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.0 ' CATAWBA COUNTY Case# IMPV-II-2022-184357
F.7: .i.II Public Health Department Subdivision LEELAND TERRACE
< ±-‘ '1 Environmental Health Division PIN# 375114345628
PO Box 389,25 Government Drive,Newton,NC 28658
'I. w LOT# 24
Site Address: 1995 LAKESIDE LN, CONOVER NC 28613
Name on Permit: WILLIAM COSGROVE
Property Size: Acres 3.74
Directions: 321 N Bus, righto onto W 20th St, road chages to S McLin Creek Rd, right onto Emmanuel Ch Rd, left onto
Keisler Rd SE, left onto Lakeside Ln, lot on the left
Owner/Authorized Representative Acknowledgement of Permit Receipt
X _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-09-2022-42290,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
7 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: 11/14/2022
Owner/Authorized Representative Signature
Date
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name ofperson sending permit)
II1tI ISignature Date/Time '
ii sf 1 Z
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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CATAWBA COUNTY Case 4 IMPV-I I-2022-184357
Public Health Department Subdivision LEELAND TERRACE
0, .1.1 )4Environmental Health Division PINT! 375114345628
PO Box 389,25 Government Drive,Newton,NC 28658 LOTH 24
Site Address: 1995 LAKESIDE LN, CONOVER NC 28613
Name on Permit: WILLIAM COSGROVE
Property Size: Acres 3.74
Dlrectlor►s: 321 N Bus,righto onto W 20th St, road chages to S McLin Creek Rd, right onto Emmanuel Ch Rd, left onto
Keisler Rd SE, left onto Lakeside Ln, lot on the 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-SFD
Basement? No Basement Plumbing? No Bedrooms: 3
Water Supply: Public Water Maximum Occupants: 6
INITIAL SYSTEM SPECIFICATIONS
Proposed Wastewater System: 25%REDUCTION
System Classification: IIIB-SYSTEM W/SINGLE EFFLUENT PUMP
Pump Required
REPAIR SYSTEM SPECIFICATIONS
Repair System Required? Required
Proposed Wastewater System: 25%REDUCTION
System Classification: IIIB-SYSTEM W/SINGLE EFFLUENT PUMP
Pump Required
Permit Conditions: *DO NOT CUT OR FILL OVER SEPTIC AREA
*THE SEPTIC SUPPLY LINE WILL NEED TO BE BORED AT LEAST 5FT UNDERNEATH
THE CREEK THAT FEEDS THE POND.
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 aooroved,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.
E04."s
11/14/2022
Authorized State Agent Permit Issuance Date
11/14/2027
Permit Expiration Date
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
11/15/2022 09:40