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Home My WebLink AboutRBPR-07-2015-22016.TIFTHIS IS NOT A PERMIT Case # RBPR-07-2015-22016 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Building New AUTH_CONST �%�� f � ih � ec1 I-� %r3r rect (1�G 1a �n h1.1 Owner TRACY HARVEY, 6593 ASHFORD NELLIS RD, ASHFORD WV 25009 NAME TO APPEAR ON PERMIT David Jarrell SITE ADDRESS: 4049 HOB LN, TERRELL NC 28682 _--PM ,# 461713124930 NAME of SUBDIVISION: Lot j€ Section/Block 2.162 PROPERTY SIZE: Square Feet Acres j DIRECTIONS: Hwy 150, right on Sherrills Ford R — ob Ln, 1/2 mile on right PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: 40 x 28 Single family dwelling w/3 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? 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 EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: NEW STRUCTURE DIM:: 40 x 28 # OF NEW BEDROOMS:: 3 BASEMENT? No New Structure PRIMARY RESIDENCE OTHER DESCRIPTION: # OF OCCUPANTS: 4 PROPOSED CONSTRUCTION BASEMENT FIXTURES? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: OTHER: INNOVATIVE: Other described: PLUMBING REQUIRED? Yes CONVENTIONAL: ANY: 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. 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 complete site evaluation can be performed. Date: Signature of Applicant or Agent 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 1,9 - chapplication 07/30/2015 13:19 Page t of 5 �ygA CATAWBA COUNTY Case # RBPR-07-2015-22016 Q G Public Health Department Subdivision .� Environmental Health Division PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 PIN# 461713124930 Ig 2 SM NAME ON PERMIT: ( DAVID JARRELL), 528 ACORN DR, RACINE WI 25165 ( David Jarrell) NAME ON PERMIT: ( TRACY HARVEY), 6593 ASHFORD NELLIS RD, ASHFORD WV 25009 ( Tracy Harvey) Site Address: 4049 HOB LN, TERRELL NC 28682 Property Size: Square Feet Acres 2.162 p S Directions: Hwy 150, right on Sherrills Ford Rd/Right on Hob Ln, 1/2 mile on right DATE „ FEE AMO NT _1 Authorization to Construct Fee (New/Expansion) 07/24/2015 $150.00 Fee , h .' TOTAL FEES, $150 00Al CI 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 - ehapplicatfnn 07/30/2015 13:19 Page 2 of 5 THIS IS NOT A PERMIT Case # RBPR-07-201 5-22016 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Building New AUTH_CONST Owner TRACY HARVEY, 6593 ASHFORD NELLIS RD, ASHFORD WV 25009 NAME TO APPEAR ON PERMIT David Jarrell SITE ADDRESS: 4049 HOB LN, TERRELL NC 28682 PIN # 461713124930 NAME of SUBDIN71SION: Lot# SectionBlock PROPERTY SIZE: Square Feet Acres 3.3 DIRECTIONS: Hwy 150, right on.Sherrills Ford Rd/Right on Hob Ln, 1/2 mile on right PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: 40 x 28 Single family dwelling w/3 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? 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 EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: New Structure PRIMARY RESIDENCE OTHER DESCRIPTION: # OF OCCUPANTS: 4 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 40 x 28 # OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED ALTERNATIVE OTHER' Other described: INNOVATIVE. PLUMBING REQUIRED? Yes CONVENTIONAL: ANY 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 under at I am solely r sponsible for the proper identification and labeling of all property lines and corners and making the site accessi a so t at, a mplete s' evaluate be performed Date: '7 — 2Y- /.5 Signature of Applicant or Agent 1 An Environmental Health Specialist will contact you within 5 working da of -application date. If you need further information or assistance please call 828-466-7291 AREA1 E9-chapplicauon 07/24/2015 1349 Page 1 of snCATAWBACOUNTY RBPR-07-2015-22016 Case ?v �\ Public Health Department ") Environmental Ilealth Division Subdivision �V PO Boy 389, 100-A Southwest Blvd. Ne++non. NC ''_8658 PIN# 461713124930 NAME ON PERMIT: (DAVID JARRELL), 528 ACORN DR, RACINE WI 25165 ( David Jarrell) NAME ON PERMIT: ( TRACY