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HomeMy WebLinkAboutRBPR-07-2015-21958.TIFld,sk)W Applicant THIS IS NOT A PERMIT Case # RBPR-07-2015-21958 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Deck/Porch IMPROVEMENT - AUTH CONST - EXPANSION TEDDY R PAMELA CLARK, 1888 VILLA DR, NEWTON NC 28658 H:8284645608 HOME:8284645608 Owner TEDDY & PAMELA CLARK, 1888 VILLA DR, NEWTON NC 28658 H:8284645608 HOME:8284645608 NAME TO APPEAR ON PERMIT TEDDY & PAMELA CLARK SITE ADDRESS: 1888 VILLA DR, NEWTON NC 28658 PIN # 363909150879 NADIE of SUBDIVISION: STARMONT VILLAGE Lot # 3 Section/Block A PROPERTY SIZE: Square Feet Acres 057 DIRECTIONS: 10W towards Startown/ left Sigmon Dairy Rd/ 1st right (Shady Ln) /next right (Villa Dr) 2nd driveway on right/ call for appointment / gates in rear are locked PRIMARY CONTACT: Owner SEWERTYPE: Septic Tank GALLONS PER DAY: j WATER SUPPLY: Public Water DESCRIBE WOR(7/17/15 revised to 8 x 18 porch on rear and expand septic system to serve existing 3br house that has 2 br \permit not a dinn a 4th hedroom at th- adding a 8 x 18 porch on rear / 3 bedrooms existing - 2 bedroom permit (wants to expand to include 1 new bedroom for a total of 4 bedrooms 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? Yes 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 single family EXISTING STRUCTURES ON SITE (IF ANY DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: 2 NEW STRUCTURE DIM:: 8 x 18 porch Existing Structure PRIMARY RESIDENCE OTHER DESCRIPTION: # OF OCCUPANTS: 2 PROPOSED CONSTRUCTION Desired system types (Improvement Permit or Authorization to Construct). ACCEPTED ALTERNATIVE: OTHER: Other described INNOVATIVE CONVENTIONAL. ANY EV - Q! I iq)r u.'It on 07/17/2015 15 49 Page I of `a„ CATANYBA COUNTY case * RBPR-07-2015-21958 z Public Health Department Subdivision STARMONT VILLAGE <1 P�. Environmental I Icalth Division PO Box 389. 100-A Southwest Blvd, Newton. NC 28658 PIN* 363909150879 Ica NAME ON PERMIT: ( TEDDY & PAMELA CLARK), 1888 VILLA DR, NEWTON NC 28658 ( TEDDY & PAMELA CLARK. Site Address: 1888 VILLA DR, NEWTON NC 28658 Property Size: Square Feet Acres 0.57 Directions: 10W towards Startown/ left Sigmon Dairy Rd/ 1 st right (Shady Ln) / next right (Villa Dr) 2nd driveway on right / call for appointment / gates in rear are locked 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 identification and labeling of all property lines and corners and making the site accessible so that �a compllet si evaluation can be performed. Date: /7- / r/ - � U / S Signature of Applicant or Agent � / b An Environmental Health Specialist will contact you within 5 working days of application date. If you need further information or assistance please call 828-466-7291 AREA1 FEENAME DATE FEEAMOUNT Authorization to Construct Fee (New/Expansion) 07/15/2015 $300.00 Fee Improvement Permit Fee 07/15/2015 $150.00 TOTAL FEES S450.00 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) C9 -chap lhcatem 07/17/2015 15 48 Page 2 of AUTHORIZATION OF REFUND Date: 7/17/2015 Case #: RBPR-07-2015-21958 Applicant: Teddy & Pamela Clark Refund Amount: 5150.00 Refund Reason: Application revised. Not adding 4th bedroom Authorizing Signature: Received By Staff: Date: Leading the TVa�� to a HealthierCamnnunitt)" 00" CARO�� A<Credi[ed tY- Health j.'. ent ]0820 t;. I Catawba'County, North Carolina - Disbursement Voucher Vendor No. Date 07/17/15 Make Payment To: �A COQ Voucher No(s). Teddy & Pamela Clark f.