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Site Address: 6475 GRACIE LN.VALE NC 28168
Name on Permit: KELLY 8 AUDRA LEONHAROT
Property Size: Acres 2.19
Directions: Head Won Hwy 10 to approx 12 miles property is on the corner of Hwy 10 and Gracie LN
Owner/Authorized Representative Acknowledgement of Permit Receipt
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a, I certit\ that I :tin the owner or authorized agent(owner's;wlhuri/atiun required representing the t'c ncr of
the propene described abo‘c.
r�yt( As the property owner or authorized representative. I have received the above referenced
permit(s)as requested in the application for service RI3l'R-01-2023-43219,by the following method(s):
Received in Person
Facsimile Transmittal (Return lien) with signature required)
+ Electronic Image Transmittal/ li-mail (Return receipt required)
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)((1_.)t 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 Dale: 03/24/2023 *//Owner/Authorized Representative Signature ���.i�( }�7--
=1 Date ELLI _ tc2 3 .. _
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name n/person son sending permit)
Signature _ Date!Time /f�01��
Method: Fax Entail US Mail Other
Owner's request to send by the above indicated method o1'transmittal in lieu of'signature
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ya`1rAir• CATAWBA COUNTY Case If1MPV-03-2023-192162
1�7 j- Public Health Department Subdivision
2 ii J Environmental Health Division PIN# 268804506466
PO Box 389.25 Government Drive.Newton.NC 28658 lAT#
Site Address: 6475 GRACIE LN, VALE NC 28168
Name on Permit: KELLY&AUDRA LEONHARDT
Property Size: Acres 2.19
Directions: Head Won Hwy 10 to approx 12 miles property is on the corner of Hwy 10 and Grade LN
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- New house
Basement? No Basement Plumbing? No Bedrooms: 3
Water Supply: Public Water Maximum Occupants: 6
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: DRIP IRRIGATION
System Classification: VA-SAND FILTER PRETREATMENT
Pump Required ***** Operator Required
Permit Conditions:
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 il'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 or the North Carolina'Laws and
Rules for Sewage Tiratment and Disposal Systems'(I SA 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 I leallh of this change prior to system installation.
Pk er Rs 03/24/2023
1
Authorized State Agent Permit Issuance Date
3/24/2028
Permit Expiration Date
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
ehpcmtit 04/28/2023 16:19