HomeMy WebLinkAboutAUTH-05-2023-194795.TIF t.
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t: i thl.hc Health Ikranmenl `ulr)r soon H L FOX PROPERTY
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Site Address: 4140 16TH ST NE HICKORY NC 28601 +.4
Name on Permit LETICIA CAZARES
Property Size: Acres 0 35
Directions: corner of t6th St E and Snow Creek Rd NE
Owner/Authorized Representative Acknovvlctlgernenl of Permit Receipt
KI certify that I am the os ncr or authorized agent(owner's authorisation required)representing the owner of
the property described above.
L. h As the property owner or authorized representative,I have received the above referenced
permit(s)as requested in the application for service EIIPR-03-2023-43857,by the following mcthnd(s):
_ Received in Person
Facsimile Transmittal(Return form with signature required)
.1 Electronic Image Transmittal/E-mail (Return receipt required)
)/ L,_C. 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(ISA NCAC ISA.19f)),
and/or Well Construction Standards(ISA NCAC ZC.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:05/02/2023
Owner/Authorized Representative Signature_ 1ejj_ e_-L.-e-% c' -0v6-3
Date r _ 0 S - 2-02.3
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by --...--._-_-- (name of person sending permit)
Signature Datc/Time 5/ 3
Method: Fax J Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of sit.nature
We wantt tto hear from yoLPlease ttake a few mornentts tto cornplette our custtomer service survey att
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.Cl� • CATARBA COUNT}' Case# AU"hH-OS-2023-194795
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h j. ,7 Public Health Department Subdivision H L FOX PROPERTY
V.� 4 Environmental Health Division PIN# 372405090514
PO Dos 389.25 Government Drive.Newton.NC 28658 I.OT#
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Site Address: 4140 16TH ST NE, HICKORY NC 28601
Name on Permit: LETICIA CAZARES
Property Size: Acres 0.35
Directions: corner of 16th St E and Snow Creek Rd NE
Authorization to Construct Permit
Permit Category: Repairs Wastewater Flow: 3 g.p.d.
Type of Facility: Primary Residence-
Basement? Yes Basement Plumbing? Yes Bedrooms: 360
Water Supply: Public Water Maximum Occupants: 6
Soil LTAR: g.p.d.ft2
WASTEWATER SYSTEM REQUIREMENTS
Proposed Wastewater System: OTHER
System Classification: IIIB-SYSTEM W/SINGLE EFFLUENT PUMP
Septic Tank: Existing Tank 1,000 gal
Pump Tank 1 000 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: Washer Box
Pre Treatment: NONE
Pump Required
Additional Specifications:
*Permit for installation an alternating valve and reconnection to the initial gravel bed.
*If gravity distribution to existing bed from septic tank is possible, install the valve between septic and pump
tank.
*If gravity distribution can not be achieved, install new washer box slightly above the initial gravel bed with the
alternating valve installed after pump tank.
*Contact Environmental Health prior to beginning work(828-320-4993 or 828-320-3077).
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? Not Required Soil LTAR: g.p.d./ft2
Proposed System:
System Classification:
,:Ili crawl 05r'032023 1519
CATAWBA COUNTY Case# AUTH-05-2023-194795
Public Health Department Subdivision H L FOX PROPERTY
Environmental Health Division PIN# 372405090514
PO Box 389,25 Government Drive,Newton,NC 28658 LOT#
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Site Address: 4140 16TH ST NE, HICKORY NC 28601
Name on Permit: LETICIA CAZARES
Property Size: Acres 0.35
Directions: corner of 16th St E and Snow Creek Rd NE
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 Authorization to
Construct Permit is subject to revocation if the site plan,plat or the intended use changes,or if site conditions are altered. The Authorization to
Construct 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 I SA.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.
3711Vt 1/)//(
05/02/2023
Authorized State Agent Permit Issuance Date
5/2/2028
Pennit Expiration Date
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
ehpermit 05/03/2023 12:48
Catawba County Environmental Health
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