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HomeMy WebLinkAboutIMPV-08-2022-178405.tif e CATAWBA COUNTY Case# IMPV-08-2022-178405 • t Public Health Department Subdivision DEERFIELD 4 -1� Environmental Health Division PIN# 268902796270 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 51 Site Address: 1301 SHADOWFAX WYND, HICKORY NC 28602 Name on Permit: JACOB BRINCOVAN Property Size: Acres 1.14 Directions: 321 exit 42,take a right on 127 south, drive for 2 miles,turn into Deerfield,turn on Shadowfax Wynd, lot is on the left 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 EHPR-02-2022-39987, 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 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: 08/23/2022 Owner/Authorized Representative Signature Date Documentation of Permit(s) Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name o/person sending permit) Signature Date/'Time I 11 1 Method: Fax Email y US Mail Other Owner's request to send by the above indicated method of transmittal in lieu of signature We wantt tto hear from yoiPlease ttake a few momentts tto complette our custtomer service survey att http://www.surveymonkey.com/s/EHCusttomerService dbrencovano, �A .tiny n,,,,, 01/10/2023 10:05 sye CATAWBACOUNTY Case# IMPV-08-2022-178405 ,' t ,Zlit Public Health Department Subdivision DEERFIELD 4 d '� Environmental Health Division PIN# 796270 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 51 !8. sm Site Address: 1301 SHADOWFAX WYND, HICKORY NC 28602 Name on Permit: JACOB BRINCOVAN Property Size: Acres 1.14 Directions: 321 exit 42,take a right on 127 south,drive for 2 miles,turn into Deerfield,turn on Shadowfax Wynd, lot is 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 480 d 9.P Type of Facility: Primary Residence-New House Basement? Yes Basement Plumbing? Yes Bedrooms: 4 Water Supply: Private Well Maximum Occupants: 8 INITIAL SYSTEM SPECIFICATIONS Proposed Wastewater System: LOW PROFILE CHAMBER System Classification: IIIB-SYSTEM W/SINGLE EFFLUENT PUMP Pump Required REPAIR SYSTEM SPECIFICATIONS Repair System Required? Required Proposed Wastewater System: DRIP IRRIGATION System Classification: VA-SAND FILTER PRETREATMENT Pump Required ***** Operator Required Permit Conditions: -Permit for IP only -Do not drive, grade, cut or fill over any part of the initial or repair septic areas. -All septic areas MUST remain 15 feet from drainage ways/ditches, 10 feet from property lines, and 25 feet from basement. -Initial system will be pumped to Low Profile Chamber system. rLp,,,,, 01/102023 10.05 rP]N#• CATAWBA COUNTY Case IMPV-08-2022-178405 Public Health Department Subdivision DEERFIELD 4 Environmental Health Division 268902796270 PO Box 389,25 Government Drive,Newton,NC 28658 1.OT# 51 Site Address: 1301 SHADOWFAX WYND, HICKORY NC 28602 Name on Permit: JACOB BRINCOVAN Property Size: Acres 1.14 Directions: 321 exit 42,take a right on 127 south, drive for 2 miles,turn into Deerfield,turn on Shadowfax Wynd, lot is on the left 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' (I 5A NCAC I8A.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. °IlidtVL 117'\ 08/23/2022 Authorized State Agent Permit issuance Date 8/23/2027 Pennit Expiration Date No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department. a,pcinnt 01/10/2023 10:05 Cataw unty Environmental Health EKNK _OZ,zoZZ-39987 1 y /offsrtQV-0, -Zo22 - I $4oSi+c P!a•r S d, P 8 P� a a,, 6i i Pm �� I • T°ocid :Is, Vo nod dfi,�&19r, k1 I Lj 11vse Cut of Fa OR At lot 8 60'x 77' Unii( all SCpic gad well 50' .,30, Pa"fr are (med. F 15' ,,� "PrNi -- �N l 5v would fvt c cr ��—Alen LillY I(di►'ill ?fop* in jeorardy. //�� • , la' c r- r L \5 uo- Ifirci r `lf\f„ ` ��a Me' �r\k l‘k VI I.. \:10- '141°‘1( 4. �QC o g'�o ' \O VO Parcel: 268902796270, 1301 SHADOWFAX 1in=40ft WYND HICKORY, 28602 1 This,ap/report product was prepared from the Catawba County,NC