HomeMy WebLinkAboutIMPV-03-2023-190827.TIF I ,
l • CATAWBA COUNTY
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.1.` Public Health Department Subdivision CHARLES WiLSON AND WILL
• , , i Environmental Health Division I'IN# 4860701365921
PO Box 389,25 Government Drive,Newton,NC 28658 1,0'f# 8
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Site Address: 3602 DOCKSIDE LN, SHERRILLS FORD NC 28673
Name on Permit: LARRY LUPORI
Property Size: Acres 0.76
Directions: Govt Dr to SW BLVD, Hwy 16S to Lil Mt Rd to Dockside
Owner/Authorized Representative Acknowledgement of Permit Receipt
KI 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-01-2023-43161, by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
,/ Electronic Image Transmittal/E-mail (Return receipt required)
•r 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: 03/09/2023
Owner/Authorized Representative Signature
a Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by _ (name ofperson sending permit)
el
Signature Date/Time
Method: Fax i Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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elipernit 03/10/2023 09:18
4 • CATAWBA COUNTY Case# IMPV-03-2023-1 90g 2 7
Public Health Department Subdivision CHARLES WILSON AND WILL
"1 Environmental Health Division PIN# 460701365921
\ PO Box 389,25 Government Drive.Newton,NC 28658 LOT# 8
11-8
Site Address: 3602 DOCKSIDE LN. SHERRILLS FORD NC 28673
Name on Permit: LARRY LUPORI
Property Size: Acres 0.76
Directions: Govt Dr to SW BLVD. Hwy 16S to Lil Mt Rd to Dockside
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
Basement? Yes Basement Plumbing? Yes Bedrooms: 3
Water Supply: Private Well Maximum Occupants: 6
INITIAL SYSTEM SPECIFICATIONS
Proposed Wastewater System: 50%REDUCTION VERTICAL
System Classification: IIIB-SYSTEM W/SINGLE EFFLUENT PUMP
Pump Required
REPAIR SYSTEM SPECIFICATIONS
Repair System Required? Required
Proposed Wastewater System: 50%REDUCTION HORIZONTAL
System Classification: VA-SAND FILTER PRETREATMENT
Pump Required ***** Operator 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 Sewaee 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.
03/09/2023
Authorized State Agent Permit Issuance Dale
3/9/2028
Permit Expiration Date
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
03/23/2023 11:14
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DEPARTMENT OF HEALTH AND HUMAN SERVICES Sheet/of /
DIVISION OF PUBLIC HEALTH,ENVIRONMENTAL HEALTH SECTION Yr/G/ PROPERTY ID#:
ON-SITE WATER PROTECTION BRANCH COUNTY:_Catawba_
SOIL/SITE EVALUATION
for ON-SITE WASTEWATER SYSTEM
(Complete all fields in full)
OWNER e7 Lt ,r. _ APPLICATION DATE
ADDRESS: DATE EVALUATED: z
PROPOSED FACILITY: 3dr PROPOSED DESIGN FLOW(.1949): 3410 PROPERTY SIZE:
LOCATION OF SITE: 36D2 P.cks: (•s• PROPERTY RECORDED:
WATER SUPPLY: ❑Private ❑Public B'SVell ❑Spring ❑Other
EVALUATION METHOD: ❑A : Vint t CI Cut TYPE OF WASTEWATER: ❑Sewage ❑Industrial Process ❑Mixed
• • • •
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SOIL MORPHOLOGY OTHER
(.1941) PROFILE FACTORS
,,.., w HORIZON _
rp"r,; , A N/ DIEM 1942 PROFILE
V ;, ' OK) .1941 .1941 SOLI. .1943 .1954 .1944 CLASS
n
-. ,;'n: STRUCTURE( CONSISTENCE/ WETNESS/ SOIL SAPRO RESTR <AIt
, .;q i,;, TEXTURE MINERALOGY COLOR DEPTH CLASS HORIZ
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DESCRIPTION INITIAL SYSTEM RFPAIR SYSTEM OTHER FACTORS(.1946): ',yy
Available Space(-1945) I J 6 * SITE CLASSIFICATION(.1948): rS
System Type(s) a �c 44 e^ OTHER(S)PRESENT:
SIteLTAR 03 D..Z-7s-
COMMENTS:
r Updated February 2014