HomeMy WebLinkAboutIMPV-08-2022-177624.TIF ,
fr a CATAH BA COUNTY Case', I M PV-08-2022-171624
Public Health Department Subdivision'a'� Environmental health Division PINN 470001098048
PO pus JS?,25 Government Drive.Newton,NC 28658 LOIN 2
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SRa Addrasa: 1657 BROWN CHAPEL RD, CATAWBA NC 28609
Name on P.rmlt JARROD 8 SHANON ADAMS
Property Slza: Acres 1.019
Dtnct1onc NC-10.right onto Hudson Chapel Rd,right onto Brown Chapel Rd,property on the right
Owner/Authorized Representative Acknowledgement of Permit Receipt
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-05-2022-41184,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
VElectronic 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:08/11/2022
Owner/Authorized Representative Signature
Date cb I Vk. #2
---------------
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (oanre of person sending permit)
j-i—
Signature _ Date'Tirnc 0 Ii g)7Z
Method: Fax J Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from yor.Please ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.corn/s/EHHcusttomerServlce
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AV)s . CATAWBA COUNTY Case# 1MPV-08-2022-177624
r, t Public Health Department Subdivision
d . c ,-1 Environmental Health Division PIN# 470001098048
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 2
8. sw
Site Address: 1657 BROWN CHAPEL RD, CATAWBA NC 28609
Name on Permit: JARROD&SHANON ADAMS
Property Size: Acres 1.0
Directions: NC-10, right onto Hudson Chapel Rd, right onto Brown Chapel Rd, 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 480 d
9.P.
Type of Facility: Primary Residence
Basement? No Basement Plumbing? No Bedrooms: 4
Water Supply: Private Well Maximum Occupants: 8
INITIAL SYSTEM SPECIFICATIONS
Proposed Wastewater System: 50%REDUCTION VERTICAL
System Classification: IVA-ANY SYSTEM WITH LPP DISTRIBUTION
Pump Required ***** Operator Required
REPAIR SYSTEM SPECIFICATIONS
Repair System Required? Required
Proposed Wastewater System: DRIP IRRIGATION
System Classification: VA-SAND FILTER PRETREATMENT
Pump Required ***** Operator Required
Permit Conditions: *Do not cut, drive, fill, or grade over septic or repair areas.
*This is an improvement permit only and is not intended for septic installation purposes.
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 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.
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.
1 -,; ---,.... 6,..5,......7
08/11/2022
Authorized State Agent Permit Issuance Date
8/11/2027
Permit Expiration Date
No grading or construction activity is allowed in areas designated far system and repair without approval of the Health Department.
Ai,,n.t 08/22/2022 IG27