� t 1888 Villa Dr v Newton, NC 28658 ATTACHMENT (Prepared by Julia English II Description Amount IAppliccation revised. Not adding 4th bedroom 150.00 1 Sub -Total $ 150.00 Food Tax Sales Tax Total I $ 150.001 For Accounting Fund Cost Center Object Project Amount Use Only 110 580200 663000 Total 11 - 11 The undersigned hereby certifies that the goods or services specified above have been received or performed. Payment has not been previously authorized and this expenditure is a proper charge to the appropriation indicated. The above charge is certified to you for payment. (SIGNATURE - APPROPRIATE OFFICIAL) PAYOR CLARK, TEDDY & PAMELA PAYMENTS CATAWBA COUNTY I OOA SOUTHWEST BLVD NEWTON, NORTH CAROLINA 28658 PHONE: 828.465.8399 www.catawbacountync.gov TRANSACTION NUMBER: TRC -506160-20-07-2015 PAYMENT DATE: 07/20/2015 PAYMENT TYPE : DV INVOICE NUMBER FEE NAME 07-15-319215 Authorization to Construct Fee (New/Expansion) Fee TOTAL PAYMENTS: RBPR-07-2015-21958 RECEIPT Monday, July 20, 2015 FEE AMOUNT ($150.00) ($150.00) CASE TYPE: Residential Building Plan Review WORK CLASS: Deck/Porch SITE ADDRESS: 1888 VILLA DR, NEWTON NC 28658 Applicant TEDDY & PAMELA CLARK, 1888 VILLA DR, NEWTON NC 28658 H:8284645608 Owner TEDDY & PAMELA CLARK, 1888 VILLA DR, NEWTON NC 28658 H:8284645608 **NO PEOPLESOFT ACCOUNT ASSIGNED ** t �a�h P)�c,> f due 01-1 611 receipt 07/20/2015 10:14 Page I of I Applicant THIS IS NOT A PERMIT Case # RBPR-07-2015-21958 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Deck/Porch IMPROVEMENT - AUTH CONST - EXPANSION TEDDY & PAMELA CLARK, 1888 VILLA DR, NEWTON NC 28658 H:8284645608 HOME:8284645608 Owner TEDDY & PAMELA CLARK, 1888 VILLA DR, NEWTON NC 28658 H:8284645608 HOME:8284645608 NAME TO APPEAR ON PERMIT TEDDY & PAMELA CLARK SITE ADDRESS: 1888 VILLA DR, NEWTON NC 28658 PIN # 363909150879 NAME of SUBDIVISION: STARMONT VILLAGE Lot N 3 Section/Block A PROPERTY SIZE: Square Feet Acres 0.57 DIRECTIONS: 10W towards Startown/ left Sigmon Dairy Rd/ 1 st right (Shady Ln) / next right (Villa Dr) 2nd driveway on right / call for appointment / gates in rear are locked PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: ^� WATER SUPPLY : Public Water DESCRIBE WOR : 7/17/15 revised to 8 x 18 porch on rear and expand septic system to serve existing 3br house that has 2 br er i not a dins a 4th bedrOnm a1Ihi = adding a 8 x 18 porch on rear / 3 bedrooms existing - 2 bedroom permit (wants to expand to include 1 new bedroom for a total of 4 bedrooms 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? Yes 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 single family EXISTING STRUCTURES ON SITE (IF ANY DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: NEW STRUCTURE DIM:: 8 x 18 porch Existing Structure PRIMARY RESIDENCE OTHER DESCRIPTION: # OF OCCUPANTS: 2 PROPOSED CONSTRUCTION Desired system types (Improvement Permit or Authorization to Construct). ACCEPTED: ALTERNATIVE: OTHER: INNOVATIVE Other described: CONVENTIONAL: ANY L9-cimppli,w1 n 07/17/2015 1549 Page I of v xA CATAWBA COUNTY Calc i! RBPR-07-2015-21958 .C' y Public Health Department G Subdivision STARMONT VILLAGE Environmental Health Division 363909150879 a� PO Box 389, 100-A Southwest Blvd, Newton. NC 28658 PIN# NAME ON PERMIT: ( TEDDY & PAMELA CLARK), 1888 VILLA DR, NEWTON NC 28658 ( TEDDY & PAMELA CLARK Site Address: 1888 VILLA DR. NEWTON NC 28658 Property Size: Square Feet Acres 057 Directions: 10W towards Startown/ left Sigmon Dairy Rd/ 1 at right (Shady Ln) / next right (Villa Dr) 2nd driveway on right / call for