w U- 0 w (n �r \ r �ra=�� (N J `` Z a ti r4, ` \\ No" \ O W 0 �„ • 'MT; �M zed ' \ �o^sliko \ LU• W tf zO ProPsed 0.0 \I,9 \ o y w 1 \ � o•5 \ apz \ °'Z \ te Q gam \ \\0- OZ„- ,J, m r 'r }LL/ Q log \ •ard \ \ Sm\Vb�. \ \ Na Q Q owz UasZ 1- .6 ali \ o \ g^O ,,_'''-co 3a :e \ w <uE ? 3g r( r'12 oad �, oN • \ -o j � ' \ o. \ ,l ¢� \ N¢<e,, \ q§ ,j' a' i VLL j NCOW L K rawK \ Mgw OWN ` l.�' _ 5 aeeyj I ,: to > % r ¢ } SW�°W�J '- Faa� 010.111 ��pP�,125 ' O a ¢ w O P.B.g4'' a re- z a N G a ��� a —� as z HppHH N _ f >7 W W r2R 5.7 x0000 aOOaa O a ,b„ a <a as< w 3 0 w ro 00 a (J2 yu cc U.W L.) Z 0 z , zcri i p wF N ga )F wp O. O. zz °c� fr a O v,z oo co W m az m �o a2 - N < �N 3 K O a a p a0 a N� K2 <2 E g2 O Fr_p V KZ O G� Ow p W ¢ y 0 w o a Q 2m o ,, c7 z F- Y m 2 Q z N Q U ❑ Q U y ¢ rz j Oc, Z m ¢ Q H V 11 r ;Ai U J W m g 2 1 wa W oa ¢ O m a n rc J Li" O(7 yy U yQ Y Q a p 8 L gib)Et' K KQay O W O_ (.9 rm U W WO KK 88 K KW yLL ce (n 2 2 a a' °1U aOK N a If, 1 a a Catawba County Environmental Health . /52 02 .5096 Olt/ J •' 2:11 cp 04 .5104 w Parcel: 362812955553, 5096 STARTOWN RD 1 in=60ft NEWTON, 28658 This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. Copyright 2021 Catawba County NC 06/15/2022 Page 1 of 1 S Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 362812955553 Owner: DAGENHARDT DENNIS WAYNE Parcel Address: 5096 STARTOWN RD Owner2: DAGENHARDT JANICE K City: NEWTON, 28658 Address: PO BOX 1750 LRK(REID): 90170 Address2: Deed Book/Page: 2474/1855 City: HICKORY Subdivision: State/Zip: NC 28603-1750 Lots/Block: / Last Sale: School Information: School District: COUNTY Plat Book/Page: Elementary School: STARTOWN Legal: PL 29-1 Middle School: MAIDEN Calculated Acreage: .950 Tax Map: 046N 01001C High School: MAIDEN Township: NEWTON School Map State Road #: 1005 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: NEWTON RURAL Zoningl: R-20 Building(s) Value: $0 Zoning2: Land Value: $12,800 Zoning3: Assessed Total Value: $12,800 Zoning Overlay: Year Built/Remodeled: / Small Area: STARTOWN Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permit Address Search for this parcel. Firm Panel #: 3710362800J If available, Building Permits for this parcel. 2010 Census Block: 2028 Septic links are not permits. 2010 Census Tract: 011702 Septic Final Permits prior to 08/2018, contact Agricultural District: Environmental Health. c, Building Details �s-�S�S 519 WaterShed: NZ t Voter Precinct: P34/Voting Map Parcel Report Data Descriptions Cie Se W C�bL_ W9t ,(Cis 6I s S List all Owners Deed History Report Assessment Report ' .j ass . eo f� � This map/report product was prepared from the Catawba County,NC Geospatial Information Services Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. ©2022, Catawba County Government, North Carolina. All rights reserved. 6/15/2022 • Julia English 4ftoard ec it Mas �1 From: Michelle Lail C,/,,B/ ) 3 , r Sent: Tuesday,June 28, 2022 2:04 PM To: Julia English Subject: RE: 5096 Startown Rd Julia, Based on DB 3753-1157,we will show Lot A in its entirety as shown on Plat 84-25.The 45' R/W (northern boundary) relocated, will not be shown until there is a deed reflecting it. We don't currently show the 45' on our maps, but do �s ow the 12' roadwa I will close it based on intent. Sorry that I coul n't assist when you called, I was in the middle of straightening out an issue. Thanks, Michelle From:Julia English Sent:Tuesday,June 28, 2022 1:52 PM To: Michelle Lail<MichelleLail@CatawbaCountyNC.gov> Subject:5096 Startown Rd Would you please take a look at the attached deed and plat to verify that property will be combined. Julia English Administrative Assistant II PO Box 389 ( 25 Government Drive, Newton, NC 28658 (828) 465-8270 office (828) 465-8276 fax httos://www.catawbacountvnc.gov/cou ntv-services/environmental-health/ We