HomeMy WebLinkAboutIMPV-05-2023-196928.TIF 1111
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�.'• Public Health Deportment Subdivision
d �� Environmental Ikaith Division I'INh 461901095708
PO Box.389,25 Government Drive,Newton,NC 28658 • t 0Tlf
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Site Address: 1328 MOLLYS BACKBONE RD,CATAWBA NC
Name on Permit: JASON FERENS
Property Size: Acres 2 4
Directions: Comer of Molly Backbone and Rowe St
Owner/Authorized Representative Acknowledgement of Permit Receipt
)i"' I certily that 1 am the owner or authorized agent(owner's authorization required)representing the owner of'
the property described above.
F As the property owner or authorized representative. I have received the above referenced
permit(s)as requested in the application for service ElIPR-04-2023-44034, by the lbllowing method(s):
Received in Person
Facsimile Transmittal (Return lin'm with signature required)
i. Electronic Image"Transmittal/E-mail (Return receipt required)
.( )\"37--__ As the properly owner or authorized representative I have reviewed and understand the specific conditions
I 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 N('AC 18A.1900),
and/or Well Construction Standards(15A N('A('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:05/30/2023
Owner/Authorized Representative SignatureY---"'a--
Date L/7/20�'3
Documentation of l'ermit(s)'Iransmittal
(permit transmitted by electronic or other means)
Permit transmitted by (mane o/person sending permit)
Signature V___ ___ _ _ Date/'little C.e/Gh3
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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CATAWBA COUNTY Case# IMPV-05-2023-196928
U.I.ii Public Health Department Subdivision
rT)
Environmental Health Division PIN# 461901095708
PO Box 389,25 Government Drive,Newton,NC 28658 LOT#
sw
Site Address: 1328 MOLLYS BACKBONE RD, CATAWBA NC
Name on Permit: JASON FERENS
Property Size: Acres 2.4
Directions: Corner of Molly Backbone and Rowe St
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 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: 25% REDUCTION
System Classification: IIIG-OTHER NON-CONY TRENCH SYSTEMS
_ REPAIR SYSTEM SPECIFICATIONS
Repair System Required? Required
Proposed Wastewater System: 25%REDUCTION
System Classification: IIIG-OTHER NON-CONY TRENCH SYSTEMS
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 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.$vstenrs' (15A NCAC 18A.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.
,44.-t—e.2-- Xf-- /:-., --,..e___
05/30/2023
Authorized State Agent Permit Issuance Date
5/30/2028
Permit Expiration Date
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
ehpennit 06/01/2023 11:27
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Catawba Count Environmen11 tal Health ���,9
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Parcel: 461901095708, 1328 MOLLYS 1 in=60ft
BACKBONE RD CATAWBA, 28609
This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends
the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and
personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may
arise from this map/report product or the use thereof by any person or entity.
Copyright 2023 Catawba County NC
05/30/2023
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Sheet___ _af
DIVISION OF PUBLIC HEALTH,ENVIRONMENTAL HEALTH SECTION PROPERTY II)#:
ON-SITE WATER PROTECTION BRANCH
COUNTY: Catawba
SOIL/SITE EVALUATION
for ON-SITE WASTEWATER SYSTEM
(Complete all fields in full)
OWNER: L:Arb HO/ill e--.3 APPLICATION DATE
ADDRESS:
DATE EVALUATED:3;a4/2z22_
• PROPOSED FACILITY: .t-iy PRnPO,SED D SIG1,11LOW(.19y): L/ J 4..„.. PROPERTY SIZE:
f
LOCATION OF SITE: 8 /11,41/ f i r W41.{- I ,S1 S '4/ PROPERTY RECORDED:
WATER SUPPLY: 0 Private Li Public [ -Wall Li Spring Fl Other
EVALUATION METHOD: 0 Au er Boring 121rirli Cut TYPE OF WASTEWATER: 0 Sewage 0 Industrial Process 0 Mixed
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DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946):
SITE CLASSIFICATION(.1948): 4
Available Space(.1945)
EVALUATED BY:
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System Type(s)
OTHER(S)PRESENT:
Site LTAR
r 3
COMMENTS:
- ---
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Updated February 2014
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