HomeMy WebLinkAboutIMPV-03-2023-191881.TIF 8,1\0 CATAW BA C
1_, t ,y, Public Health DepartmentOUNTY Subdivision
,It .ill,.-.' Environmental Health Division PIN# 372409070148
PO Box 389,25 Government Drive,Newton,NC 28658 LO"1#
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Site Address: 1703 KOOL PARK RD NE, HICKORY NC 28601
Name on Permit: MATTHEW BOUNDS
Property Size: Acres 1.22
Directions: Turn Right onto Radio Station RD, 0.1 mi Left 321 Bus N/NW blvd, 2.2 mi Right Conover Blvd W, 1 mi left 1st
ST E, 2.3 mi Section House RD, 3.3 mi Right Springs RD NE, 0.2 mi Left Kool Park RD NE
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-02-2023-43385,by the following method(s):
Received in Person
t Facsimile Transmittal (Return form with signature required)
J Electronic Image Transmittal/E-mail (Return receipt required)
1 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:03/21/2023
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)
WI u 7
Signature Date/Time 1Il3/J 3
Method: Fax .‘/ Email 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
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11
chpemut 03/22/2023 09:21
41Ir•e CATAWBA COUNTY Case# IMPV-03-2023-191881
t~ .f. 2 Public Health Department Subdivision
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� �� Environmental Health Division PIN# 372409070146
PO Box 389,25 Government Drive,Newton,NC 28658 LOT#
18 .
Site Address: 1703 KOOL PARK RD NE, HICKORY NC 28601
Name on Permit: MATTHEW BOUNDS
Property Size: Acres 1.22
Directions: Turn Right onto Radio Station RD, 0.1 mi Left 321 Bus N/NW blvd, 2.2 mi Right Conover Blvd W, 1 mi left 1st
ST E, 2.3 mi Section House RD, 3.3 mi Right Springs RD NE, 0.2 mi Left Kool Park RD NE
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
Basement? No Basement Plumbing? No Bedrooms: 4
Water Supply: Public Water 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: *See AC
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'(I5A NCAC I 8A.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.
°I )/laY4L ill'r\
03/21/2023
Authorized State Agent Permit Issuance Date
3/21/2028
Permit Expiration Date
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
ehpcnnit 03/22/2023 09:21