HARVEY), 6593 ASHFORD NELLIS RD, ASHFORD WV 25009 ( Tracy Harvey) Site Address: 4049 HOB LN, TERRELL NC 28682 Property Size: Square Feet Acres 3.3 Directions: Hwy 150, right on Shernlls Ford Rd/Right on Hob Ln, 1/2 mile on right FEENAME DATE FEE AMOUNT Authorization to Construct Fee (New/Expansion) 07/24/2015 $150.00 Fee TOTAL FEES 5150.00 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 - ehapph,auon 07/24/2015 13 49 Pagc 2 of 5 THIS IS NOT A PERMIT CIkINNAIRC011NTti' _ CATAWBA COUNTY HEALTH DEPARTMENT Application for Enviroranental Services Page 1 Improvement Permit ❑ Authorization to Construct Septic Repair El Septic Malfunction ❑ Septic Expansion [:1 New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre -Approval Required) ❑ Application//is for New Construction ❑ Existing Facility ❑ Property Address 41b 1/.J7, ,�i} h �. Subdivision %V a Lot #,% Acres .1 L Section/Block/Phase Driving Directions to Property f vn , n 1.51 �� 5% �� . 115 —F,5,J �� 7 - NAME TO APPEAR ON PERMIT? ❑ Owner [] Applicant ❑ Contractor Applicant Contact Information Name Address �� ✓w %� f Phone ��"/ — .> ? Owner Contact Information Name Address Phone Contractor Contact Information Name Address Phone Cell Phone 3D`/_ 4/yy_ / �7 Cell Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site # of Bedrooms *t Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures 0 Yes 0 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. ® Yes kNo Does the site contain any jurisdictional wetlands? 11 Yes 10 No Does the site contain any existing wastewater systems? 0 Yes hNO Is any wastewater going to be generated on the site other than domestic sewage? El Yes kNo Is the site subject to approval by any other public agency? (� �,,� _RYes 0 No Are there any easements or right of ways on this property? Describe -=a � I��u 1 0 Existing water supply in use ❑ Individual Well ❑ Community Well ❑ Semi -Public Well ❑ County/City/Township Water Line Is a public water supply available? *1' ❑ 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 0 Alternative ❑ Conventional 0 Innovative 0 Other ❑ Any TA '`UGUNTY CATAWBA COUNTY HEALTH DEPARTMENT Mar Application Application for Enviromniental Services Proposed Facility Type ❑ Primary Residence N New Residence ❑ Addition to Residence Project Description Structure Dimensions Z11 X 2y' # of Occupants Basement ❑ Yes ;N No Basement Fixtures Yes a No ❑ Accessory Structures) Describe # of New Bedrooms *t y # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi -Family Residence # Units #Bedrooms per Unit*t Total # Bedrooms *t 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 W Individual Well ❑ Semi -Public Well ❑ Community Well Abandonment Type Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ No Describe Page 2 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. t 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 WILL 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 may be revoked if the information on this application, site plans dr 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 runes. I understand that I am solely responsible for the proper identification and labeling of all property•liries and corners and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent 4.'J J Date - 02 Gl -1 Printed Name of Owner or Agent �^ A (' CATAWBA COUNT)' Q ' 7 Public Health Department 4 : . Environmental Health Division PO Box 399, 100-A Southwest Blvd, Newton. NC 28658 137 Case # IMPV-06-2015-062255 Subdivision PIN0 461713124930 L.0T# 2 NAME ON PERMIT: TRACY LEE HARVEY, 6593 ASHFORD NELLIS RD, ASHFORD WV 25009 Site Address: 4049 HOB LN, TERRELL NC 28682 Property Size: Square Feet 94176.72 Acres 2.162 Directions: Hwy 150 right on Sherrills Ford Rd, right on Hob Ln., 1/2 mile on right Improvement Permit Facility: Primary Residence - House Permit Category: New Septic Bedrooms 3 WATER SUPPLY: Private Well Basement? Yes Basement Plumbing? Yes INITIAL, S1 STLM SPI✓--- --- -- _.. -- ---. -. .-..--- --- -- --- --.. -..-- --- --- –_ _.-... ' CIFICATIONS Permit valid: Expires In Five Years: _X— No Expiration: Projected Daily Flow 360 g.p.d Proposed Wastewater System: 25% REDUCTION Type: IIIG - OTHER NON -CONY TRENCH SYSTEMS Permit Conditions: *Do not grade, drive, or fill over anydesignated septic area. REPAIR SYSTEM SPECIFICATIONS A Repair System Required? Required Proposed Wastewater System: 25% REDUCTION Type: IIIG - OTHER NON -CONY TRENCH SYSTEMS Landscaping or other site alterations that potentially divert groundwater or surface water toward the septic system, or prevent proper drainage away from the septic system, including the direction of gutter flows or foundation drains, is not approved, and may result in failure to aoprove the initial system installation, or the suspension/revocation of existing permits. The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of [lie applicant/property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are me(. This Iniprovetnent Permit is subject to revocation if the site plan, plat or the intended use changes, or if site conditions are aitered. The Improvement Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina 'Lrlws and Rates for Sewage Treaftnent and Disnnsal Svstems' (I5A NCAC I SA .1900). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for any given period of time. Robbie Phelps 06/30/2015 AUTHORIZED STATE AGENT APPROVAL. DAI'£ Permit Expiration Date: 06/29/2020 No grading 01' C017S11'11cfioi7 activil), is allowed in tineas C/esignated for S)'stein and repair without approval of the Keoll/l Department. ehPermit 07/06/2015 13:48 Page I of Catawba County Environmental Health Parcel: 461713124930, 4041. HOB LN TERRELL, 28682 lin=60ft This map/repurt product was prepared frorh the Catawba County, NC Gempatial Information Services, Catawba County has made substantial efforts to ensure the accuracy of location and Lab4ling information contained on this map or data on this report. Catawba County prumates and recommends the independent verification of arty data contained an this maptrepott product by the user. The County of Catawba, IN employees, agents, and personnel, disclaim, and shall not be hold gable for any and all damages, loss or IlabRy, whether d1reci, Indirect or consequential which arises or may arise from this map/report product or the use thereof by a= n or entity. ht 2014 Catawba County NC 0710112015 ��,f ('rt- �.ry /7? #,1 i ,CS; J• •t�::;l} Nom' � ..:G. r Z 1:r'•z+��": i �� '• r C•' iS�' ':ii :'uu+. y _ \ i r; DEPAgTMD,fr OF ENVI>&Or Opt ENr AND NATURAL R.ESMUES Shat DM ION OF ENVIRONMENTAL 118ALTi1 PROPERTY ID #. .l7ta•SM WASTEWA1aSF=ON COUNTY: SfJYi1S"ITE EVALUATION for ON-SITE WASTEWATER SYSTEM OWNM. T, v " AFPLICAiION DATE ; 1 s s AbDRESS: UN , G 9 )4,,l Lh __ DATE EV•ALUAM% PWPOSED FACILITY: 1 il> n PROPO= DESIGN FLOW (.I 949): PROPEM SIZE: LOCATION OF MM. PROPERTY REMRDEa: VAM "PLY. �pdvact 0 Public &'Wen 0 S g 0 Other EVALUATION METHOD: 0 Auger Dc ring R -Pit U Cut og WAMMAnSt: 0 S .. 0 Inial Yto = 0 }. me d 1 n r2ox I xr."AL5y5r34! KEPA-M n* -S7 vu) OTHER FACTORS (.1946}: Aru1>+ble Spa= ( 2943} � i- � �- � SI M C LA.S5IL✓ CAT10N (,./19.4 i6): 4y ! p s / Sya=T)I*S) `L 1p �Z,-pP(, EVALUk PRESENT.J2rbbr`s P4a�i > � h+�C SitLTAlc ! , '1 � : � COMMEM: 4� I f t? E10—(L� � L; ill'• f rr — J�C,� �1a (� n f �'r .S, S ao 3C'� ii i J c r{!tI i f 1 n r2ox I xr."AL5y5r34! KEPA-M n* -S7 vu) OTHER FACTORS (.1946}: Aru1>+ble Spa= ( 2943} � i- � �- � SI M C LA.S5IL✓ CAT10N (,./19.4 i6): 4y ! p s / Sya=T)I*S) `L 1p �Z,-pP(, EVALUk PRESENT.J2rbbr`s P4a�i > � h+�C SitLTAlc ! , '1 � : � COMMEM: 4� STATE OF NORTH CAROLINA IS I A761". 11 111—Ol L OCA MAP CT 10 SCALE -------------- "3541"'ll IT IAI Is INI—S HI -11 eV E F.TIIN IF 1111—I AREA 2.162 ACRES LET #1 A - 1.111 ACRES llIFF F) RE TRGE— FILED 11121,1111 1239 IIIL ID 111-1111� 1. 2.2 11 CATAWBA COUNTY NC BOOK 00075 GWAT Ho..E DONNA HICKS SPENCER PAGE OD23 REGISTER OF DEEDS INST# 1205e AID1 11 If 111TH 110— GITE IIHAAY $Y -N. DAII '