HomeMy WebLinkAboutIMPV-5-11-17688.TIF �q CATAWBA COUIYTY Case # IMPV-5-11-17688
� G� Public Health Department
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` i � Emironmental Health Division Subdivision
�` �`�' PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Lot # A
18 2 � PIN# 2647026�9579
ApplicanUOwner Thomas Prayer House
Site Address: 5264 HOPE RD, Vale, NC �/� /4� � C/—I� —/QS ��
1I / /
Property Size: SF 0.569 ACRES
Directions: Hwy 10 / Left onPlateau / Lf Scronce / Rt on Hope
Improvement Permit
' : IlvITIAL SY,STElVI EXISTING IP �FOR REPAIR��'SYSTE�M ONL� ��� � � '� �
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Facility: public Assembly church �
Permit Category: Other Bedrooms
WATER SUPPLY: Private Well ����'=
Basement? No Basement Plumbing? No ,S�`
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INITIAL 5YSTEM SPECIFICATIONS '�
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Permit Valid: Expires In Five Years: _X_ No Expiration:
Projected Daily Flow 270 9•P•d
Proposed Wastewater System: CONVENTIONAL
Type: IIA - CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS)
Permit Conditions: Existing system was visually functioning 4/28/11 however no guarantee can be given as to its longevity.
This permit is not intended for septic system installation.
Do not drive, grade, cut, or fill over system or repair area.
The proposed modular classroom is not permitted to have plumbing or be connected to the septic system.
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REPAIR SYSTEM SPECIFICATIONS
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Repair System Required? Required
Proposed Wastewater System: 50% REDUCTION
Type: NA - ANY SYSTEM WITH LPP DISTRIBUTION
PUMP REOUIREI) ***** OPERATOR REOUIRED
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 suspensioNrevocation 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
applicanbproperty 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 SewaPe Treatment and Disnosa/ Svstems' (15A NCAC 18A .1900). Neither
Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily
Megen McBride OS/OS/20ll
AUTHORIZED STATE AGENT APPROVAL DATE
Permit Expiration Date: OS/03/2016
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
�
05/05/11 09:58
�q�t CATAWBA COUNTY
� , G Pubiic Health Department
� _` �„ Subdivision
Environmental Health Division
'' �a� J`�' PO Box 389, 100-A Southwest Blvd, Newtoq NC 28658 Lot # p
Ig42 �, P�N# 269702659�79
ApplicanUOwner Thomas Prayer House
Site Address: 5264 HOPE RD, Vale, NC
Property Size: SF 0.569 ACRES
Directions: Hwy 10 / Left onPlateau / Lf Scronce / Rt on Hope
Owner/Authorized Representative Acknowledgement of Permit Receipt
�I certify that I am the owner or authorized agent (owner's authorization required) 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 EHPR-4-ll-10575 , by the following method(s):
�� Received in Person
_ Facsimile Transmittal (Return form with signature required)
_ Electronic Image Transmittal/ E-mail (Return receipt required)
� 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 C'onstruction 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: OS/OS/2011
Owner/Authorized Representative Signature � "
Date 1 - � — ��
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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.
OS/OS/11 09:58