appointment / gates in rear are locked 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 identification and labeling of all property lines and corners and making the site accessible so t/hat�a complete site evaluation can be performed. Date: '-7 / r% - `� U / S Signature of Applicant or Agent / v An Environmental Health Specialist will contact you within 5 working days of application date. If you need further information or assistance please call 828-466-7291 AREA1 FEENAMEDATE FEE AMOUNT Authorization to Construct Fee (New/Expansion) 07/15/2015 $300.00 Fee Improvement Permit Fee 07/15/2015 $150.00 TOTAL FEES $450.00 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) 179 - 07/17/2015 15 48 Page 2 of 4 Applicant Owner THIS IS NOT A PERMIT Case # RBPR-07-2015-21958 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Deck/Porch IMPROVEMENT - AUTH CONST - EXPANSION TEDDY & PAMELA CLARK, 1888 VILLA DR, NEWTON NC 38658 H 8284645608 HOME:8284645608 TEDDY & PAMELA CLARK, 1888 VILLA DR, NEWTON NC 28658 H:8284645608 HOME:8284645608 NAME TO APPEAR ON PERMIT TEDDY & PAMELA CLARK SITE ADDRESS: 1888 VILLA DR, NEWTON NC 28658 PIN # 363909150879 NAME of SUBDIVISION: STARMONT VILLAGE Lot # 3 ScclionBlock A PROPERTY SIZE: Square Fcct Acres 0.57 DIRECTIONS: 10W towards Startown/ left Sigmon Dairy Rd/ 1st right (Shady Ln) /next right (Villa Dr) 2nd driveway on right/ call for appointment / gates in rear are locked PRIMARY CONTACT: Owner GALLONS PER DAY: 480 SEWER TYPE: Septic Tank WATER SUPPLY: Public Water DESCRIBE WORK: adding a 8 x 18 porch on rear / 3 bedrooms existing - 2 bedroom permit (wants to expand to Include 1 new bedroom for a total of 4 bedrooms 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? Yes 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: Existing Structure PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF single family EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: NEW STRUCTURE DIM:: 8 x 18 porch # OF NEW BEDROOMS:: 1 # OF OCCUPANTS: 2 PROPOSED CONSTRUCTION Desired system types (Improvement Permit or Authorization to Construct) ACCEPTED. ALTERNATIVE OTHER. INNOVATIVE: Other described CONVENTIONAL, ANY. E9-chapplication 07/15/2015 1704 Page 1 of C18 CATAWBACOUNTY Case# RBPR-07-2015-21958 Public Health Department Subdivision STARMONT VILLAGE Environmental Health Division PIN# 363909150879 PO Box 389. 100-A Southwest Blvd. Newton. NC 28658 '.M NAME ON PERMIT: ( TEDDY R PAMELA CLARK), 1888 VILLA DR, NEWTON NC 28658 ( TEDDY & PAMELA CLARK) Site Address: 1888 VILLA DR, NEWTON NC 28658 Property Size: Square Fcet Acres 0.57 Directions: 10W towards Startown/ left Sigmon Dairy Rd/ 1 st right (Shady Ln) / next right (Villa Dr) 2nd driveway on right / call for appointment / gates in rear are locked 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 identification and labeling of all property lines and corners and making the site accessible so that a complet� site evaluation can be performed Date: r%—/ r-2.a[� Signature of Applicant or Agent _4P/Ti' _ (41 An Environmental Health Specialist will contact you within 5 working days of 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 TOTAL FEES DATE FEE AMOUNT 07/15/2015 $300.00 07/15/2015 $150.00 $450.00 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 - ahappliaanon 07/15/2015 17 04 Page 2 of 4 CTAWBe THIS IS NOT A PERMIT Cc AUNTY 9.Y v�iJl ]� CATAWBA COUNTY HEALTH DEPARTMENT �. •. Application for Environmental Services Paae I Authorization to Construct Septic Repair El