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OPERATION PERMIT or ice se nv
Catawba County Public Health Department 'CDP File Number 3 1 5 4 8
/t Environmental Health Division WLS2009-00236
P.O Box 389, 100-A Southwest Blvd County ID Number:
Newton NC 28658 Evaluated For. NEW
Phone: (828)-465-8270 Fax: (828) 465-8276 Township:
Applicant: Property Owner-. ROBERT FOXX
Address: Address: 1246 HILLSBORO AVE
City: City: HICKORY
State/Zip: State2ip: NC 28602-892
Phone Phone
Property & Site Information
Address/Road Subdivision: CLAUDE SIGMON Phase: Lot: 2
1234 HILLSBORO AV
HICKORY NC Directions
Structure: SINGLE FAMILY HWY 10 W/ RT ON 127/ LFT ON GARDEN RD/ 1 ST
PAVED LIFT / LOT 2 ON LFT/
# of Bedrooms: 3
# of People:
'Water Supply: NEW WELL
'IP Issued by: 18s6 -Lucas Sears "System Classifcatan/Description:
TYPE III G. OTHER NON-CONY. TRENCH SYSTEMS
'CA issued by: 1896 - Lucas Sears
Design Flow: 3 6 0 'Distribution Type: GRAVITY
Soil Application Rate: 0 3 *Pre Treatment,
Drain field
Nitrification Field 9 0 0 Sq. ft. 'System Type: INFILTRATOR QUICK 4 STANDARD
No. Drain Lines 6 Installer: Leatherman
Total Trench Length: 3 0 0 ft- Certification 1111
Trench Spacing: - 9 ()Inches O.C.
0.4 Feet O.C. 'EH S: 2246 - Megen McBride
Trench Width: 3 Inches
Feet Date: 0 1/ a 7/ D 0 1 0
Aggregate Depth: inches
Minimum Trench Depth:
Inches
Minimum Soil Cover. Inches Approval Status
Maximum Trench Depth: a 0 inches 9 Approved D Disapproved
Maximum Soil Cover: 0 8
Inches
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CDP File Number 31548 Septic Tank County ID Number: WLS2009-00236
Manufacturer. GST Lat.
STB: 160 Long:
1000 Installer: Leatherman
Gallons:
Date: 0 9 / 0 8 0 0 9 Certification 1111
/ x
'EH S: 2246- Megen McBride
`Filter Brand: POLYLOK PL-68
ST Marker: Q Yes ❑ No Date: 0 1/ a 7/ a 0 1 0
Reinforced Tank: El Yes ❑ No Approval Status
1 Piece Tank. ❑ Yes ❑ No Approved ❑ Disapproved
Pump Tank
Manufacturer. Installer:
PT: Certification
Gallons: 'EH S:
Date: Date:
Riser Sealed ❑ Yes ❑ No
Riser Height: ❑ Yes ❑ NO (Min. 6 in.) Approval Status
Reinforced Tank: ❑ Yes ❑ No ❑ Approved O Disapproved
1 Piece Tank: ❑ Yes ❑ No
Supply Line
Pipe Size: inch diameter Installer:
Pipe Length: feet Certification
`Schedule: `EH S:
Pressure Rated ❑ Yes ❑ No Date:
Approved fittings ❑ Yes ❑ No Approval Status
❑ Approved ❑ Disapproved
Pum Re uirement
Pump Type: Installer:
Dosing Volume: - Gal Certification R:
Draw Down: Inches 'EH S:
`Chain:
Date:
Valves Accessible ❑ Yes ❑ No
Flow Adjustment Valve ❑ Yes ❑ NO
Check-valve ❑ Yes ❑ NO Approval Status
PVC Unions ❑ Yes ❑ No ❑ Approved ❑ Disapproved
Vent Hole ❑ Yes ❑ No
Anti-siphon Hole ❑ Yes ❑ No
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CDP File Number 31548 County ID Number: WLS2009-00236
Electric Equipment
NEMA 4X Box or Equivalent ❑ Yes ❑ NO Installer:
Box 12 inches Above Grade ❑ Yes ❑ No
Certification
Box Adj. To Pump Tank ❑ Yes ❑ NO
Conduit Sealed ❑ Yes ❑ No 'EH S:
Pump Manually Operable ❑ Yes ❑ NO
*Activation Method: Date:
Alarm Audible ❑ Yes ❑ NO Approval Status
❑ Approved ❑ Disapproved
Alarm Visible ❑ Yes ❑ NO
2246 - Megen McBride
'Operation Permit completed by:
Authorized State Agent: MO-4knA Q Date of Issue: 0 2/ 0 8/ 2 0 1 0
Q
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 nl G. sewage septic system.
Rule .1961 requires that a Type TYPE 11f G. septic system meet the following criteria:
Minimum System Review By The Local Health Department: N/A
Management Entity: OWNER
Minimum System Inspection/Maintenance Frequency By Certified Operator:
N/A
Reporting Frequency By Certified Operator: NIA
Rule .1961 requires that a Type IV and V septic systems designed for a homelbusiness owner must maintain a valid contract
with a public management entity with a certified operator or a private certified operator for the life of the septic system.
Rule .1961 requires that Type VI septic systems designed fora homelbusiness owner must maintain a valid contract with a
public management entity with a certified operator for the life 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 tong 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 Penn it that subsequent owners of the systems execute such a contract.
(S~Hand Drawing Olmport Drawing
**Site Plan/Drawing attached.**
Total Time:(HH:MM)
0 0 Hours 0 0 1.1 inures
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CDP File Number: 31548 County File Number: WLS2009-00236
Drawing Type: Operational Permit Date: 0 2/ 0 8 / a 0 1 0
Q Inch
Scale: QBlock = ft.
Drawing pN/A
53 bcj"Om
r ho~Sc-
15~ +U-Z ~ S
e").. 31 X 5 0,
300..x. -6+4
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Page 4 of 4