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HomeMy WebLinkAboutRBPR-07-2015-21908.TIFApplicant Contractor Owner Paid By THIS IS NOT A PERMIT Case # RBPR-07-2015-21908 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Building New IMPROVEMENT - AUTH CONST - NEW WELL ROBERT FRANTZ. , 0:7047911783 0 a] LAURENSON CARPENTRY INC (JAMES LAURENSON), 7860 COVE SIDE DR, DENVER NC 280 B:(704)622-4442 C.(704)483-65I0F:(704)483-6510 LAURENSONSuBELLSOUTH.NET LOU MATTESEN, 249 N H WY 16, DENVER NC 28037 INLAND SEA DEVELOPMENT LLC, 7860 COVE SIDE DR, DENVER NC 28037 NAME TO APPEAR ON PERMIT Lou Mattesen SITE ADDRESS: 3192 MOUNTAIN CREEK DR, SHERRILLS FORD NC 28673 PIN # 369803300454 NAME of SUBDIVISION: MOUNTAIN CREEK RIDGE Lot # 40 SectionBlock _ PROPERTI SIZE: Square Feet Acres 1 02 DIRECTIONS: 16S/ left Balls Creek/ right on Little Mtn Rd/ left on Mtn Creek Rd/ on right PRIMARY CONTACT: Applicant SEWERTYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: 1 story dwelling w/attached garage **will also stake out a future detached garage location** SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is "YES", then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? No Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: STRUCTURE TYPE: FACILITY TYPE: Single Family Residence DESCRIPTION OF vacant lot EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: New Structure PRIMARY RESIDENCE OTHER DESCRIPTION: # OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 55 x 60 # OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? No Desired system types (Improvement Permit or Authorization to Construct). ACCEPTED ALTERNATIVE. OTHER: INNOVATIVE Other described: PLUMBING REQUIRED? Yes CONVENTIONAL: ANY: YES APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO E9-ehapph,anon 07/09/2015 11 27 Pagel of s� CATAWBA COUNTY Case # R13PR-07-2015-21908 �� �\ Public Health Department Subdivision MOUNTAIN CREEK RIDGE 4 �� '' Environmental Health Division PIN# 369803300454 TO Bot 389, 100-A Southwest Blvd, Nemon. NC 28658 18 2 . NAME ON PERMIT: ( LOU MATTESEN), 249 N HWY 16, DENVER NC 28037 ( Lou Mattesen) Site Address: 3192 MOUNTAIN CREEK DR, SHERRILLS FORD NC 28673 Property Size: Square Feet Acres 1'02 Directions: 16S/ left Balls Creek/ right on Little Mtn Rd/ left on Mtn Creek Rd/ on right Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified conditions An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable, Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility I have read this application and certify that the information provided herein is true, complete and correct Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper ident'fJJcation and labeling of all property lines and corners and making the site accessibl s tha co a valuation can be performed Date: 7-9 — 2 o rS Signature of Applicant or Ager4 _ _ // An Environmental Health Specialist will contact you within o working day application date. If you need further information or assistance please call 828-466-7291 AREA1 FEENAME Authorization to Construct Fee (New/Expansion) Fee Improvement Permit Fee Well Permit & Inspection Fee TOTAL FEES :DATE FEE AMOUNT 07/09/2015 $150.00 07/09/2015 $150.00 07/09/2015 $300.00 $600.00 FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9 - chapphcanon 07/09/2015 It 27 Pape 2 of 4 �"I',�, THIS IS NOT A PEIn4IT Lo-t!NT SL -- --� CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page I Improvement Permil)( Authorization to Construct K Septic Repair ❑ Septic Alalfunction ❑ Septic Expansion ❑ New Well Permit�eplacement Well ❑ Well Abandonment 1:1Well Repair El Existing System I spectioonn (Pre -Approval Required) El Appplication is for New Construction Q� Existing Facility ❑ Property Address 31/� (Y)nv-alb�(� I� / tdivisionJ( jz-9oC� s'{1P(z2 �Ljro�n y aS{/�73 LotAcres I , 0,;'-- Section/Block/Phase Driving Directions to Property P 1,, 6 .59d -n} / Ltf' o,]Oc, C2r-37i{ a icy w'r I_F� -r d,✓ M —, 1. (�__ J� (Z- _ o j.) 2 I (9 W -7 - NAME TO APPEAR ON PERMIT? JOwner ❑ Applicant folffontractor Applicant Contact Information Name ( Address 4751 SrI;r-1L PV-lz L 2 V 0a7 Phone 700(- 79l- 1733 I Cell Phone 7o y-79/-i7Y3 Owner Contact Information Name LoJ 15 Address pv9 Phone Cell Phone Contractor Contact Information Name t(' -Az - Address -7g6o (1 PG ;Az-Address-7S6o (�urz 5,PE- 0(L. (Phone CellPhone 7ov yL/�y.�a_ WHO WILL BE THE PRIDLIRY CONTACT? ❑ Owner ❑ Pplicant ❑ Contractor Description of Existing Struc ores on Site (7 c # of Bedrooms *j -- Structure Dimensions I ` = ` # of Occupants Basement❑ Yes -44-4414- Basement Futures Yes 9 - I S I\ _,.Q6 C The Applicant shall notify the local health department upon submittal of this application if any -'of the following apply to the property" question. If the answer to any question is "yes", applicant must attach supporting documentation. ® Yes To Does the site contain any jurisdictional wetlands? ® Yes XNo Does the site contain any existing wastewater systems? • Yes is(No Is any wastewater going to be generated on the site other than domestic sewage? AYes ©�'o Is the site subject to approval by any other public agency? ® Yes To Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well ❑ Community Well ❑ Semi -Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes ❑ No If applying for an Improvement Permit or Authorization to Construct, Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) 0 Accepted 11 Alternative ❑ Conventional 0 Innovative ❑ Other Any CAT,+tl"[; BA THIS IS NOT A PERMIT COUNT}, &� CATAWBA COUNTY HEALTH DEPARTMENT ,o Application for Environmental Services Page 2 Pro osed Facility Typ Primary Residence New Residence ❑Addition to Residence # of New Bedrooms * j ��j"` Project Description ,SS y W, o-rH X a OeP_�W lAooS� ,GartA�. Structure Dimensions 55/ X 6 � / # of Occupants 2— Basement ❑ Yes [g -Vo Basement Fixtures ® Yes ®'No AccessoryStructures *Desc ibe . 2Y N () L1� nCt� mens # of New Bedrooms - if applicable Structure Dimensions # of Occupants 16 Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes KNo Describe Plumbing Needed ❑ Multi-Famil Resident y e #Units #Bedrooms per Unit*'l Total # Bedrooms *j' Structure Dimensions ❑ Food Service Specify Type # Seats Floor Space -Entire Food Service Facility (Sq Ft) # Employees per Shift # of Shifts Dining Area (Sq. Ft.) ❑ Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Church # of Seats Kitchen ❑ Yes [:]No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi -Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ No Describe Calculated Design Flow, Commercial t Additional information may be required to determine design flow from certain facilities. This value will be determined during consultation with on-site staff. *Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as a bedroom and counted on all applications. The number of bedrooms will be confirmed by rooms identified on house plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system size increase in the future. f If structure is plumbed but no bedrooms, calculated design flow is required. ** If No, a well permit must be issued with the Authorization to Construct. SYSTEM REDESIGN AND/OR RETRIP RILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified conditions. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits maybe revolted if the information on this application, site plans or intended use changes for the'proposed facility. I have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and comers and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent Printed Name of Owner or Agent P oeEn'/ / -_ Date GENERAL NOTES h 1) CORDEDEASEMENTS OR MAY DE SVOF ' 4 UNRECORDED W S R NOT EOBSERV RIGHTS OF WAYS OR EASEMENTS NOT OBSERVED AND/OR RESTRICTIVE COVENANTS n C / AN 2) OWNER ID S PRI ALL SETBACKS NIG ZONING REGVIRTCTIO PRIOR TO AUT PLANNING OR \ O CLL m` 3) ALL DISTANCES ARE HORIZONTAL GROVN9 D1=LANEE= DISTANCES l� VNLE55 OTHERWISE NOTED 4) ALL RRPAT SHOWN HEREON WERE DETERMINED BY COORDINATE ION 5J THIS PROPERTY DOES NOT LIE WITHIN A SPECIAL TED DOES NO G ARG AS AGEMENT D BY THE FLOOD L EMERGENCY ENCY FEDERAL EAS SIR 6) SHOWN ARE R AS SHOWN PRE PER CURRENTJ0\- R-40SETRAC ZO R-40 ZONIrvG LEGEND BOUNDARY LINE �w OVERHEAD UTIDIIES FENCE(TYPE NOTED) CP COMPUTED PONT (UNMARKED) RIW RICHT-OF-. EDP EDGE OF PAVEMENT CIL CENTERLINE UTILITY ROLE LOT 41 5C, LOT 40 �g',F,\ \ 1. ACRES +— 9 A- TO \ %\ \ 47, Q CURVE FABLE I CUHK I TENS ERI RADIUStlfAMNG I GIPPU I CI 12000`11. RS N 46v9J97EI 119111 LOT J9 5 87'48'5J'W 18311 ELAINE C. MCCORKLE OB2942-1998 a Ur A, C, aomo > =nm vi qo:o A4a c a USA PAH A r 11515` MCIA. E RA JULY u&1� u Paan -1 M, h b ' 4 \ W \ m` 5C, LOT 40 �g',F,\ \ 1. ACRES +— 9 A- TO \ %\ \ 47, Q CURVE FABLE I CUHK I TENS ERI RADIUStlfAMNG I GIPPU I CI 12000`11. RS N 46v9J97EI 119111 LOT J9 5 87'48'5J'W 18311 ELAINE C. MCCORKLE OB2942-1998 a Ur A, C, aomo > =nm vi qo:o A4a c a USA PAH A r 11515` MCIA. E RA JULY u&1� u Paan -1 M, Catawba County Environmental Health Q Parcel: 369803300454, 3192 MOUNTAIN CREEK DR SHERRILLS FORD. 28673 -90s, 1 in=60ft This map/report product was prepared from the Catawba County, NO Geospahal Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report. Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user. The County of Catawba, its employees, agents, and personnel, disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NO 07/09/2015 e' Trench Length / / - */ � / / Feet on Center Maximum Trench Depth Distance of Nearest Well *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* *************************************************************************************************************************** Topo 3 % Slope Texture C- Structure'3j ,jb[4 Clay Min. t Soil Wetness — Soil Depth Lt $ Restric. Hoz. at Available space6%/no L(0 1 Overall Class S U Comments: f-yf;t. AvL K /y3 . ai6 Filter Required Riser required when tank is more than 6 inches deep. **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** ************************************************************************************************************************ *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility. An Authorization to Construct is valid for (5) five years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. The siting of the well by the Health Department staff is to provide protection from known possible sources of contamination. No volume of water is guaranteed at any 4site by the Health Department. Permit Date 4 �Z3- 0 L( EHS / �/j b &u v" Q u�r Owner/Agent �_,� Septic Tank Installed By Date EHS t Well Installed By Well Grout Approval Date Well Head Approval Date Date Sample Collected Date of Results Results EHS White - Office Yellow - Owner/Agent Pink - Building Inspection Authorization to Construct PDS wl CATAWBA COUNTY HEALTH DEPARTMENT Telephone: (828) 465-8270 TDD: (828) 465-8200 WLS # 0V6q -665 7 Y' Improvemeni Permit V� AC Repair Permit._ Operation Permit. System Type Well Permit. Replacement Well Owner,/Agentllc("Tr 0_r VZ/.'Z4• - Phone Address (-1p A x y ( Subdivision A ., , in (Auk P,' rue-r,`llr Fin, /V(-, -41'v) ) Section/Blo k/Phase Lot# (7 Lot Size f, ol- Direction: 7A r / /Yl� /S.:vC.t l %��/ Ifl �ijflt Aj-,/y f Jo A"'JA CrrLjn R��lan2. �`, Property Address Md_v�Afm L/"6f A, Facility: House V Mobile Home Business Multi -family_ Other: Pin Number G