want to hear from you. Please take a minute to take our customer service survey. English Queremos escuchar de usted. Tomese un minuto para realizar nuestra encuesta de servicio al cliente. Espanol Catawba county MAKING. LIVING. IEi1ER. Confidentiality Statement:The information contained in electronic transmissions is confidential and may be subject to protection under the law,including the Health Insurance Portability and Accountability Act(HIPAA).An electronic transmission is intended for the sole use of the individual or entity to whom it is addressed.If you are not the intended recipient,you are hereby notified that any use,distribution or copying of the message Is strictly prohibited.If you received a message in error, please contact the sender immediately by replying to the e-mail and delete the material from any computer. 1 • FILED Cataihtig CO lift," ",'1r Jun 23, 2022 •.t O3:03:0O Excise Mt' t'!-Otl (M :74 INST. " 4465 DONNA. HICKS SPENCER, it i$te-o 1:i ;tri 0,_. 5.3 p 1 5.s _1 . :3 REVENUE $ NONE Recording Time, Book and Page Tax Lot No. Parcel Identifier No. Portion of 362812955553, 362812959740 & 362812979027 LRK (REID) Portion of 90170, 30114 & 30403 Verified by County on the day of by Nei • Orin bati Mail after recording to: Amber R. Mueggenburg, AMBER R. MUEGGENBURG, PLLC Post Office Box 1268, Newton, North Carolina 28658 This instrument was prepared by: Amber R. Mueggenburg, AMBER R. MUEGGENBURG, PLLC Post Office Box 1268, Newton, North Carolina 28658 Brief Description for the index Lot "A", 2.966 Acres Plat Book 84, Page 125 Does property include the Primary Residence of Grantor ? YES X NO NORTH CAROLINA GENERAL WARRANTY DEED THIS DEED made June 27, 2022, by and between GRANTOR GRANTEE Dennis W. Dagenhardt and wife, Kerry Shawn Dagenhardt and wife, Janice K. Dagenhardt Paula L. Dagenhardt Post Office Box 1750 5096 Startown Road Hickory, North Carolina 28603 Newton, North Carolina 28658 Enter in appropriate block for each party: name, address, and, if appropriate, character of entity, e.g., corporation or partnership. The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall include singular, plural, masculine, feminine or neuter as required by context. 1 3 • WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged, has and by these presents does grant, bargain, sell and convey unto the Grantee, in fee simple, all that certain lot or parcel of land situated in Newton Township, Catawba County, North Carolina and more particularly described as follows: BEING all and the full contents of Lot "A", containing 2.966 total acres, more or less, as shown on that certain plat recorded in Plat Book 84, Page 125, Catawba County Registry, reference to which is hereby made for a more complete and detailed description. THE DRAFTSMAN OF THIS INSTRUMENT DID NOT SEARCH TITLE NOR ABSTRACT TITLE TO THIS PROPERTY; THEREFORE, SHE MAKES NO CERTIFICATION NOR ACCEPTS ANY LIABILITY FOR THE CONDITION OF THE TITLE THERETO; AND IS NOT THE CLOSING AGENT. The property hereinabove described was acquired by Grantor by instrument recorded in Book 2474, Page 1855 and Book 1204, Page 642, Catawba County Registry. A map showing the above described property is recorded in Plat Book 84, Page 125, Catawba County Registry. TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the Grantee in fee simple. And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee simple, has the right to convey the same in fee simple, that title is marketable and free and clear of all encumbrances, and that Grantor will warrant and defend the title against the lawful claims of all persons whomsoever except for the exceptions hereinafter stated. Title to the property hereinabove described is subject to the following exceptions: This conveyance is made subject to restrictive covenants and