HomeMy WebLinkAboutIMPV-2-11-15577.TIF CATAWBA COUNTY Case # IMPV -2 -11 -15577
G Public Health Oe artment
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an -3 Environmental Health Division Subdivision SHANGRI -LA
,•<' PO Box 389, 100 -A Southwest Blvd, Newton, NC 28658 Lot # 4
18'2 5w PIN# 376113022598
Applicant/Owner Clyde Hill
Site Address: 3029 SHANGRI LA DR, Conover, NC
Property Size: SF 0.36 ACRES
Directions: Keisler Dairy Rd to LEFT Shangri -La Subdivison / 1st House on Left after Entering Development.
Improvement Permit
INITIAL SYSTEM EXISTING - IP FOR REPAIR SYSTEM ONLY
Facility: Primary Residence
Permit Category: Other Bedrooms 3
WATER SUPPLY: Community Well
Basement? Yes Basement Plumbing? No
INITIAL SYSTEM SPECIFICATIONS
Permit Valid: Expires In Five Years: X_ No Expiration:
Projected Daily Flow 360 B.P•d
Proposed Wastewater System: CONVENTIONAL
—
Type: I1B - CONV SYSTEM WITH <750 LINEAR FEET OF LINE
Pump Required ?: No
Operator Required ?: NO
Permit Conditions: IP for as built for existing septic system for storage building.
REPAIR SYSTEM SPECIFICATIONS
Repair System Required? Required
Proposed Wastewater System: 25% REDUCTION
Type: IIIG - OTHER NON -CONV TRENCH SYSTEMS
Pump Required ?: No
Operator Required ?: NO
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 Systems' (15A NCAC 18A .1900). Neither
Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily
Susan Bumgarner 02/24/2011
AUTHORIZED STATE AGENT APPROVAL DATE
Permit Expiration Date: 02/23/2016
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
02/24/11 15:29
CATAWBA COUNTY Case # IMPV -2 -11 -15577
Publie Health Department
3 Environmental Health Division Subdivision SHANGRI -LA
° 7 1-2 , < PO Box 389, 100 -A Southwest Blvd, Newton, NC 28658 Lot # 4
I8.2 sx PIN#
376113022598
Applicant/Owner Clyde Hill
Site Address: 3029 SHANGRI LA DR, Conover, NC
Property Size: SF 0.36 ACRES
Directions: Keisler Dairy Rd to LEFT Shangri -La Subdivison / 1st House on Left after Entering Development.
Owner /Authorized Representative Acknowledgement of Permit Receipt
e I certify that I am the owner or authorized agent (owner's authorization required) representing the owner of the
property described above.
C0 As the property owner or authorized representative, I have received the above referenced permit(s) as
requested in the application for service EHPR -2 -11 -9485 , by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/ E -mail (Return receipt required)
eellAs 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: 02/24/2011
Owner /Authorized Representative Signature
Date 3 —.(— 2011
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Date /Time
Method: Fax Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
acknowledges the conditions and statements above.
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