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HomeMy WebLinkAboutIMPV-11-2023-208958.tif Permit ti:j,/Vf-II-70L'7 - ltg 1 5-r w�..s � s�+. ROY COOPER• Governer ?�fi 1 ) NC DEPARTMENT OF KODY H.KINSLEY•Secretary 3 ,4t'i—..:ih HEALTH AND +,ram ,_r_•.¢ ij HUMAN SERVICES MARK BENTON•Deputy Se::retary for Heal:h .*•,.'-.,-.v' SUSAN KANSAGRA•Assistant Secretaryfor Public Health Division of Public Health Submittal Includes: DS(a2)Improvement Permit ❑(a2)Construction Authorization ❑Fee$ IMPROVEMENT PERMIT FOR G.S. 130A-335(a2) County:_ s3.SAJ_12¢' -- — - PIN/Lot Identifier: 2L tr g 0 a 9 3 3 Cf 4 1 Issued To: ke ri co; r1 k _ Property Location: &LMe e.t' k Rd Subdivision(if applicable)- Lot a: Block: Section: LSS Report Provided: Yes 03. No❑ If yes,name and license number of LSS: SOe D %-y[j n 'Ur ter J D8.`) New® pp Expansion ❑ ! System Relocation D Change o►Use ❑ Proposed Structure: Re.i:_der1C'Z Numbor of bedrooms: 3 Number of Occupants! Other Design Wastewater Strength:®domestic ❑high strength ❑industrial process Proposed Design Daily Flow: JE+D GPD Proposed[TAR(lnitial): Proposed[TAR(Repair): Proposed Wastewater System Type•. Z- % r sJGf'cn ('.•4„mix``;(Initial) Pump Required. ❑Yes ®No ❑May be required Proposed Wastewater System Type':d.f.t`r 1tl-ti-fi1J-ri (,. o _(Repair) Pump Required: ❑Yes ®No ❑May be required 'Please include system classification far proposed wastewater system types in accordance with 15A NCAC ISA.1961 Table V(o) Saprotite System(initial):❑Yes ©No Saprolite System(repair):❑Yes 21 No Fill System(Initial):❑Yes al No If yes,specify.❑New ❑Ex:sring (when adding more than 6 inches of fill to system area provide a fill plan) • Fill System(repair):❑Yes ®No If yes,specify:❑New ❑Existing (when adding more than 6 inches of fill to system area provide a fill plan) Usable Soil Depth(Initial): 39 Usable Soil Depth(Repair): £/7 Max.Trench Depth(Initial)': I V Max,Trench Depth(Repair)': j k' 'Measured on the downhill side of the trench Artificial Drainage Required: ❑Yes No If yes,please specify details: type of Water Supply:2C Private well 0 Public well ❑Shared well ❑Municipal Supply ❑Spring ❑Other: Drainfleid location meets requirements of Rule.1945 Yes Idl No❑ Grainfield location meets requirements of Rule.1950: Yes❑ No❑ Permit valid for:A Five years(site plan submitted pursuant to GS 130A-334(13a)) ❑No expiration(plat submitted pursuant to GS 130A-334(7a)] Permit conditions: Licensed Soil Scientist Print Name: Jo - D 1.y MI T.,- Licensed Soil Scientist Signature:_ Date:_ �1G/.�0 The 155 eval atiJ on is being submitted pursuant to and meets the requirements of G.S.130A-335(a2). *See attached site sketch* NC DEPARTMENT OF HEALTH AND HUMAN SERVICES • DMSION OF PUBUC HEALTH LCCArtot::5605 Six Forks Road,Building 3,Raleigh,NC 27609 '.'AILING ADDRESS 1632 Mad Service Center,Raleigh,NC 27699.1632 wssw.ncdhhs.gcv • tEL:919-707-5854 • FAx 919-545-3972 AN EC JAI OPpowTUNI r''AFFIRMATIVE ACTION F.M rl OvfR Permit#: IMPV-11-2023-208958 1240 Camp Creek Rd This Section for Local Health Department Use Only Initial submittal received: 1 1/13/2023 by RP Date Initials G.S. 130A-335(a3)states the following: When an applicant for an Improvement Permit submits to a local health department an Improvement Permit application,the permit fee charged by the local health department,the common form developed by the Department,and a soil evaluation pursuant to subsection(a2)of this section,the local health department shall, within five business days of receiving the application,conduct a completeness review of the submittal.A determination of completeness means that the Improvement Permit includes all of the required components.If the local health deportment determines that the Improvement Permit is incomplete,the local health department shall notify the applicant of the components needed to complete the Improvement Permit.The applicant may submit additional information to the local health department to cure the deficiencies in the Improvement Permit.The local health department shall make a final