Malfunction Elimprovement Permit Septic Expansion ❑ New Well Permit ❑ Replacement Well ❑ Well Abandon")ent ❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) Application is for New Construction ❑ Existing Facility Property Address I 1�g3 Vi (R 1 09—N-C Subdivision �6r rvNcuA I' V t t [age Nft.J,Itd0 NC avLss Lot# Acres .570 Section/Block/Phase Driving Directions to Property_ flake >~�U14 �� u�Yrrds �Urfuw a lrr„ le Cl nn -(c S%�rnon 1� ru �. Aa1<e iki� riyFt� (SkoAu Inane) -{-aloe hatvic�hi(v lla De ve� �rc1 dr;rewa.� en ric,k+. Cal l -rayl a� aLnterr! 9a4es in rear are lock ed h. wal< NAME TO APPEAR ON PERMIT° ❑ Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name -Ta-6V ()Ja r k Address 1(3 g �(1�`cL 1)eNiV ,-�Pl�i%oll NC oL`61o5g Phone $ Zg. �(q(�- 510052 I Cell Phone Contractor Contact Information Name Address Phone I Cell Phone WHO WILL BE THE PRIMAR%` CONTACT'' ❑ Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site H mse # of Bedrooms * j 3 Structure Dimensions # of Occupants 2 Basement ❑ Yes 2 No Basement Fixtures Yes ® No The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in question If the answer to any question is "yes", applicant must attach supporting documentation 0 Yes O No Does the site contain any jurisdictional wetlands° 'Yes 0 No Does the site contain any existing wastewater systems° ❑ Yes 0 No Is any wastewater going to be generated on the site other than domestic sewage° , 'Yes ❑ No Is the site subject to approval by am other public agency? 0 Yes it No Are there any easements or right of ways on this property? Describe Existing water suppiv um use ❑ Individual Well ❑ Commmnity Well ❑ Semi -Public Well 0 Counry/City/'Township Water Line Is a public water supply available9 ** ❑ 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 prel'erencc) 0 Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other 0 Any CATA �Q A "PHIS IS NOTA PERMIT cLou ��/v A�l� CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type [✓] Primary Residence ❑ New Residence [yKAddttion to Residence # of New Bedrooms *' Project Description hack pay -eh Structure Dimensions %' K 19' # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ® Yes ®No ❑ AccessoryStructure(s) Describe # of New Bedrooms *f if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ 'Multi -Family Residence # Units #Bedrooms per Unit* f Total # Bedrooms *j Structure Dimensions ❑ Food Service Specifv "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 Davcare Specie Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Senmi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ No Describe Calculated Design Flow, Commercial f 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 yu 11 be intended for slccpmg 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 he confirmed b\, rooms identified on house plans as a bedroom at the time of building permit issuance This may prevent the need lilt septic system size merease in the futui e f If structure is plumbed but no bedrooms, calculated design llow is required ** If No, a well permit must be issued Nvith the Authorization to Construct SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) Improvement Permits issued as a result of this information are valid for 5 \,ears or may be nun -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 tacdn\, I have read this application and certif , 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 corners and making the site accessible so that a complete site evaluation can he