HomeMy WebLinkAboutOP-09-2022-179231.TIF (= � CATAWBA COUNTY Case;t OP-09-2022-179231
i:r .j,� Public I lealds Department Subdivision
�.,
4 Environmental health Division PINtf 277004519593
PO Box 389,25 Government])rive,Newton,NC 28658 LOTH
1_ sr.
Site Address: 4083 OLD SHELBY RD, HICKORY NC 28602
Name on Permit: TONY VAN HORN
Property Size: Acres 3.37
Directions: 1 1/2miles past Advent Crossroads on Old Shelby Rd, 2nd house on the right before Faith Olive Baptist
Church going toward cooksville
Operation Permit
Permit Category: Repairs Wastewater Flow: 240 g.p,d.
Type of Facility: Primary Residence-Repair
Basement? No Basement Plumbing? No Bedrooms: 2
Water Supply: Private Well Maximum Occupants: 4
System Type: IIIG -OTHER NON-CONV TRENCH SYSTEMS
Description: LOW PROFILE CHAMBER
System Code: IQ4PLP System Code Description: Infiltrator Quick 4 Plus Low Profile
Types V and VI systems expire in 5 years.
Owner must contact Environmental Health 6 months prior to expiration for permit renewal.
System Installation Comments: *NEW 1000GAL SEPTIC TANK
GST 1000 STB-160 6-20-22
PERMIT CONDITIONS:
1.All maintenance, monitoring,&performance requirements shall be in accordance with 15A NCAC 18.1900, Rule.1961
2. Operation& Maintenance Specifics: 'PUMP SEPTIC TANK AND CLEAN FILTER EVERY 2
YEARS
Subsurface system operator required? Yes_ No_X_
This system has been installed in compliance with applicable NC General Statutes,Rules for Sewage Treatment and Disposal.
COLE LEATHERMAN#3769 09/02!2072
System Installer Installation Date
efl.............„.--- -'Deq,, E,4•+s
09/02/2022
Authorized State Agent Permit Issuance Date
Form F
i.1,ml o9.14/2022 I5:09
,
r.,.........—, Catawba County Envirorimantai Health
123.80 o P .. ..-c2Oaral 179 a 31
io„62
\ y
♦ `l� ,1
V, 1
1�
s14.d 0°'`-
.4083
- Weil •
.41t:i
Syr 't
0
;tt o�Z-
s�r , ," 53.40
cS`o, e f 0„0
w
1/s
$ .4080
r:
N
Parcel;277004519593, 4083 OLD SHELBY RD 1 in=50ft
HICKORY,28602
Tres mapirapod product was prepared from the Catawba County,NC aeo,patW Information Services. Catawba County has made substantial efforts
to enom the acaracyof location and labonq infonrtation confatnad on true map or data on this report,Catawba County promotes and recommends
the independent verification of any data confautad on hats maplroport product by the user.The County of Catawba.Its employees,agents,and
personnel,dtadalm and shail not be head Itsbie for any and aG damages,Zoos or liability,whether direct,Indirect or consequential NYhich arises or may
arias from this meplreporl product or the use thereof by any pawn
2Q21 entity.
wba County NC
09r02n022