Geospatlal Information Services. Catawba County has made subatanbal efforts to enure Itie accuracy of location end labeling Information contained on this map or data on this report.Catawba County promotes and recormiends the independent venfication of any data contained on this map/report product by the user.Tho County of Catawba,Its employees.agents,and personnel,dictum,end shall not be held liable for any and all damages,loss or Itabitity,whether direct,indirect or consequential Much arises or may arise from this map/report product or the use thereof by any person or entity. Copyright 2021 Catawba County NC 06/29/2022 A 1)1 I'AR I MI.N I 0I.111iAI:11I AND I IOMAN SERVICES Sheet ! of Z I)IVISION III.PUBLIC I II'.AI,III,ENVIRONMENTAL I11'.AI;11I SECTION PROPIitt'I Y ID N _j{rgy0111167 ' I IN-Nil I WATER I'RO'1'GCI'ION I3RANCII COIJNTY (a4,OM SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM (Complete all fields in ILIlt OWNER: An APPLICATION DATEV.T., Z Z ADDRESS: 5)75 -114 )1 /� 7K( DZDATE EVALUATED: Z PROPOSED FACILITY: We o PROPOSED DES/IGN FLOW(.1949): y_p GPA PROPERTY SIZE: 1. I9' ii5 LOCATION OF SITE: cle kJ MA ey NC 78100 Z PROPERTY RECORDED: WATER SUPPLY: C Private l7 Public ff Well r.1 Spring Fl Other EVALUATION METHOD: I-1 Aubcr Boring Rill 0Cut TYPE OF WASTEWATER: (9/Sewage El Industrial Process Cl Mixed • • r r I, R SOIL MORPHOLOGY OTHER w (.1941) PROFILE FACTORS 1 .1940 Y LANDSCAPE HORIZON POSITION/ DEPTII 1942 PROFILE rl SLOPE% (IN.) .1941 .1941 SOIL .1943 .1956 .1944 CLASS STRUCTURE/ CONSISTENCE! WETNESS! SOIL SA PRO RESTR &LTAR TEXTURE MINERALOGY COLOR DEPTH CLASS 11ORIZ LS 6— &9 , s$le s ��xxf fora( I S Zo-35 C - Ffs(s I C ?h eZy 1 S )00(0 �// �/z 25 LS 0-Z2 C Sac Ss,$19,SII 5 71-3b 12OCk 2 ZZ v a D, zS LS 0-1z c 5 ,f (,ss,s1 z. sy p5 IZ- k ( AU- r� SS S�Is �i, 3 ► 3c� rl NI° 39 O. 29-5 LS 0-zb c sl a ' 7.5Yfic Zb- y3 C AM ?lie Ah Ji 0. Z5 DESCRIPTION - o Available Space(.1945) 1� PS INITIAL SYSTEM REPAIR SYS'rl?M OTHER FACTORS(.1946): 4 5n SITE CLASSIFICATION(.1948): SystemType(s) LSIC Drip EVALUATED BY: C L., Av(yr, { _ OTIIER(S)PRESENT: Site LIAR 0 25 0. 125 COMMENTS: .�._Updated February 2014 ------ r w ' SOIL/SITE EVALUATION Sheet of (Continuation Sheet-Complete all field in full) DEPARTMENT OF HEALTH AND HUMAN SERVICES PROPERTY ID#: DIVISION OF PUBLIC HEALTH DATE OF EVALUATION: ENVIRONMENTAL HEALTH SECTION COUNTY: ON-SITE WATER PROTECTION BRANCH • • a • or P R SOIL MORPHOLOGY OTHER 0 F (.1941) PROFILE FACTORS 1 1948 E LANDSCAPE HORIZ .1942 POSITION/ ON .1941 .1941 SOIL .1943 .I956 .1944 PROFILE tt SLOPE% DEPTH STRUCTURE/ CONSISTENCE! WETNESS/ soiL SAPRO RESTR CLASS (INTEXTURE MINERALOGY COLOR DEPTH CLASS HORIZ &LTAR 1,s o 3 ci- 6 1;.sc,y s S 3- C S6k Friss 5o foT II 3b4o i,iR . / ns/nto,.Sty 3 WI, 0, 25 0-5 CL 6 hr,ss,se/.cocf2 IoY�4 ?_.�S - $ X s �1� +� w1z 5- 2 C 6 fr, s /115X�P t, to ZOO-yo C BC 4ek_ rf_ Serso(( z(ot' i Vo u 1 'IQ - ,12,0 0. 25 zc� I • EJ cf o-( 61. 6 fr,35,51PISPp fS f,,n,h}- (0-33 C ASK - risSiSi),S f ii '"~i0 33 5o C J /� r, cs/ s f l COO 50 61./15 lZ I CIC-i. ° 14° eL G fir ss1spis co-3Lo C AB v 4- 2oC(c 6. SS S 5< V h� 36 0 33b-5o wcic /2 9 O. 75 COMMENTS: Updated Febnnry 2014 11.1111111aar EPR -01-Zo2z-39g87 Cataw unty Environmental Health 7 , IV :7 4, F / • a.-.1 i Pry ' °ced 3 15 Kovse gC't K 77' ., . 0 50 •1301 M I , • �n I 1 V" . ei 9j' < A* UrT. AjEW ay © <- L ' L- 52 .I(, / c 4. f L c 4 b ' T lb . \� , 0 at- a? 8 h' ti L15 / Parcel: 268902796270, 1301 SHADOWFAX tin=40ft WYND HICKORY, 28602 / This mapheport product was prepared from theCatawba Coup NC I Information Services. Catrwbe has made substantial efforts to ensure rne accuracy independent buillicetion dab contained this pact by he g inlormation contained on dile map or data The County report. Catawb Catawbaa, agents promotria and moarrnends the 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 2021 Caber County NC 06/2912022