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y��� CATAWBA COUNTY _._ ...
�f .j-I� Public Health Department Subdivision
�..� Environmental Health Division PIN# 366803049853
11 PO Box 389,25 Government Drive.Newton,NC 28658 LOTb
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Sits A-dress: 2852 N OLIVERS CROSS RD, NEWTON NC 28658
Name •n Permit: PEDICINO CONSTRUCTION LLC
Props Size: Acres 0.82
Direct•ns: Hwy 16 South, Right on Providence Mill RD, Left on North Olivers Cross RD, Property on Left
Owner/Authorized Representative Acknowledgement of Permit Receipt
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I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
�r he property described above.
/�, As the property owner or authorized representative, I have received the above referenced
r rmit(s)as requested in the application for service RBPR-08-2022-42004,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 1 have reviewed and understand the specific conditions
pf 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 ISA.1900),
and/or Well Construction Standards(15A NCAC 2C.0140), shall apply to the issuance of this permit and
the construction of the wastewater system and/or water supply well permitted.
Permit Issue Date:09/30/2022
•wner/Authorized Representative Signature �..+. `-'""�1'—
1 Date i ;/i/.2
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature 1if t..- Date/Time io'i i/Z"_
Method: Fax I 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 yoiPiease ttake a few moments tto complete our customer service survey att
http://wi.vw.surveymonkey.com/s/EHCusttomerService
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CATAWBA COUNTY Case# IMPV-09-2022-181513
;Q' f. ,1 Public Health Department Subdivision
Q „ O 4, Environmental Health Division PIN# 366803049853
PO Box 389,25 Government Drive,Newton,NC 28658 LOT#
Site Address: 2852 N OLIVERS CROSS RD, NEWTON NC 28658
Name on Permit: PEDICINO CONSTRUCTION LLC
Property Size: Acres 0.82
Directions: Hwy 16 South, Right on Providence Mill RD, Left on North Olivers Cross RD,Property on Left
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
Basement? No Basement Plumbing? No Bedrooms: 3
Water Supply: Public Water 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: 50%REDUCTION VERTICAL
System Classification: IIIB-SYSTEM W/SINGLE EFFLUENT PUMP
Pump Required
Permit Conditions:
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 I Icalth 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 Pennit
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/r 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.
09/30/2022
Authorized State Agent Permit Issuance Date
9/30/2027
Pennit Expiration Date
No grading or construction activity is allowed in arras designated for system and repair without approval of the Health Department.
chocrmit 10/11/2022 13:04
DEPARTMENT OF HEALTH AND HUMAN SERVICES Sheet—_of--
DMSION OF PUBLIC HEALTH,ENVIRONMENTAL HEALTH SECTION PROPERTY ID e:
ON S=WATER PROTECTION BRANCH COUNTY:_Catawba
SOUdS=TE EVALUATION
for ON-SITE WASTEWATER SYSTEM
( all fields is ibB)
OWNER:__TEC).1 C. (!1O 11 1 � . ►?9 rt L(L.C _ APPLICATION DATE
ADDRESS: DATE EVALUATED:
PROPOSED FACILITY: O�OSBD DESIc��t,oW(.I PROPERTY StZE:
LOCATION OF SITE: ,41 0 Alfe15 C fdi Is PROPERTY RECORDED:
WATER SUPPLY: 0 Private 0 Public 0 Well D Spring ❑Other
EVALUATION METHOD: ❑A > Boring ❑Cut TYPE OF WASTEWATER Q'Sewage 0 induatrlal Process °Minted
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ossourriobt DJtTUL sYSIEM REP 1 a. OTHER FACTORS(.19445):
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ST1E CLASSIFICATION(.1948)
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COMMENTS:
Updated Foe en 2014