HomeMy WebLinkAboutIMPV-08-2022-178326.TIF �$• • CATAWBACOUNTY Case# IMPV-08-2022-178326
• l 2 Public Health Department Subdivision
Q . Environmental Health Division P1N# 376301098838
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 3
Site Address: 5376 RIVERBEND RD, CLAREMONT NC 28610
Name on Permit: PAUL EXON
Property Size: Acres 1.90
Directions: NC 16, right onto River Bend Rd, property on the right
Owner/Authorized Representative Acknowledgement of Permit Receipt
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-07-2022-41777, by the following method(s):
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: 08/22/2022
Owner/Authorized Representative Signature
' 4° Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Date/Time ''I)(sI2 2
Method: Fax V 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 yoiPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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08/23/2022 16:03 ��
e CATAWBA COUNTY Case# IMPV 08 2022 178326
Public Health Department Subdivision
Environmental Health Division PIN# 376301098838
PO Box 389,25 Government Drive,Newton,NC 28658 LOTH 3
Site Address: 5376 RIVERBEND RD, CLAREMONT NC 28610
Name on Permit: PAUL EXON
Property Size: Acres 1.90
Directions: NC 16, right onto River Bend 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 360 g.p.d
Type of Facility: Primary Residence-SFD
Basement? No Basement Plumbing? No Bedrooms: 3
Water Supply: Private Well Maximum Occupants: 6
INITIAL SYSTEM SPECIFICATIONS
Proposed Wastewater System: 25% REDUCTION
System Classification: IIIG-OTHER NON-CONY TRENCH SYSTEMS
REPAIR SYSTEM SPECIFICATIONS
Repair System Required? Required
Proposed Wastewater System: 25%REDUCTION
System Classification: IIIG-OTHER NON-CONY TRENCH SYSTEMS
Permit Conditions: 'DO NOT CUT OR FILL OVER SYSTEM AREA
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 I8A 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.
Dec, E-r4H s
08/22/2022
Authorized State Agent Permit Issuance Date
8/22/2027
Permit Expiration Bate
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
cl ipei mit 08/23/2022 15:03
,' Catawba County Environmental Health
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This map/report product was prepared from the Catawba County,NC Genepatal Information Services. Catawba County has made substantial efforts
go ensure the accuracy of location and labeling Information contained on this map or data an this report Catawte County promotes and recommends
the independent vrtfieation of any date contained on Via map/report product by the user.The County of Catawba,its.employees.agents,end
personnel,discIalmt and than not be held liable for any and all damages,toss or tlabaly.whether died,Indirect or consequential which arises or may
arise from this map/report product or the use thereof by any Copyiperson 2or 021 Catawba Gounty NC
08/2212022
DE'ARTMFNT OF E' AIRMEN- AND NATURAL RESOURCES Shu!I of
DWYLS1DN OF E VI RONMFNTAL HEALTH PROPERTY ID#:
.ON-SITE WASTEWATER SECTION COUNTY:
SOIL/SITE EVALUATION (.44r,k4
I I(�r ON—S�3EWASTEWATER SYSTEM J(I;376. z,09., 3�
OWNER (.)Ct r APPLICATION DATE •
ADDRESS: DATE EVALUATED:
PROPOSED FACILITY: PROPOSED DESIGN FLOW(A 949): PROPERTY SIZE:
LOCATION OF SITE: PROPERTY RECORDED:
WATER SUPPLY: 0 Private 0 PubGo 0 Well 0 Spring 0 Other
EVALUATION METHOD: 0 Augcr Boring 0 Pit 0 Cut -
TYPE OF WASTEWATER: 0 Sewage 0 Industrial Process 0 Mixed •
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Catawba County Environmental Health
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This map/report product was prepared from he Catawba County,NC Geospatial Inbmutlon Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling Information contained on this map or data a t ihb 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,lou or Ilahaity,whether dired.Indirect or consequential which arises or may
arise from this maprreport product or the use thereof by any person or entity.
Copyright 2021 Catawba County NC
08/22/2022
Catawba County Environmental Health
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This map/report product was prepared from the Catawba County,NC Qeoepntlal Information Services, Catawba County has made substantial efforts
to ensure the accuracy of location and labeling Information contained on INS map or data on this report,Catawba County promotes and recommends
the independent verification of any data contained on ViLi rmp/report product by the user,The County of Catawba.Its employees,agents,end
personnel,disclaim and shall not be held liable far any and all damages,loss or rrabtilty,whether direct,Indirect or consequential which arises or may
wise from this map/report product or the use thereof by any person or entity.
Copyright 2021 Catawba County NC
08/22/2022