HomeMy WebLinkAboutIMPV-12-2022-186612.TIF .-, ('A'I'AWItA(MINTY
Public health Department Sulkh+•Isnin LEELAND TERRACE
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i lin+uonn,ental ll ,llth Ihv„u'I, I'lN 375110454295
PO Ros 38').25 Gn+enuncnt I)nae.Ne+o m.N(' 2U(58 Lott 53-56
Slte Address: 2393 SHADETREE RD, CONOVER NC 28613
Name on Permit: *ERIKAARTEAGA TISCARENO
Name on Permit: EDGAR ARTEAGA FEREGRINO
Property Size: Acres 0.49
Directions: Left on Keiser Rd SE, Left onto Lakeside Ln Rd(name change to
Owner/Authorized Representative Acknowledgement of Permit Receipt
XEAI certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described ahoy e.
EA As the property owner or authorized representative. I have received the above referenced
permit(s)as requested in the application for service RBPR-I 1-2022-42713. by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
✓ l{Iectronic Image 'I•ransmittal/ -mail (Return receipt required)
f( EA As the property owner or authorized representative I have reviewed and understand the specific conditions
1" 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(I 5A NCAC I8A.1900),
and/or Well Construction Standards(I5A 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: 12/27/2022
Owner/Authorized Representative Signature 411
EArri
Date 1/11/2023
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name a/person,'eau/ir{L'permit)
Signature Date/Time , 11%12 3
Method: Fax J Email (IS Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from yoaPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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��/ e CATAWBA('OIUN'I'1' Case# IMPV-I2-2022-186612
Public Health Department Subdivision LEELAND TERRACE
< t PIN# 375110454295
Q Environmental Health Division
•
PO Box 389,25 Government Drive,Newton.NC 28658 Lop/ 53-56
8 sm
Site Address: 2393 SHADETREE RD, CONOVER NC 28613
Name on Permit: *ERIKAARTEAGATISCARENO
Name on Permit: EDGAR ARTEAGA FEREGRINO
Property Size: Acres 0.49
Directions: Left on Keiser Rd SE, Left onto Lakeside Ln Rd(name change to
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: 50%REDUCTION VERTICAL
System Classification: IIIE-PPBPS GRAVITY DOSED SYSTEM
REPAIR SYSTEM SPECIFICATIONS
Repair System Required? Not Required,has space
Proposed Wastewater System: 50%REDUCTION VERTICAL
System Classification: IIIB-SYSTEM W/SINGLE EFFLUENT PUMP
Pump Required
Permit Conditions: *DO NOT CUT OR FILL OVER SYSTEM 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 I lealth 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 l'ennit
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 oldie property. This permit was issued in compliance with the provisions of the North Carolina'Laws and
Rules for.Sewaee Treatment and Disposal Systems' I I5A NCAC I 8A 1900). Neither Catawba County nor the Environmental I lealth
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 authoriiation or permit
modification. Please notify Environmental I lealth of this change prior to system installation
/ ^ ✓4N$
12/27/2022
Authorized State Agent l'ennit Issuance Date
12/27/2027
Permit Expiration Date
No grading or construction activity is allotted in areas designated for system and repair without approval o/the(lealth Department.
01I05'2023 I0:26
Catawba County Environmental Health
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CONOVER, 28613
This map/report product was prepared from the Catawba County,NC Geospatlal Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling Information contained on this map or data on this report Catawba County promotes and recommends
the Independent verification of any data contained on this map/report product by the user.The County of Catawba,Its employees,agents,and
personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct Indirect or consequential which arises or may
arise from this map/report product or the use thereof by any person or entity.
Copyright 2021 Catawba County NC
12/21/2022
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