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4j6,:larva CATAWBA COUNTY Cased AtfU1-09-2022-181312
ill1-Ng Public Health Department Subdivision
.� Environmental Health Division PINd 278002677899
PO Box 389,25 Government Drive,Newton,NC 28658 I.016
Site Address: 6367 MOUNTAIN GROVE RD, HICKORY NC 28602
Name on Permit KATELYNN DANIEL
Property Size: Acres 1.11
Directions: Hwy 127,turn on Mountain Grove Rd,driveway on left at Brookford Cemetery, Follow gravel dr property at end
Owner/Authorized Representative Acknowledgement of Permit Receipt
1er4 certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
POAs the property owner or authorized representative,shave received the above referenced
permit(s)as requested in the application for service RBPR-03-2021-37192,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
IADDAs 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 I8A.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:09/28/2022
V
Owner/Authorized Representative Signature _ ____ _
Date Toak,ga.......
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature --jlYr-1 Date/Time I3oj)J
Method: Fax J Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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rLprnurt 09,28,2022 16 38 1• `
CATAWBA COUNTY Case# AUTH-09-2022-1 8 1 3 1 2
f."C' Public Health Department Subdivision
'" Environmental Health Division PIN# 278002677899
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PO Box 389,25 Government Drive,Newton,NC 28658 LOT#
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Site Address: 6367 MOUNTAIN GROVE RD, HICKORY NC 28602
Name on Permit: KATELYNN DANIEL
Property Size: Acres 1.11
Directions: Hwy 127,turn on Mountain Grove Rd,driveway on left at Brookford Cemetary, Follow gravel dr property at end
Authorization to Construct Permit
Permit Category: New Septic Wastewater Flow: 360 g.p.d.
Type of Facility: Primary Residence-New House
Basement? No Basement Plumbing? No Bedrooms: 3
Water Supply: Public Water Maximum Occupants: 6
Soil LTAR: 0.275 g.p.d.Ift2
WASTEWATER SYSTEM REQUIREMENTS
Proposed Wastewater System: 25% REDUCTION
System Classification: IIIG-OTHER NON-CONY TRENCH SYSTEMS
Septic Tank: New Tank: 1,000 gal
Pump Tank _gal Grease Trap_gal
Dosing Volume gal Pump Specs: GPM @ TDH
Pressure Head ft Draw Down in
Drainfield: Total Area: 990 sq ft Total Trench Length: 330 ft
Aggregate Depth: in Maximum Trench Depth on Downhill Sidewall: 30 in
Minimum Soil Cover: 6 in Minimum Trench Separation: 9 ft on center
Number of Drain Lines: 6 Trench Width: 3 ft
Distribution: Serial
Pre Treatment: NONE
Additional Specifications:
-Do not drive,grade,cut or fill over any part of the initial or repair septic areas.
-Install new 1000 gal septic tank and 330 feet of 25% reduction product according to manufacturer
specifications.
-All parts of the septic system area MUST be 6 feet from porch, 15 feet from paved drive(due to ditch), 15 feet
from right property line(due to ditch),and 10 feet from water line.
-Property corner pins must be uncovered and visible, and property lines strung prior to the septic installation.
-See site plan for drainage ditch and water line details.
See also attached site plan.
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.
>>>>> Do not install system under wet conditions <<<<<
PROPOSED REPAIR
Repair System Required? Required Soil LTAR: 0.25 9•P•d.lft2
Proposed System: 50%REDUCTION HORIZONTAL
System Classification: IVA-ANY SYSTEM WITH LPP DISTRIBUTION
Pump Required ***** Operator Required
ehpermit 09/29/2022 15:27
%� CATAWBA COUNTY Case# AUTH-09-2022-181312
•
fy .t•` ,� Public Health Department Subdivision
„ -_J Environmental Health Division PIN# 278002677899
PO Box 389,25 Government Drive,Newton,NC 28658 LOT#
Site Address: 6367 MOUNTAIN GROVE RD, HICKORY NC 28602
Name on Permit: KATELYNN DANIEL
Property Size: Acres 1.11
Directions: Hwy 127,turn on Mountain Grove Rd,driveway on left at Brookford Cemetary, Follow gravel dr property at end
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 Authorization to
Construct Permit is subject to revocation if the site plan,plat or the intended use changes,or if site conditions are altered.The Authorization to
Construct 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'Levu s 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.
3rt (1176 .
09/28/2022
Authorized State Agent Permit Issuance Date
7/6/2026
Permit Expiration Date
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
ehpcnnit 09/29/2022 15:27
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