determination as to whether the Improvement Permit is complete within five business days after the local health department receives the additional information from the applicant.If the local health department fails to act within any period set out in this subsection,the applicant may treat the failure to act as a determination of completeness.The Department shall develop a common form for use as the Improvement Permit. The review for completeness of this Improvement Permit was conducted in accordance with G.S. 130A-335(a3). This Improvement Permit is determined to be: ❑Incomplete(If box is checked,information in this section is required.) The following items are missing: Copies of this were sent to the LSS and the Applicant on Date State Authorized Agent: Date: ©Complete State Authorized Agent: t'Z' "" 1941 Date: 11/27/2023 This Improvement Permit is issued pursuant to G.S.130A-335(a2)and (a3)using the signed and sealed LSS/LG evaluation(s) attached here. The issuance of this permit by the Health Department in no way guarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements.This permit is subject to revocation if the site plan,plat,or the intended use changes. The Improvement Permit shall not be affected by a change in ownership of the site. This permit is subject to compliance with the provisions of the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. The Department,the Department's authorized agents,and the local health departments shall be discharged and released from any liabilities,duties,and responsibilities imposed by statute or in common law from any claim arising out of or attributed to evaluations,submittals,or actions from a licensed soil scientist or licensed geologist pursuant to GS 130A-335(a2). Improvement Permit Expiration Date: 1 1/27/2028 *See attached site sketch* G.S. 130A-335(a2)Common Form 2 V.2023.07 , 0'l•,� ay;Je siol Il D U 5 e +s f T 8 o x O W q cc) s‘15-eM Lpai 5D. I. 1�O a96' Carr (&I' RJ . • _ _ _ .. • . A U, elLn. ri co ch in (filc; vr. -----__ .4 ...._,..,,..„ co 0 . . ...-*IA aLtirter., • , ,;. ID laji. . < r-- t•i 2.6. Vag.b);•1/4.2- ,r o' ._ N , . 6 .., 4 \ • (-§z ....._. 20 • / , , : Yi:vi 1.4toivr,.0 tri I ... • L, Ito • 08 )13383 c.1l4Vd3 - 4..4 SOIL/SITE EVALUATION FOR ON-SITE WASTEWATER SYSTEM Owner/Applicant: Lori Pink Date Evaluated: 4/3 10/24//2023 Address/Phone #: County/ PIN #: Catawba 266902983962 Facility: Residence Design Flow: 360 gpd Property Size: 2.47 acres Location/Road: Camp Creek Subdivision/Lot#: Water Supply Public Private Well Community well X Evaluation Method Auger Boring X Pit Cut Type of Wastewater Sewage X IPWW Mixed Profile Landscape Horizon Texture Structure Consistency Saprolite Soil Soil Profile Position& Depth Mineralogy Wetness depth classification Slope in. Color &LTAR 1 LS 8% 0-5/6 L GR FR 5/6-25 CL SBK/ABK Fl 25-46 C ABK/SBK Fl rock Little 46 PS .275 46-48 SL Fl 2 LS 10% 0-8/10 L GR FR 8/10-35 CL SBK/ABK Fl 35-49 C ABKJSBK Fl 49 PS .275 49 Auger refusal 3 LS 0-2 L GR FR 2-27 CL SBK/ABK Fl 27-46 C mica ABK/SBK Fl little 46 PS .275 4 LS 0-3 L GR FR 3-17 SCL SBK/ABK Fl 17-32 C ABK/SBK Fl 39 PS .275 32-39 C ABKJSBK Fl little 5 LS 0-2/3 L GR FR 2/3-20 CL SBK/ABK Fl 20-35 C ABK/SBK Fl 35-47 C ABK/SBK Fl little 47 PS .275 PRESENT USE: WOODS OTHER FACTORS: EVALUATED BY: Joe Lynn OTHER(S) PRESENT: Britt Ms Pink COMMENTS: I. Landscape Texture Structure Mineralogy Mineralogy Position consistency consistency Ridge Sand Crumb Moist Moist R S CR Shoulder slope Loamy sand Granular Slightly expansive Expansive S LS GR Nose slope Sandy loam Block like loose Very firm N SL VF Head slope Loam Subangular Very friable Extremely firm H L SBK VFR EF Foot slope Silt loam Angular Friable FS SIL ABK FR Flood plain Silt Platy Firm FP SI PL Fl Drainage way Sandy clay loam Prismatic D SCL PR Terrace Silty clay loam Absence Wet Wet T SICL A Debris slope Clay loam Slightly sticky Very sticky DS CL SS VS Sandy clay Sticky SC S Concave slope Silty clay Non plastic Very plastic CC SIC NP VP Convex slope Clay Slightly plastic CV C SP Plastic P