HomeMy WebLinkAboutIMPV-11-2022-184730.TIF !`c CATAWBA COUNTY
• .t.No Public Health Department Subdivision
Environmental Health Division PIN# 279109169936
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 1
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Site Address: 2389 MOSS FARM RD, HICKORY NC 28602
Name on Permit: TERRY GOOCH
Property Size: Acres 17.35
Directions: Hwy 127 S past 321 Hwy Right on Moss Farm RD near end of RD, Driveway w/2383 Moss Farm RD going
into property 2389 Moss Farm RD
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 RBPR-10-2022-42552,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
J
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: 11/18/2022
Owner/Authorized Representative Signature
- Date
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)1
Signature -----q----r-- Date/Time i 1 1 I I))
Method: Fax 'Email (IS Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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ehpcnnit 11/18/2022 10:II
�' CATAWBA COUNTY Case# IMPV-11-2022-184730
k ,� Public Health Department Subdivision
, Environmental Health Division PIN# 279109169936
PO Box 389,25 Government Drive.Newton,NC 28658 LOT# 1
/g 2 w
Site Address: 2389 MOSS FARM RD, HICKORY NC 28602
Name on Permit: TERRY GOOCH
Property Size: Acres 17.35
Directions: Hwy 127 S past 321 Hwy Right on Moss Farm RD near end of RD, Driveway w/2383 Moss Farm RD going
into property 2389 Moss Farm RD
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 240 g.p d
Type of Facility: Accessory Structure-Barn with Kitchen and full bathroom
Basement? No Basement Plumbing? No Bedrooms:
Water Supply: Public Water Maximum Occupants:
INITIAL SYSTEM SPECIFICATIONS
Proposed Wastewater System: CONVENTIONAL
System Classification: IIA-CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS)
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: ADO NOT GRADE OR FILL OVER SEPTIC 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 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,
5.40.1
11/18/2022
Authorized State Agent Permit Issuance Date
11/18/2027
Pennit Expiration Date
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
ehpcnnit 11/29/2022 15:53