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HomeMy WebLinkAboutEHPR-08-2014-19668 (2).TIFDEPARTMENT QF ENVIRONMENT AND NATURAL RESOURCES Sheet ~ oj~ DIVISION OF ENVIRONMENTAL HEALTH PROPERTY ID #: ON-SITE WASTEWATER SECTION COUNTY: SOIL/SITE EVALUATION n ~ for ON-SITE WASTEWATER SYSTEM 1,c1LS 2~~ - ~ ~35~7 OWNER: _ ~ ~i c#41t' }'S~a.FF' APPLICATION DATE ~ 2y d[-o ADDRESS: (~.~A DATE EVALUATED: -1 ~2.0 PROPOSED FACILITY: .3 i32 PROPOSED DESIGN FLOW (.1949): .3CoU PROPERTY SIZE: ~-oa3~1 LOCATION OF SITE: PROPERTY RECORDED: WATER SUPPLY: `"Private 0 Public 0 Well ~ Spring ~ Other EVALUATION METHOD: Auger Boring ~ Pit ~ Cut TYPE OF WASTEWATER: Sewage ~ Industrial Process 0 Mixed :::~~ :::: :: ::. :: :: :::::::::::::::::::::::::: ::::::~::::::::::::::::::: .:::::::::::::::::::: ............::::::::: :: ~: p :::::::::;:::::::::::::::::::::: ::S~~~. 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B~.LTAR.:. `1 O oJ- Jf~- - Y ~~ 1 ~ - 5 3 o..L g ~ ~ • ~g P5 2 3~ Dr ~ C(. ~~ ~~. ~ g ~s 3 .3~ 14 DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS (.1946): Available Space (.1945) Pl) nS Y SITE CLASSIFICATION (.1948): _r System Type(s) ~Q~ /~ _~ ~ ~d'Yl i~ EVALUATED BY: OTHER(S) PRESENT: Site LIAR , ~ . ?j`j COMMENTS: Apr 19 07 12:39p Dan Huffman 828.397.6701 p.2 ~~''~ WELL CONSTRUCTION RECORD ~~ North Carolina - Department of Environment and Natural Re ounces -Division of Water Quality -Groundwater Sectio~~n~n//~~ ~~ WELL CONTRACTOR {IiYDMDUAL) NAME (print) O S- CERTIFICATION q~L ~ J P1tONE i3 (~'1 ..3~` ~~~ WELL CONTRACTOR COMPANY NAME ~ STATL WELL CONSTRUCTION PERMTTB OCIATED WQ YSRMTTM (if applicable) (ifapplicahle) 1. WELL USE (Check Applicable Box): Rss~idential~ Mynicipal/Public ^ Industrial O Agricaltural d Monitoring ^ recovery ^ Hcat Pomp Water Injection ^ Other ^ If Other, List Use 2. WELL LOCATI N: ~ l~' ' ' TopographiclLand setting ^Flat DValle OSl ' County Nearest Town: y ope ^Ridge -$ (~app~~>~ (StreetName.N Cm~mtrnity,ytithcyvssioo,latNo~TlpCodt) LatitndeJlongitudeofweIllocation 3. OWNER ~ (SeD~d') IBtitude/longitude sot>zce:^GPS^Topograpbic map ~~~ xp~ No_) / ~ /~ /'~ ~cf' S~ (~ 6os) Dom' DRI[.LiNG I..(~C y ~~r ~~ - . _ chy or Town Sta®e T.tp Code From To Formation Description ~)' Ares codo- Phanc Dumber ' -07 D`f ~ . 4. DATE DRILLED 5. TOTAL DEPTH: ~`/'~ - 6_ DOES WELL REPLACE E)USfiNG WELL-? YES O NO ~ 7. STATIC WATER LEVEL Below Top of Castng: ~~ FT. (Ux °`~ i! Above Top of Ct~~ 8. TOP OF CASING [S Z FT. Above Land Stuface• '?op or raatos terminded at/or below reed rr+r6ee regnlrer a vnrianee to •erardance alto 15A NCAC 1C .O11S. 9. YIELD (gpm): 7~ -_ ME'i'HOD OF TEST ~ / t0. WATER ZONES {depth); T ATIQ~l SKETCH 1 i. DISITiFECTION: Type Amotmt X02 Show direction ~ ~~~ m ~~ ~ ~ leavt two State Roads m Couaiy Roads. Include the road 12. CASING. WaII Thidmess ~~y~ l c~~4. L~ 957~7L T~ L~2 Ft numbers and wmmon road names. . Fro A~ From To J From To F't: 13. GRO(3T: Deptlt Manorial ethod ~ ~ ~ ~~i ~L N,~ G ~I ~,~D , 3A Frost r> To~_ Fi.~~{ f ~ ~~~~, ~ .~ u Frorr>r To Ft. l M i ~ 1' ater a 14. SCREEN: Depth Diameter Slot Sim (~ FrorrL To Ft___.~n. in. ~ From; To Ft. ia. in. C ~p I ~~ ~ d K: 15. SAND/GRAVEL PA ~r Depth Size Material ~ J~ \ 'r Front To Ft. Gt/~Lli s (o From To Ft. 16. REMARKS• I DO HER®Y CERTIFYTHAT THIS 1'VELI. WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF TH]S RECORD HAS BEEN PROVIDED'i'O THE VvBLL OW[JER SIGNATURE OF PERSONCON'STRU~ NGTHEWELL UA1C Submit the original to the Division of Water Quality, Groundwater Sectlon,1636 Mail Service Center -Raleigh, NC 27b49-1636 Phone No. (919) 733-3221, within 30 days. GW-I REV. 07/2001 se-,. , "`.:i .' Riblic Health Departn,cnt ` ~"Environmental Health Division <, \\ "~_ /% FO Box 389, 100-A Southwest Blvd, \ewton. NC 2868 ~,q,, ~" " (828) 46~-82?0 F:~ i8281:16~-8276 TDD 1828; 46~-8200 House X Mobile Home