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Al/TII-05-2023-194347 1•
T` ,, PUNK Health Department Sutdinosion HIDDEN CREEK ESTATES
l�w,,a i Environmental Health Division PIN 370012955443
1�;..0 Government PO Box 389,25 Goverent Drive,Newton,NC 25658 I.O l 43
tMartrs on Psr
Slis Adams-nrlt 1228JAMES HIDDENMILEVYSKI CREEK CIR,HICKORY NC 28602 l
erclarlY Stec Acres 0.35Direct
tons: Startown Rd,left onto Sandy Ford Rd,bear right onto River Rd,left onto Hidden Creek Circle,property on the
left
Owner/Authorized Representative Acknowledgement of Permit Receipt
~)gft\certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
'�z/91 As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-05-2023-44186,by the following method(s):
Received in Person
_ Facsimile Transmittal(Return form with signature required)
NI Electronic Image Transmittal/E-mail (Return receipt required)
rtitjV\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 1SA.1900),
and/or Well Construction Standards(I5A 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:051212023
n
Owner/Authorized Representative Signature ' 141,4L
Date (g 109 123
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
. Signature__qt..' Date/Time I,IL,/03
Method: Fax L Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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,44}3' • ('ATA BA('OI'NTI Case 8 .AllIII-05-2023-196347
,? Public Health Department Subdivision HIDDEN CREEK ESTATES
Q lotlit `' Environmental Health Div'sum PIN# 370012955443
PO Bo\389.25 Government Drive.Newton.NC 28658 LOT# 43
/842 w
Site Address: 1228 HIDDEN CREEK CIR, HICKORY NC 28602
Name on Permit: JAMES MILEWSKI
Property Size: Acres 0.35
Directions: Startown Rd, left onto Sandy Ford Rd, bear right onto River Rd, left onto Hidden Creek Circle, property on the
left
Authorization to Construct Permit
Permit Category: Repairs Wastewater Flow: 360 g.p.d.
Type of Facility: Primary Residence-
Basement? No Basement Plumbing? No Bedrooms: 3
Water Supply: Community Well Maximum Occupants: 6
Soil LIAR: g.p.d.fft2
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 is located underneath the rear deck. Deck modifications will be necessary to access and
abandon the tank.
*The hot tub in the back yard may need to be removed in order to run the new supply line from the septic tank to
the drain field.
*Existing tank to be 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 LTAR: g.p.d./ft2
Proposed System:
System Classification:
,1,, ,I 06 06 2023 14'(11