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.. L Public IIralih DepartmentSuhd ia•m KINGSWAY
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Site Address: 5863 KINGSWAY BLVD, HICKORY NC 28602
Name on Permit: RICHARD GRIFFIN
Property Size: Acres 0 52
Directions: S NC 127 Hwy, right Kingsway Blvd at end on left
Owner/Authorized Representative Acknowledgement of Permit Receipt
certif.) that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property .crihed aho e.
tAs the property owner or authorized representative. I have received the above referenced
permit(s)as requested in the application for service EHPR-03-2023-43783. by the following nietho(I(s):
Received in Person
Facsimil°. Transmittal (Return limn with signature required)
7 El onic Image Transmittal'E-mail (Return receipt required)
the property owner or authorized representative I have reviewed and understand the specific conditions
10( 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 I MA.1900),
and/or Well Construction Standards (I5A NCAC 2(7 .0100), shall apply to the issuance of this permit and
the construction of the wastewater s)sten) and or water supply well permitted.
Permit Issue Date: 04/03/2023
Owner Authorized Representative Signature _,r, / .
I)ate - I`. 24 Z3
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
) i.,
5hi)3
Signature Date'"time
Method: Fax 4 Email US Mail Other
O>,sncr's request to send by the above indicated method of transmittal in lieu of signature
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# ntI"III-04-2023-i92878
t. x, Public!With Department Subdivision KINGSWAY
d Environmental Health Division PIN# 269905194778
PO Itox 389.25 Government Drive.Nev,ion.NC 28658 LO'fl! 9
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Site Address: 5863 KINGSWAY BLVD, HICKORY NC 28602
Name on Permit: RICHARD GRIFFIN
Property Size: Acres 0.52
Directions: S NC 127 Hwy, right Kingsway Blvd at end on left
Authorization to Construct Permit
Permit Category: Repairs Wastewater Flow: 480 g.p.d.
Type of Facility: Primary Residence-
Basement? Yes Basement Plumbing? No Bedrooms: 4
Water Supply: Public Water Maximum Occupants: 8
Soil LIAR: g.p.d./ft2
WASTEWATER SYSTEM REQUIREMENTS
Proposed Wastewater System: REPLACEMENT OF SEPTIC TANK ONLY
System Classification: IIA-CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS)
Septic Tank: New Tank: 1,000 gal
Pump Tank _gal Grease Trap_gal
Dosing Volume gal Pump Specs: GPM @ _ TDH
Pressure Head ft Draw Down in
Drainfield: Total Area: sq ft Total Trench Length: ft
Aggregate Depth: in Maximum Trench Depth on Downhill Sidewall: in
Minimum Soil Cover: in Minimum Trench Separation: ft on center
Number of Drain Lines: Trench Width: ft
Distribution:
Pre Treatment: NONE
Additional Specifications:
'Existing septic tank to be crushed and abandoned
See also attached site plan.
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.
>>>>> Do not install system under wet conditions <<<<<
PROPOSED REPAIR
Repair System Required? Soil LIAR: g.p.d./ft2
Proposed System:
System Classification:
;I q,.•i in a 05102/2023 10:31