HomeMy WebLinkAboutAUTH-08-2023-202453.tif •
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a,Ptt=`a► L'ATAIVBA COtt1 I'y
1i Public Health Department Sulxtivision
lot . Is' Environmental Health Division PIN% 266801485389
lilt./ PO Box 389.25 Government Drive,Newton.NC 28658 1 r}ro
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Site Address: 8765 JACOB FORK RIVER RD,VALE NC 28168
Name on Permit ADAM DYMORA
Property Size: Acres 34.05
Directions: Hwy 18 to Jacob Fork River Rd,Property is on the Right,Approx. 1 mile form Hwy 18(white fence/black)
Owner/Authorized Representative Acknowledgement of Permit Receipt
r v'P I certify that I um the owner or authorized agent(owner's authorization rcquircd)representing the owner of
the property described above.
As the property owner or authorized representative,I have received the above referenced
permit(s)as requested in the application for service itBI'K-07-2023-44950, by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
7 Electronic Image Transmittal/E-mail (Return receipt required)
I" 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 18A.1900),
and/or Well Construction Standards(15A 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:08/11/2023
Owner/Authorized Representative Signature
Date 10 /g—she-n
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by _ (name of person sending permit)
(Aire
Signature �____ _____.____Date/'fime_�Q1� �3
1
Method: Fax 'Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from yor,Please ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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V.: ; CATAWBA COUNTY Casc# At!'11 I-08-2023-202453
iQ'' .f.I ,Z Public Health Department Subdivision
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linvironmental Health Division PINK 266801485389
PO Box 389,25 Government Drive,Newton,NC 28658 LOT{t
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Site Address: 8765 JACOB FORK RIVER RD, VALE NC 28168
Name on Permit: ADAM DYMORA
Property Size: Acres 34.05
Directions: Hwy 18 to Jacob Fork River Rd, Property is on the Right, Approx. 1 mile form Hwy 18(white fence/black)
Authorization to Construct Permit
Permit Category: New Septic Wastewater Flow: 360 g.p.d.
Type of Facility: Primary Residence-New house
Basement? NO Basement Plumbing? No Bedrooms: 3
Water Supply: Private Well Maximum Occupants: 6
Soil LIAR: 0.3 g.p.dift2
WASTEWATER SYSTEM REQUIREMENTS
Proposed Wastewater System: 25%REDUCTION
System Classification: IIIG-OTHER NON-CONV TRENCH SYSTEMS
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: 302 ft
Aggregate Depth: in Maximum Trench Depth on Downhill Sidewall: 33 in
Minimum Soil Cover: 6 in Minimum Trench Separation: 9 ft on center
Number of Drain Lines: 3 Trench Width: 3 ft
Distribution: Serial
Pre Treatment: NONE
Additional Specifications:
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? Required Soil LIAR: 0.275 9•p•d.lft2
Proposed System: 50%REDUCTION HORIZONTAL
System Classification: IIIE-PPBPS GRAVITY DOSED SYSTEM
elipemi i l 09/26,2023 16:48
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��A • CATAWBA COUNTY Case# AUTH-08-2023-202453
.f. ,z Public Health Department Subdivision
Q Environmental Health Division
0PIN# 266801485389
PO Box 389,25 Government Drive,Newton,NC 28658 LOT#
IH4, sm
Site Address: 8765 JACOB FORK RIVER RD, VALE NC 28168
Name on Permit: ADAM DYMORA
Property Size: Acres 34.05
Directions: Hwy 18 to Jacob Fork River Rd. Property is on the Right, Approx. 1 mile form Hwy 18(white fence/black)
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 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 Sewaee Treatment and Disposal Systems'(15A NCAC 18A.1900). Neither Catawba County nor the
Environmental Health Specialist wan-ants 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.
4 :‘i 1€--IgiCkee Pr,•k 4s
09/26/2023
Authorized State Agent Permit Issuance Date
9/26/2028
Permit Expiration Date
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
chpcnnn 10/11/2023 09:43