U 0.3 '2ol +7 D Other . Zoning Approval # # Bedrooms L4 # Seats # Employees . Application Rate a..,... GPD Flow 4 A D Hot Tub or Spa yes/no Special Fixtures Basement(gs/no 100% Repair Area yes/no Basement Plumbing yes/no Water Supply: -private Well v1 Public Semi -Public ************************************************************************************************************************ V Type of System: Trench Bed Pump Pump/Panel Panel LPP Other 2.,j °/v nyji C�r U l Septic Tank Size —'' Pump Tank Size — Nitrification Field: Total Square Feet —-Depth of Stone Bed Size Trench Width Total Length of All Trenches -- Number of Trenches — Trench Length / / - */ � / / Feet on Center Maximum Trench Depth Distance of Nearest Well *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* *************************************************************************************************************************** Topo 3 % Slope Texture C- Structure'3j ,jb[4 Clay Min. t Soil Wetness — Soil Depth Lt $ Restric. Hoz. at Available space6%/no L(0 1 Overall Class S U Comments: f-yf;t. AvL K /y3 . ai6 Filter Required Riser required when tank is more than 6 inches deep. **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** ************************************************************************************************************************ *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility. An Authorization to Construct is valid for (5) five years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. The siting of the well by the Health Department staff is to provide protection from known possible sources of contamination. No volume of water is guaranteed at any 4site by the Health Department. Permit Date 4 �Z3- 0 L( EHS / �/j b &u v" Q u�r Owner/Agent �_,� Septic Tank Installed By Date EHS t Well Installed By Well Grout Approval Date Well Head Approval Date Date Sample Collected Date of Results Results EHS White - Office Yellow - Owner/Agent Pink - Building Inspection Authorization to Construct Parcel Report Tax/Value Information: Tax Rates(pdf) Zoning Information: Parcel Report- Catawba County NC Parcel Information: Owner Information: Parcel ID: 369803300454 Owner: MATTESEN LOU Parcel Address: 3192 MOUNTAIN CREEK DR Owner2: MATTESEN LAURIE City: SHERRILLS FORD, 28673 Address: 165 MILE HILL RD LRK(REID): 802665 Address2: Deed Book/Page: 2803/0960 City: TOLLAND Subdivision: MOUNTAIN CREEK RIDGE State/Zip: CT 06084-3232 Lots/Block: 40/ School Information: Last Sale: $41,000 on 2006-12-21 School District: COUNTY P Plat Book/Page: 601126 Elementary School: BALLS CREEK Legal: LOT 40 40 PL60-126 MTN CRK RIDGE Middle School: MILL CREEK PL 60-126 High School: BANDYS Calculated Acreage: 1.020 School Map Tax Map: Township: MOUNTAIN CREEK State Road #: Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoningl: R-40 Building(s) Value: $0 Zoning2: Land Value: $30,600 Zoning3: Assessed Total Value: $30,600 Zoning Overlay: WP -O Year BuilURemodeled: / Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710368800J Building Details 2010 Census Block: 3017 WaterShed: WS -IV Critical Area 2010 Census Tract: 011501 Voter Precinct: P31 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report Page 1 of 1 This map/report product was prepared from the Catawba County, NC Geospanal Information services Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contaned on this map or data on this report Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user The County of Catawba, its employees, agents, and personnel, disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity (D 2015, Catawba County Government, North Carolina. All rights reserved. l http://gis.catawbacountync.go\,/nomap/parcel_ report. php?kev=3698033 454&typ=P aJc) »�f-1 dcly 7/9/2015