performed Signature of Owner or Agent / P�%{� P41 Date %— 5- OZ o �Jr Printed Name of Owner or Agent Parcel Report Parcel Report- Catawba County NC Parcel Information: Owner Information: Parcel ID: 363909150879 Owner: CLARK TEDDY EUGENE Parcel Address: 1888 VILLA DR Owner2: CLARK PAMELA LOWMAN City: NEWTON, 28658 Address: 1888 VILLA DR LRK(REID): 41351 Al Deed Book/Page: 3043/1050 City: NEWTON Subdivision: STARMONT VILLAGE State/Zip: NC 28658-9311 Lots/Block: 3/ A Split Zoning Districts: / School Information: Last Sale: School District: COUNTY Plat Book/Page: 14/107 Elementary School: STARTOWN Legal: LOT 3 3A PL14-107 STARMONT PL 14- Middle School: MAIDEN 107 High School: MAIDEN Calculated Acreage: .570 School Map Tax Map: 084N 06001 Township: NEWTON State Road #: TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: NEWTON Zoning District: NEWTON County Fire District: All in City Zoningl: R-20 Building(s) Value: $70,700 Zoning2: Land Value: $13,400 Zoning3: Assessed Total Value: $84,100 Zoning Overlay: Year Built/Remodeled: 1972/ Small Area: Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710363900J Building Details 2010 Census Block: 2014 WaterShed: 2010 Census Tract: 011702 Voter Precinct: P34 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 Geospatial 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 © 2015, Catawba County Government, North Carolina. All rights reserved. ^' �Sac�����CCf�1�ns�.�. http://gis.catawbacountyne.gov/nomap/parcel_report.php?key=363909150879&typ=P 7/15/2015 Catawba County Environmental Health Parcel: 363909150879, 1888 VILLA DR NEWTON, 28658 1 in=50ft This map/report product was prepared from the Catawba County, NC 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 NC 07/15/2015 CATAWBA COUNTY HEALTH DEPARTMENT N° 6769 Telephone (828)465-8270 `f D (828)465-8200 Imp Print. Auth. to Const. Rpr Prmt.��Opr Prmt.�Sys Type�Well Print. Well Rpr Pmd. Owner/Agent&l� /r// Phone Address )KK;f)IL.(-A -ba)Vc-� Subdivision A1P-w7-D/V, , iI L. 2Rz42 2 Section/Block/Phase Lott Lot Size Directions !JT IL.� n S/(hrn.un n i.9 r/ ,e.t)` G6 lOtl !Zp�i—./n/ r 4 s r/C Facility House e_--Vebile Home_ Business_Multi-family_ Other- Tax Map or Pin Number ,X'3? -Cc Other Zoning Approval N N Bedrooms q Seats k Employees Application Rate GPD Flow Hot Tub or Spa yeso pecial Fixtures Basement yes/no 100% Repair Area yes/no Basement Plumbing yes/rtCd1 Water Supply Private Well Public_ Semi -Public_ Type of System. Trench Bed s.iRtmp Pump/Panel — Panel LPP Or],— Septic Tank Size 2T>,//l// mp Tank Size Nitrification Field: Total Square Feet Depth of Stone %,4 " Bed Size , / Trench Width Total Length of All Trenches Number of Trenches Trench Length *DO NOT INS ! Topo% S 'fextt-rre ,. yes/no -PS U I Feet on Center Maximum Trench Depth � Distance of Nearest Well C HEN WET* *WELL RECORD REQUIRED AT COMPLETION* Lln/cs i'J'D thSg 'y=c lrT ✓"i1251 mcnes'ucep. NTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OFT E-THIS-SI'STEM 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 most 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 site by the Health Department. Permit Date J / -qq FHS (1--- Owner/Agent 1i Septic Tank Installed By!/��'�Ly-'j�.�J Dater -yy EMS ! �, Well Installed Bv` /ti�fi, Well Grout Approval Date N Well ead Approval Date- /(/,¢ Date Sample Collected 46A Date of Results AjrQ. Results &//Ij EHS White - Office Blue - Buddmg Inspection Operation Peraut Yellow - OwnerlAgent Green -gJdmg laspection Autborization to Commict