easements of record, and to any and all easements and rights-of-way on location on the above-described property heretofore granted or existing in favor of any individuals, corporations, public or private associations of individuals, public utilities, and governmental agents, commissions or departments for the purpose of constructing, erecting, laying, building or maintaining any streets, roads, highways, signs, service alleys, power lines or poles, gas lines, water lines, lines for pipes or sewer lines and any and all other similar or related public or private utility service facilities or otherwise. Subject to ad valorem taxes for 2022. 2 IN WITNESS WHEREOF, the Grantor has hereunto set their hands and seals to this instrument the day and year first above written. I. G e4gy (SEAL) Dennis W. Dagenhardt (SEAL) nice K. Dagenhard STATE OF NORTH CAROLINA COUNTY OF CATAWBA I, the undersigned, a Notary Public of 1're.8ell County and State aforesaid, certify that Dennis W. Dagenhardt and wife, Janice K. Dagenhardt, Grantor, personally appeared before me this day and acknowledged the execution of the foregoing instrument. Witness my hand and official seal, this the a1'day of June 2022. AYY1,LQx • H.,,ncer&Aki (S + Notary Public `D4 g�`�6 Printed Name: Am1p y R. Huect,nbur, My commission expires: p9-o 0aa Notary ; Public 4,416104 3 • FILED AR 21.2022 10:19 nm ma • i aAGE eoolt aaow CAT A HICKS BACO 8Min 125 DONNA SPENCER ER REGISTER OF DEEDS MIST/OW 7 AC GRID(NAD 99)P.A 99-1. I:�ii J } 6 v I 0.1 i°,s93 6. e a • w 1 q�tiy' 8 p1..55.bt. Nor 111 uq 00JI gillN 4e NAm0 I. w 1*y�A 1 ji' Z0M70 ..;,joS i I P 2 i 1 S,P°pa uM M , ✓w $ ^ GU"et ,�Yq l'�M i A , M 9t.tt• .-fr• A i \ a tea' i f $_ IAA �g1'' i/(A ; `, 3 N ig4R $ M.� ,a,nsn, _ ._ _. _ ./ $aa�1 °t\ ;. 1 `pper $ 7.; \ t t x I t &I a 1 .......------". i I gg I.• ) i> c , 1 i. w I,t ,8 ll 01 i q i • I. • °' 1� � m 1, a gill 3 1 V, S �� Q� `\`f'�.� .\ J 1 4 ag lift:oi 1` t W y qy 41 - aif ', 1 pad I '�' ►* �, 2 N$ 1R I :4+,,s 4 1 s, iii e .1 s > .>:re. N o :�,., {yp, iil • e.e. " k-. �Ie IIp:- i °4. \ I 1, mei 4f IT N L .ry \; ' , ' y • 1 xq. \ Ii \ N ii' � H I \`..iv, I "Ir t?Ii11111!!!! ,..°t Ii i[ll + $ Alit!! i o it L ,-- 3 w,�'t I `.t$ :: n t.ii 21t 1 11 fit R Sp t t 1 ii r .m r.). , .11 I I iiiiiii I/111 z tit , -,_ !..,e; al il 1 i i k riiil tiflitti; i il �I.IIilllllygli� ! a 'ill 1 1 te ~ i 1 II t.,-11111illi 1 H., _ ar• .. 1 pi. ill hit ? ? � t:lii.1�il l i 1 C� b P4 0 a ?ta 1 ti3 4 .Jlp $t- °1/11i,11i' 1 i \� Z. , t tIII °1$ t Rill 11 1 say I 1 H � .�i,t a k \° .. r• y i `>. CATAWBA COUNTY HEALTH DEPARTMENT PE NEWTON, NORTH CAROLINA �0 .��� COMPLETION PERMIT FOR SEPTIC TANKS loci Iw`.k s i S Cc;lie PERMIT N° 1418 DATE : C,t4, a71yy OWNER CL;L, e �J ADDRESS 0-f , i.y ¢a l , /JJ -["1,-.� ,JVjC. BUILDING CONTRACTOR JJ SUBDIVISION A, °"' S w fr /�`�''`''. . �-' � /IFS LOCATION M, QQ,,..) �Q a� LOT # LOT SIZE c ,� BLOCK OR SECTION HOUSE ( ) MOBILE HOME (,,,)� BUSINESS ( ) OTHER ( ) FHA-VA LOAN ( ) SEPTIC TANK: (SIZE /oaf GALS) WATER SUPPLY : R NO. BEDROOMS C3. NO FIXTURES 2, INDIVIDUAL PUBLIC GARBAGE DISPOSAL UNIT:YES (-7-ff0 (c IF WELL, TYPE : BORED DRILLED DUG.:. AUTO WASHING MACHINE : YES (.�)rNO ( ) DISTANCE FROM SEPTIC TANK OR NEAREST NITRIFICATION FIELD: • G;oa SQ.FT. POLLUTION: ' ,o ' " FT. 1) NUMBER OF LINES 3 SEPTIC TANK IN/S��LLED B : 2) LENGTH AND WIDTH OF LINES A,...Z4"j{ 7a 3 PERMIT FEE $ l� a) BED SYSTEM ( CERTIFICATE OF COMPLETION BY: _ _ _.__._b.)-TRENCH_SYSTEM-..(�a/__- -� -z.--_--- - --- -- _ . �� 3) DEPTH OF STONE IN LINES /2_ REMARKS : ADEQUATE FALL (GRADE) ON: 1) BUILDING (HOUSE) SEWER LINE : YES ( .a/NO ( ) 2) NITRIFICATION LINES : - bATE INSTALLED: �u,s �� /?ey YES ( NO ( ) `�` J g� "ANK LAY UT / -,„ � \ 3 ` • / ' ` r70 `>4 3 , H %, -1 1 v z MI ' H • 0 i I HEALTH DEPARTMENT COPY • 4. - \