HomeMy WebLinkAboutIMPV-04-2023-194617.tif CATAW RA COUNTY
1P .t, ,ra Public Iterilth Department Subdivision
Environmental lk.ilth Division 1'INtr 462801469069
\�\: PC)ION 389.25 Government Drive.Ncs,mn.NC 2Nfi58 t.i l ru 1
Site Address: 9685 ISLAND POINT RD• SHERRILLS FORD NC 28673
Name on Permit: •BLUEFIELD BUILDERS, LLC
Property Size: Acres 0 91
Directions: Take Island Point Rd all the way to end past Riviera Dr. Empty lot to rignt• next to 9667 Island Point Rd.
t Owner/Authorized Representative Acknowledgement of Permit Receipt
,
}fit ; I certify that I am the owner or authorized agent(o«ner's:tuthorization required)representing the owner of
the property described above.
,.
ti As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-04-2022-40885,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
J Iilectronic Image'I ransrnittal!N.-mail (Return receipt required)
�`'^;•�`' 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 fur Sewage Treatment and Disposal Systems(ISA NCAC 18A.1900),
and/or Well Construction Standards(1 5A 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:04/28/2023
Owner/Authorized Representative Signature / -. ...
Date — - " i.
Documentation of Permit(s)'I'ransmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of persun.sending permit)
Signature _ - - -t l)atci'1ime 5/3/ 3
Method: Fax J Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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118' CATAWBA COUNTY Case# IMPV-04-2023-194617
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Public Health Department Subdivision
d „ t ,,sj Environmental Health Division PIN# 462801469069
PO Box 389,25 Government Drive,Newton,NC 28658
84 w LOTS 1
Site Address: 9685 ISLAND POINT RD, SHERRILLS FORD NC 28673
Name on Permit: *BLUEFIELD BUILDERS, LLC
Property Size: Acres 0.91
Directions: Take Island Point Rd all the way to end past Riviera Dr. Empty lot to right, next to 9667 Island Point Rd.
Improvement Permit
AN AUTHORIZATION TO CONSTRUCT MUST BE ISSUED PRIOR TO BUILDING PERMITS
TIIIS PERMIT IS NOT FOR SEPTIC INSTALLATION
Permit Category: New Septic Wastewater Flow 480 g.p.d
Type of Facility: Primary Residence
Basement? Yes Basement Plumbing? Yes Bedrooms: 4
Water Supply: Private Well Maximum Occupants: 8
INITIAL SYSTEM SPECIFICATIONS
Proposed Wastewater System: 50%REDUCTION VERTICAL
System Classification: IVA-ANY SYSTEM WITH LPP DISTRIBUTION
Pump Required ***** Operator Required
REPAIR SYSTEM SPECIFICATIONS
Repair System Required? Required
Proposed Wastewater System: 50%REDUCTION VERTICAL
System Classification: IVA-ANY SYSTEM WITH LPP DISTRIBUTION
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 arc 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 18A.1900). Neither Catawba County nor the Environmental Ilcalth
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 he used for an accepted system without Environmental Health authorization or permit
modification.Please notify Environmental I lealth of this change prior to system installation.
04/28/2023
Authorized State Agent Permit Issuance Date
4/28/2028
Pcnnit Expiration Date
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
04/28/2023 16:58
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Parcel:462801469069, 9685 ISLAND POINT RD 1in=50ft
SHERRILLS FORD, 28673
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to ensure the accuracy of location and labeling information combined on this map or data on this report Catawba County promotes and recommends
the independent verirkation of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and
personnel,diseMlm,and shal not be held liable for any and al damages,loss ar liability,whether direct.indirect or consequential vend/arises or may
arise from this map/report product or the use thereof by any person or entity.
Copyright 2023 Catawba County NC
t
04/28/2023