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OPERATION PERMIT or ice use ny
Catawba County Public Health Department *CDP File Number 3 5 9 3 3
Environmental Health Division EHPR-10-09-2321
P.O Box 389, 100-A Southwest Blvd County ID/Number :
Newton NC 28658 Evaluated For: REPAIR
Phone: (828)-465-8270 Fax: (828) 465-8276 Township: DP, /
Applicant Roger Lail Property Owner: Roger Lail
Address: 2560 31St ST DR NE Address: 2560 31st ST DR NE
City: Hickory City: Hickory
State/Zip: NC State/Zip: NC
Phone 9: Phone
Property Location & Site Information
Address/Road : Subdivision: Randon Woods Phase: Lot: 3
2560 31St ST DR NE
Hickory NC Directions
Structure: SINGLE FAMILY
9 of Bedrooms: 3
of People: g
Water Supply: NIA
'System Classification/Description:
IP Iss
Issued by: 1952 - Phelps, Robert
TYPE III S. SYSTEM W/SINGLE EFFLUENT PUMP
"CA issued by: 1952 - Phelps, Robert
Design Flow: 3 6 0 PUMP TO GRAVITY
Distribution Type:
Soil Application Rate: 3 'Pre-Treatment:
Drain field
FoD n Field 9 0 0 Sq, ft. 'System Type: INFILTRATOR QUICK 4 STANDARD
Lines 9 Installer : Max's Digging Service
Total Trench Length. 3 0 0 ff. Certification 9: 1127
Trench Spacing: - 9 Inches O.C.
Feet O.C. EH S: 1919 - Susan Miller
Trench Width - 3 Inches
)Feet Date: l a/ 1 1/ a 0 0 9
Aggregate Depth: inches
Minimum Trench Depth: a 4 Inches
Minimum Soil Cover. 1 a Inches Approval Status
Maximum Trench Dept'Y_3_ 0 Approved Cl Disapproved
Inches
Maximum Soil Cover: 1 8
Inches
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CDP File Number 35933 Septic Tank County ID Number: EHPR-10-09-2321
Manufacturer. Lat.
STB: Long:
Gallons: Installer:
Date: Certification
"EH S: 2246 - Megen McBride
'Filter Brand: POLYLOK PL-68
Date: l a/ 0 8/ a 0 0 9
ST Marker: ❑ Yes ❑ NO
Reinforced Tank: ❑ Yes ❑ No
fipp,C~Ve~ ❑ A~s'p~a~'eef
1 Piece Tank: ❑ Yes ❑ NO
Pump Tank
Manufacturer. WP Installer: Max's Digging Service
PT: 274 Certification 1127
Gallons: 1000 'EH S: 2246 - Megan McBride
Date: 9/ 3 0/.2 0 0 9 Date: 1 a/ 0 8/ a 0 0 9
Pa(
Riser Sealed tom
? Yes ❑ No
Riser Height: 9 Yes ❑ No (Min.6 in.)
einforced Tank: ❑ Yes No
fi❑sa t
x 4 .
1 Piece Tank: ❑ YeS ~ NO
Supply Line
Pipe Size: a inch diameter Installer: Max's Digging Service
Pipe Length: 1 5 0 feet Certification 1127
`EH S: 1919 - Susan Miller
'Schedule: ao
Pressure Rated 9( Yes ❑ No Date: 1 a/ 1 1/ a 0 0 9
Approved fittings Yes ❑ No Ars1G°its`
F
"'A e40.
s
Pump Requirement
Pump Type: Zoeller N152-B 4/tOhp Installer: Max'x Digging Service
('Dosing Volume: - Gal Certification 1127
Draw Down: Inches *EH S: 1919 - Susan Miller
'Chain: ROPE 1 a/ 1 Date: 1/ a 0 0 9
Valves Accessible A& Yes ❑ No
Flow Adjustment Valve 91 Yes ❑ No
Check-valve to Yes ❑ No ApprEyr
PVC Unions Yes ❑ No fiproVed~ 'asap~t4yi
Vent Hole ( Yes ❑ No
Anti-siphon Hole Y2S ❑ NO
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CDP File Number 35933 County ID Number: EHPR-10-09-2321
Electric Equipment
NEMA 4X Box or Equivalent Yes ❑ NO Installer: Max's Digging Service
Box 12 inches Above Grade
Yes ❑ NO Certification 1127
Box Adj. To Pump Tank Yes ❑ NO
Conduit Sealed Yes ❑ No 'EH S: 1919 - Susan Miller
Pump Manually Operable Yes ❑ No
'Activation Method: Date: l a/ 1 1/ a 0 0 9
~ppcpu~'I:Sleivs
Able
Yes ❑ No [ Yes ❑ NO
1919 - Susan Miller
'Operation Permit completed by:
Authorized State Agent: Date of Issue: 1 1 / 1 3 / a 0 0 9
This system has been installed in compliance with applicable NC General Statutes: Article 11, Chapter 130A, Rules for
Sewage Treatment and Disposal, 15A NCAC 18A.1900 et. Seq., and all conditions of the Improvement Permit and
Construction Authorization. This property is served by a TYPE 111 13, sewage septic system.
Rule .1961 requires that a Type TYPE III B. septic system meet the following criteria:
Minimum System Review By The Local Health Department: 5YRS.
Management Entity: OWNER
Minimum System Inspection/Maintenance Frequency By Certified Operator:
N/A
Reporting Frequency By Certified Operator: N/A
Rule .1961 requires that a Type IV and V septic systems designed fora home/business owner must maintain a valid contract
with a public management entity with a certified operator or a private certified operator forthe life of the septic system.
Rule .1961 requires that Type VI septic systems designed fora home/business owner must maintain a valid contract with a
public management entity with a certified operator for the fife of the septic system.
Rule. 1961 (2) (e) requires a contract shall be executed between the system owner and a management entity prior to the
issuance of an Operation Permit for a system required to be maintained by a public or private management entity, unless the
system owner and certified operator are the same. The contract shall require specific requirements for maintenance and
operation, responsibilities of the owner and systems operator, provisions that the contract shall be in effect for as long as the
system is in use, and other requirements for the continued proper performance of the system. It shall also be a condition of
the Operation Permit that subsequent owners of the systems execute such a contract.
OHand Drawing *Import Drawing
**Site Plan/Drawing attached.**
Total Tirme:(HH:MM)
0 0 Hours 0 0 M mutes
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CDP File Number: 35933 County File Number: EHPR-10-09-2321
Drawing Type: Operational Permit Date: l a/ 1 3 / x 0 0 9
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