Multi-Family Bedrooms ~ New? 3~D g.p.d Water SupplyPrivate Well? X Public? Semi-Public? Basement Plumbing: N HotTub/Spa: N Special Fixtures (explain): Case # ~; Subdivisioi*i SectBlJPhr'Lot # PIN# Applicant/Owner~NGELA C BIGGERSTAFF Site Address: LOG BARN RD NEWTON NC ~pS ~ Property Size: 2.0034 Directions: HWY 10 W/ GO THRU STARTOWN & PAST ROBINSON RD 1/4 MILE/ LFT ON LOG BARN RD/ PASS 1 ROCK HOUSE/ PASTURE ON RT Improvement Permit Permit Valid For: Five years )( No Expiration Facility (Residential): House Projected Daily Flow Basement: Y Proposed Wastewat Proposed Repair: _ Permit Conditions: Owner or Legal Representa~7ive Signature: Date: Authorized State Agent: ,~~ ~ ~~~- Date: ~• f~ •(,Yp 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 Buildine Inspections requirements are met. This Impro~~ement Permit is subject to re~•ocation if' the site plan, plat or the intended use changes, or if site conditions are altered. The Impro~~ement Permit is not affected b}- a change in o~i•nership of the property. This permit ~~~as issued in compliance «•ith the pro~-isions of the \orth Carolina 'Laws mid Rules for Sewage Treatment and Disyosal Systefns' (15A \CAC 18A .1900). Neither Cata«~ba County nor the Em~ironmental Health Specialist ~rarrants that the septic tank s~-stem ~~ill continue to function satisfactorily- for any gi~-en period of time. Authorization to Construct Wastewater System (Reauired for Buildina Permit See cite plan mid additional attachments ( ) Proposed Wastewater System: Type: Wastewater Flow g.p.d New Repair Expansion Soil LTAR: g.p.d./ft2 Tvoe of Facility: Basement: Y Basement Plumbing: N HotTub/Spa: N Special Fixtures (explain): Wastewater System Requirements Tank Size: Septic Tank gal Pump Tank gal Grease Trap gal Drainfield: Total Area: Trench Width ft Distribution: Distribution Box Additional Specifications: . Authorized State Agent: Permit Expiration Date: I hm~e read and accept the specifications mtd all conditions of this permit as indicated. Q~ C Addition? Date: Owner or Legal Representative Signature: ~ ~- Date: ~- Z(}•-(~~o rr System: WLS2006-01357 91136191693125-1 Type: -.J~ (-~ sq ft Total Length: ft Maximum Trench Depth in Minimum Soil Cover Minimum Trench Seperation ft SerialnDistribution Pressure Manifold LPP Other r: \T i demn r\Fonn sV a Zsc ~~. rU t ' CATA~VBA COL1N•TY a;' ~~'~~.` P j~:' .: \' Public Health De ar[mcatt ' ` ' ~ '~ En\-ironmental Health Dieicion ~ `~_ ~ PO Box 389, 100-A Sottth«'est Bhd, \ewton, NC 28658 ~~,q a ; ~ ~ (828 i 465-8270 F:1X 18281 465-8276 TDD (838j 465-8200 ® Improvement Permit PIN # 911361916931255-1 Construction Authorization ANGELA C BIGGERSTAFF Applicant/Owner Name ~~_ ~utho ed State gent SITE PLAN VVLS # ~VLS2006-01357 Subdivision/Section/Lot ~-13-t1[.P Date System components represent approximate contours only. The contractor must llag the system prior to beginning the installation to insure that proper grade is maintained. Do not install system under wet conditions. This permit is subject of revocation if the site plan or site conditions are altered. aE ~-e..pkiG h-t.t,~~~- ~'J~e 0. YYl-i ~ o~ - icy` -~;-c?m ~-n`~~i-~-ct~.1~C.~~ - Ip' -{-~i-6rn i~Ve.l_~ _1 ~.i-e'~.~j S ° -Fi-arn L+u.~ S ~ ~n i1n~ dk~ vle., ~vo~t-e- , o-v .~,Q per ~~ ~ ~.~'(~-Q rte- ~~-`S .~~ Case # R'LS2006-01357 Subdivisioin SectBL/Ph/Lot # PIN# 911361916931255-1 `Nell Permit a~; I ~, ~~v r ---°-_" t ~ J' ~~ ti. _ , lJ. i1V~571-1 VT0.Y 7~`X ~~ ' z ~ ~~ ~ .~.~~ e~'b't' g ~~ ~~sen-~~-~~ t----> ~-`'~ fi'"~-n fed ~,,~ ,~, Scale r:\Tideira r.