HomeMy WebLinkAboutIMPV-02-2023-189202.TIF P1 480701380146
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.'.r -, r FORD NC 28673
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°t:'•mailbox south of Camp Dogwood on Mt Pleasant RD Gate code 2425 Park next to trailer end of path
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Owner/Authorized Representative Acknowledgement of Permit Receipt
X 'certify that I urn the owner or authorized agent(owner's authorization required)representing the owner
'/ t mperty described Elbow.
l' As the property owner or authorized representative,I have received the above referenced
permit(s)as requested in the application for service RItPR-1I-2022-42759,by the following method(s):
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Received in Person
Facsimile Transmittal(Return form with signature required)
V Electronic Image Transmittal/E-mail (Return receipt required)
slAs the property owner or authorized representative I have reviewed and understand the specific conditions
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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(I5A 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 Dale:02/15/2023
Owner/Authorized Representative Signature ICLUt1224_ _ —
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Date ti_ig1
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
_ Permit transmitted by. (name of person sending permit) -
Signature _ Date/Time314T)3
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Method: Fax '+ Email US Mall Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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http://www.surveymonkey.com/s/EH CusttomerService
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.gie CATAWBACOUNTY Case# IMPV-02-2023-189202
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,2 Public Health Department Subdivision
" Environmental Health Division PIN# 460701390146
PO Box 389,25 Government Drive,Newton,NC 28658 Lon 1
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Site Address: 3394 MT PLEASANT RD, SHERRILLS FORD NC 28673
Name on Permit: JOSHUA&AUDRA NOONE
Property Size: Acres 12.01
Directions: 3400 mailbox south of Camp Dogwood on Mt Pleasant RD Gate code 2425 Park next to trailer end of path
propertyon 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 720 g.p.d
Type of Facility: Primary Residence
Basement? Yes Basement Plumbing? Yes Bedrooms: 6
Water Supply: Private Well Maximum Occupants: 12
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: 25%REDUCTION
System Classification: IIIB-SYSTEM W/SINGLE EFFLUENT PUMP
Pump Required
Permit Conditions: *Do not cut,drive,fill,or grade over septic or repair areas.
"This is an improvement permit only and is not intended for septic installation purposes.
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 I SA.1900). Neither Catawba County nor the Environmental I Iealth
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.
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02/15/2023
Authorized State Agent Permit Issuance Date
2/15/2028
Permit Expiration Date
No grading or construction activity is allowed in areas designated Jbr system and repair without approval of the Health Department.
ehpennit 02123n023 I I:46