HomeMy WebLinkAboutEHPR-08-2015-22209 (2).TIF BA �� THIS IS NOT A PERMIT Case # EHPR-08-2015-22209
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PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES i .
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1842 SM Environmental Health Plan Review - OSWP `nit- o - o X
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IMPROVEMENT- AUTH_CONST- EXPANSION a a; "steb"
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Contractor BUMGARNER SEPTIC TANK&GRADING (MICHAEL BUMGARNER), 1190 DUDLEY SHOALS
GRANITE FALLS NC 28630
B:8283961795 C:8283200878
Owner KEITH MITCHELL,4505 BUFFALO SHOALS RD, MAIDEN NC 28650
C:8283023984
NAME TO APPEAR ON PERMIT
Keith Mitchell
SITE ADDRESS: 3344 HILLCREST DR, CLAREMONT NC 28610 PIN # 375212961499
NAME of SUBDIVISION: Sigfield Acres 25-29 F
Lot it Section/Block
PROPERTY SIZE: Square Feet 24,829.20 Acres .570
DIRECTIONS: 140 East 135, Left on Oxford St, Left on Sigfield Dr, Left on Hillcrest Dr.
PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank
CONS PER DAY: 360 ) WATER-SUP-PLY: Public Water
DESCRIBE WOR Revised-3/9/1-6-:-Changing home to 3 BdRms-360 gallons per day. 4 BdRmswlff • I on the lot without soil
scientist proposal. The existing system is sized for 2 BdRms. Expanding to account for 3 BdRms. l
House is currently-a'4-bedroom house. Home is about to go on the market for sale. `unable to locate original
septic permit on file. Septic inspection revealed that lines were sized for a 3 bedroom &that the tank was
cracked & needed to be replaced. Applying for a Septic Expansion &to replace the tank.*
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? No
Are there any easements or right-of-ways on this property? No
APPLICATION FOR: Existing Structure
STRUCTURE TYPE: PRIMARY RESIDENCE _.
FACILITY TYPE: House OTHER DESCRIPTION:
DESCRIPTION OF 67x50
EXISTING STRUCTURES
ON SITE(IF ANY)
DIM EXISTING STRUCTURE: �
NUMBER OF EXISTING BEDROOMS:\ - #OF OCCUPANTS: 5
PROPOSED CONSTRUCTION
BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED?
Desired system types (Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL:
OTHER: INNOVATIVE: ANY: YES
Other described:
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,- no CATAWBA COUNTY Case# EHPR-O8-2015-222 9
C' c' Public Health Department Subdivision
Sea A Sigfield Acres
4 °'a Environmental Health Division
�� PIM 375212961499
.. PO Box 389, 100-A Southwest Blvd,Newton,NC 28658
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NAME ON PERMIT: (KEITH MITCHELL),4505 BUFFALO SHOALS RD, MAIDEN NC 28650
( Keith Mitchell)
Site Address: 3344 HILLCREST DR, CLAREMONT NC 28610
Property Size: Square Feet 24,829.20 Acres .570
Directions: 140 East 135, Left on Oxford St, Left on Sigfield Dr, Left on Hillcrest Dr.
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�('d labeling of all property lines and corners and making the site accessi so that a complete site evaluation can be performed.
Date: S/ 1( [�(v Signature of Applicant or Agent- "-_
I 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
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rgrFEENAME 'M ainini ilt ta s Fiiii au U isal ti DATE y i?FEE'AMOUNTo
Authorization to Construct Fee (New/Expansion) 08/24/2015 $300.00
Fee
Improvement Permit Fee 08/24/2015 $150.00
Erail : s >TOTA!IlFEES4l.' '�{ 'h fir . a. I' at klt s t; '' r a t)
ie„N f tis� .: s _` t $a50 OO aik
E, "i AI 1 LLagO asa Man- .in Ntfl Ef,h4ril t^filain R6a"m'E nliaaiaal.'uuw"ilba?.:: :ak @ter`
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)
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