+\Fonn s\r'.4L~n oo.rot DEPARTMEN3' OF ENVIRONMENT AND NATURAL RESOURCES DIVISION OF ENVIRONMENTAL HEALTH ON-SITE WASTEWATER SECTION Sheet ~ of PROPERTY ID #:1~ COUNTY: SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM 1~LS 2~c~ - ~ ~3s~7 OWNER: C` i S APPLICATION DATE ~ .'l~/-c)(O ADDRESS: (..l;q DATE EVALUATED: ~I'1"Z•v PROPOSED FACILTTY: 3 i3(L PROPOSED DESIGN FLOW (.1949): ~ PROPERTY SIZE: __ ~-oa3y LOCATION OF SITE: PROPERTY RECORDED: WATER SUPPLY: '®"Private ~ Public 0 Well ~ Spring ~ Other EVALUATION METHOD: Auger Boring ~ Pit ~ Cut TYPE OF WASTEWATER: Sewage ~ Industrial Process 0 Mixed . .. :::E :::: ......................... .......................... :::::::::::::::::::::::::: .................... .................... :::::::::::::::~::::: .......................................................................................... ...................................................... . :::~:::::::::::::::::::::::::::::::::::::::::::::::::::::::;:::::::::::::::::::::::::: ......................................................................... ...... . :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::~:::::::::::::~:::::::::::::::::::::: ................ . ::::::::::::t::::::::::::: ....................... .. :: m::: :::::: ~ ::::::::::::::::::::: :::::::::::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::................................ .....OTHER........:::...:::::::::::::::::::::::::::::::::::::::::::::::............... : .....................::.:. ::: ::: F :::::::::::::::::::::::::::. ::::::::::::::::::::::::::: ::::::::::::::::::::: ::::::::::::::::::::: ::::::::::::::::... :::.::::::::::::::: s:::::::::::::::::::::::::::::::::::::: 1941 :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::~r:.........~............................................................ :.::...:::::.:::.:.:..::..:. :::.. ...PY2f~~'~~~ ...:::::......:..,..:::::::::::: ~:::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::: ~'ACTU :::::::::::::::::::::::::: ::...,................... :::::::: :::::::::t19.4~::::::::: ::::::::::::::::::::: .. ::::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::: ::::::::::::::::::::::: :::::::::::::::::...... ........................ ......................... ::: ~ :::: ::E :::: ............ :::::::.... ...... :::::::..:..:.:.....^. ~:::::: .... ....H .... _:::: ::::......:...::::::: ::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::: •: ~:::::::::::::::::: :::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::::::::::::::: :::::::::: ::::::::::.................. ...................... ..................... .................. . ........................ : ......................... :...................... ::::::::: :::::: SiEAPE ::: :N::: l: 41 ............ €€:€~.. ....................... ................._194.1:::::::::::::::: .................................. .. . ::::::::::SOIL........ .......I943:.._.. ::::: :: :: :: .. . :....... ::::::.195tis::::: ....... ................ ::::::: :::::::1944.. . :::::::::::::::::~::~::: : ~:::: :: :::P43SxT1QNl . ::DEPTH ::: , ::::::::..TRUCTURE/:::::::: ::: ::: : :: :: : :: : . ... ... a:::.CONSiSTE1~ItEI::::: ............................. ::::~3'ETNESS/:: ........ .. . . ::::: SOIL:~ . :: . . $APRO . ... ......._...::::: RESTR " ... ... F1LE.. ::::::::::.:::::.:...... . " :::::::: ... ::::SL©PI~: °fa ::: ..................... :::::: .....:... ............. . .. . . . . ........ . ....................:..:~~~ ...........::.::.::.:....::.::.:......:...:. :::::::MINERAL.nGY:::::: ::::::::::::::::::::::::::::: :::::::CULOR::::: ....... ......... :::: ::::DEPTH.. ....................... .....CI.ASS::.: .... :: : ::::liORLZ:::: ... . ::: :::::..::..:...:....:::: . ........................................... ....::..::::::::::::::::::::: ::::::::::::::::::::::: :::::::::::::::::::::::. :::... ................. ..::4~:L1;AR::: v ~ v Lw oi• .i~~- r n 1 ~ 35 o- $ Cl. 2 ~g Ps 3s 3 ~ $ P3~ 14 DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS (.1946): Available Space (.1945) Q ~~ SITE CLASSIFICATION (.1948): System Type(s) ~-~ ~ ~ EVALUATED BY: _ ~~~ OTHER(S) PRESENT: Site LTAR , ~/ , ' j~j ~.V1V11v1~1V 1 J: