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HomeMy WebLinkAboutEHPR-02-2016-23261 (2).TIF Sti$A °� THIS IS NOT A PERMIT Case # EHPR-02-2016-23261 C CATAWBA COUNTY HEALTH DEPARTMENT r°. f CI \� ` !"�` PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES :Ir aI+I• \842 SM Environmental Health Plan Review - OSWP ea ° ): •f T++ ABANDONMENT ° °i O K • • Applicant ANDY DEAL CONSTRUCTION, 210 W 150 BYPASS, LINCOLNTON NC 28092 C:7049135576 Contractor FRANCIS WELL& PUMP CO. (MICHAEL FRANCIS), 1501 MT. ZION CHURCH RD, IRON STATI NC 28080 H:7042324834 C:7045069373 HOME:7042324834 Owner BOJANGLES RESTAURANT INC (CLAUDE CLARK), 9432 SOUTHERN PINES BLVD, CHARLO'1 NC 28273 C:7045272675 NAME TO APPEAR ON PERMIT Bojangles Restaurant Inc (Claude Clark) SITE ADDRESS: 5612 E NC 150 HWY, MAIDEN NC 28650 PIN # 368615548676 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 284,446.80 Acres 6.53 DIRECTIONS: Across Hwy 150 from Food Lion at Hwy 150& Hwy 16 PRIMARY CONTACT: Contractor SEWER TYPE: Public Sewer GALLONS PER DAY: WATER SUPPLY: Public Water DESCRIBE WORK: Old well found on property during construction process. Well to be Abandoned. Restaurant to have Public water & Sewer. 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: STRUCTURE TYPE: ** NO STRUCTURE SELECTED ** FACILITY TYPE: Restaurant OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: APPLICATION FOR WELL ABANDONMENT ABANDONMENT TYPE: Drilled E9-ehapplication 02/23/2016 10:19 Page 1 of 8 iia CATAWBA COUNTY Case N EHPR-02-2016-23261 2 �y Public Health Department Subdivision 4 Environmental Health Division PIN# 368615548676 '�' PO Boa 389, 100-A Southoest Blvd,Newton.A'C 28658 1842 9 NAME ON PERMIT: BOJANGLES RESTAURANT INC (CLAUDE CLARK), 9432 SOUTHERN PINES BLVD, CHARLOTTE NC Bojangles Restaurant Inc ( Claude Clark) Site Address: 5612 E NC 150 HWY, MAIDEN NC 28650 Property Size: Square Feet 284,446.80 Acres 6.53 Directions: Across Hwy 150 from Food Lion at Hwy 150& Hwy 16 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 identific beling of all property lines and corners and making the site ac sible 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 Er lr . i 4n x # ' ° 71P i ' .k r P ${ `$1 III`I . t *li ^ sFEENAME N:, ' 11411' 1„}. " _.,vv.:.: DATE-i k ,i tFEE AMOUNT1xy Well Abandonment Fee 02/23/2016 $100.00 ..0 a�t.� l....TAL FEES ' a'-'cSa'sj rC t li*;aJ ` ; "a'ili11``.l , S100 00' x- r '?t kit <_r Pub r 4 ce �2.,3- °'..� 'T 221119 nA�',11+,a.. s.:1.,n,l r111S11 3s° .^.'..7,111 s@t'u FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-eliapplication 02/23/2016 10:19 Page 2 of 8 02/18/2010 22: 55 FAX 7047361929 [0002/003 CAIAWBA TFIIS IS NOT A PERMIT • t` ti L�.V V CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permit ❑ Authorization to Construct❑ Septic Repair❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment 51 Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction XI Existing Facility ❑ �7 Property Address_ .�loj L Ea5+ tv j t 5 0 Subdivision a,i ot,.n Al.c. Zgbc o Lot# Acres Section/Block1PhaseT4 TO 36$rc 155H %7L Driving Directions to Property A Cr-0 CS H.,/ t.co iron-. t-o as 1-4 o rt c4. (}, , .� 14/) tLn& (4uA3 t (d J �� NAME TO APPEAR ON PERMIT? ❑ Owner ❑ Applicant Eja Contractor Applicant Contact Information/ Name Anek..3 %CcU C K.S±ru c-fh cvv ..., Address 2- lo ldeS4 lc0 b cs L '■ tfra'ar , AJ, C1 2geti Phone Cell Phone '7 o'-f C1 13 551 to Owner Contact Information y 1 Name Boj cc .yt es R,€.5 o..ura...c T-n_e / [ C (a....de. C1 at-k) Address 94 ;n. Co. �-�.4r r> ? ric s 1'�tsr•cl . atarts it; P. C, L 5'2? Phone -j o� rj7-'j ) cc-75 I Cell Phone Contractor Contact Information Name /N.i e6,cLe( �'runc S Frputit s t.1-1'Q,IA d- Pi.nge CO ) Address 150 1 ,&&+, Zi ort Cl�, l-d. ir+or, Stitt on ,t' C. Z SC 8 Phone 104 22_e{.g 3 i-( Cell Phone 704 5 D eI 3 7 WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant Contractor Description of Existing Structures on Site a., t; # of Bedrooms *t Structure Dimensions #of Occupants Basement ❑ Yes ❑ 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. ❑ Yes ErNo Does the site contain any,jurisdictional wetlands? IfiNes L No Does the site contain any existing wastewater systems?NO l_otliO US[✓ ❑Yes O'No Is any wastewater going to be generated on the site other than domestic sewage?. ❑ Yes V o Is the site subject to approval by any other public agency? ❑ Yes No Arc there any easements or right of ways on this property? Describe Existing water supply in use Individual Well LI Community Well U Semi-Public Well bl 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) N/�4 ❑ Acceptted ON ❑Alteerrnnative 0�Con�veentional ❑ Innovative ❑ Other ❑ Any �V �l I �-^1�( < V�Cg- ,X02/18/2010 22: 55 FAX 7047361929 U001/003 •tiCATAVVBA THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT „p„„c„o Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes ❑ No Li Accessory Structure(s) Describe it 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 Dithcosions Q Food Service Specify Type f3&j a-"-es t e,S # Seats Floor Space-Entire Food Service Facility (Sq Ft) # Employees per Shift # of Shifts w, 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 [3 No Describe )5 t -l-6. c J v.. c-aS i h9 Calculated Design Flow, Commercial t / t l tt 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 figure 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 Rom 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 complete site evaluation can be performed. Signature of Owner or Agent ,714(..4416'`F / -4-‘1-- Date Z "-1 Printed Name of Owner or Agent ficr Catawba County Environmental Health I C / ii \ cri \ is i . .0. 2:Li\1/4. ti 1 , lis 1 \ ,..,.. _a.91 Ilir \ O illtt L t ( n . `` Cir `%../' 4 9 te in Z • fP N J.... v.,..... * s __ _ _ __ _ __/„„pi__ \ \\ ,,,,,....c),, ,,,l ` Y ..- f 0\ , 0 --------;_e N - • 1111‘ E MAlDEtJ Rp r Cri r A'IJ (27. ` \ \\\\( Parcel: 368615548676, 5612 E NC 150 HWY 1in=150ft MAIDEN, 28650 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. Copyright 2014 Catawba County NC 02/23/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC • Parcel Information: Owner Information: Parcel ID: 368615548676 Owner: MAIDEN SQUARE LLC Parcel Address: 5612 E NC 150 HWY Owner2: City: MAIDEN, 28650 Address: 7984 LAKEVIEW DR LRK(REID): 15991 Address2: Deed Book/Page: 3141/1660 City: DENVER Subdivision: State/Zip: NC 28037-9265 Lots/Block: / Last Sale: $722,000 on 2012-08-21 School Information: Plat Book/Page: School District: COUNTY Elementary School: CONTACT SCHOOL Legal: DISTRICT Calculated Acreage: 6.530 Middle School: CONTACT SCHOOL DISTRICT Tax Map: 015 X 02005 High School: CONTACT SCHOOL DISTRICT Township: MOUNTAIN CREEK State Road #: 150 School Map TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoningl: HC Building(s) Value: $0 Zoning2: Land Value: $695,800 Zoning3: Assessed Total Value: $695,800 Zoning Overlay: MUC-O,WP-O Year Built/Remodeled: / 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 #: 3710368600J Building Details 2010 Census Block: 3013 WaterShed: WS-IV Protected Area 2010 Census Tract: 011602 Voter Precinct: P31 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report 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. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=368615548676&typ=P 2/23/2016 . . r • CATAWBA COUNTY HEALTH DEP . 7 N° O 0 $ 3 5 (704) 465-8270 ,Lot Evaluation t-Improvement Permit ✓ Repair Permit Completion Permit L— Owner/Agent ,p01A.fi Lf W l.L)C= .S>'ST"E✓r7_5- Phone ' Address .el) . #nxx 7_9`7 Subdivision e/.ect /i Cne i1J:c. - 7 Section/Block Loth_ Lot Size Directions: /LS az.) /S'cd e.47 nt) Gee iv F2. O = /Ca o F tsnniDr Facility: House_ Mobile Home Business_ . Other: Zoning Approva ye no A 3/7 Multi-family_ Other aFF/G6 3 emftaYtIS1002 Repair Area yes/no Bedrooms Seats Employees . CPO Flow /cos„n.Avplication Rate , V Hot Tub or Spa yes/no Special Fixtures . REPAIR NOTICE: REPAIRS MUST BE WITHIN Basement yeS Basement Plumbing yes o� 30 DAYS OR DAYS FROM DATE OF Water Supply: Private_ Public_ . PERMIT. - . wwwwwwww Type of System: Trench t.---11ed System Other (Specify) Tank Size: Septic Tank 1(187— � �.,.,�- Pump Tank Nitrification Field: Total Square Feet ..C3 v Depth of Stone J.2 ” Bed Size Trench Width 3 / Totaik.I,fpth of All Trenches ee * Number of Trenches .0_ Individual Trench Length n_/_/_ Feet on Center Maxisua Trench Depth .251r' Distance of Nearest Well S' h Lot Evaluation: Approve.( no (Void After 24 months) -y wwwwwwwwwwwwwww Topo i''0 I Slope I Sk t h of lot Evaluation Site - System Design ab t Texture 5247Y c/A e I rn cc Structure /34-Le.,Xy }I `o' Clay Min. / ' J Soil Wetness " 1 S'fS Em FeYL Soil Depth 36 OFF#C£ use a.VC. Restric. Hoz. at 36" Y Available space47' ol Overall Class SCPS;11-'"I IComments: ( - ', \. k1� t-al \ } �l� • , 4 1 .k07,.. \cz_i:ii I., ',:i fe::: ' ,w‘ II iRCNottes I It\i' ; r.I in I 1 EAST IrMAI DEN._ __—__---_ . w-w,c+ewwwww+rwwwwwww _ _ Permit Date • - `•' (Improvement Permit void after 61 months) Owner/Agent aj 1 ", ✓. Sanitarian 6-- trws,— Installed By . e .. - : "e Sanitarian!"-�., .. _ (Note any changes/informAeion`in red or by sketch on back) --c-, CATAWBA COUNTY ily,A IOOA SOUTHWEST BLVD _ a NEWTON,NORTH CAROLINA 28658 RECEIPT K._d �P PHONE: 828.465.8399 r. Tuesday, February 23, 2016 842 sM www.catawbacountync.gov PAYOR: Francis Well & Pump Co. Francis Well & Pump Co. (Francis, Michael) PAYMENTS TRANSACTION NUMBER: TRC-625778-23-02-2016 PAYMENT DATE : 02/23/2016 PAYMENT TYPE: Credit Card Payment by phone from Michael INVOICE NUMBER FEE NAME FEE AMOUNT 02-16-325521 Well Abandonment Fee $100.00 TOTAL PAYMENTS : $100.00 EHPR-02-2016-23261 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 5612 E NC 150 HWY, MAIDEN NC 28650 Applicant ANDY DEAL CONSTRUCTION, 210 W 150 BYPASS. LINCOLNTON NC 28092 C:7049135576 Owner BOJANGLES RESTAURANT INC, 9432 SOUTHERN PINES BLVD, CHARLOTTE NC 28273 C:7045272675 Contractor FRANCIS WELL& PUMP CO., 1501 MT. ZION CHURCH RD, IRON STATION NC 28080 H:7042324834C:7045069373 ** NO PEOPLESOFTACCOUNTASSIGNED ** receipt 02/23/2016 10:18 Page 1 of 1