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HomeMy WebLinkAboutEHPR-03-2016-23296 (2).TIF $A THIS IS NOT A PERMIT Case# EHPR-03-2016-23296 CATAWBA COUNTY HEALTH DEPARTMENT a ` iti 0 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1 ' 4 /842 sM Environmental Health Plan Review - OSWP : o to t o.: • • Y .1 IMPROVEMENT Applicant CHRISTOPHER BURCHELL, 3781 ANDERSON MOUNTAIN RD, MAIDEN NC 28650 C:8288510301 Owner EVAN TOWNSEND, PO BOX 651, CLAREMONT NC 28610 C:828-729-9215 NAME TO APPEAR ON PERMIT Christopher Burchell SITE ADDRESS: 1300 FOX DAIRY RD,NEWTON NC 28658 PIN # 376004608799 NAME of SUBDIVISION: Eyan Townsend Lot 1 Section/Block PROPERTY SIZE: Square Feet 87,163.56 Acres 2.001 DIRECTIONS: hwy 10 E, right on Balls Creek, left Love Rd, 2 miles right on Fox Dairy Rd, approx 1/4 mile on left, intersection of Fox Dairy and Walling Dr PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP for property subdivision 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? No Are there any easements or right-of-ways on this property? Yes Property Easements Description: Walling Dr is partially on this property APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 75 x75 #OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-ehapplicaoun 03/01/2016 12:02 Page I of5 t$n CATAWBA COUNTY Case# EHPR-03-2016-23296 . . ?". in , Public Health Department Subdivision Eyan Townsend 2 F4 Environmental Health Division PIN# 376004608799 -,e PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 1842 s. NAME ON PERMIT: (CHRISTOPHER BURCHELL), 3781 ANDERSON MOUNTAIN RD, MAIDEN NC 28650 ( Christopher Burcheli) Site Address: 1300 FOX DAIRY RD,NEWTON NC 28658 Property Size: Square Feet 87,163.56 Acres 2.001 Directions: hwy 10 E, right on Balls Creek, left Love Rd, 2 miles right on Fox Dairy Rd, approx 1/4 mile on left, intersection of Fox Dairy and Walling 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 and labeling of all property lines and corners and making the site acce ible/�.s�so'that�cogsplete evalu Non a be performed. Date:_ ?2- /6 Signature of Applicant or Agentyi't,., ) 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 E o � ji. _ a i7,715/11764: !i 12 3,I re i a € ri5 a ` " C FEENAME _ w i to 1.; " SEDATE ^ #FEE#AMOUNT Improvement Permit Fee 03/01/2016 $150.00 .1170,170- TOTA L n FEES i �� p i. a r wWir;a � e i i r �S50a 0 0�y i 7 c4 A r � Ee e i n ..�,i `'Uii ,. l«c -t' v,liiku- ". t _1"_ —T-1_ ..u4rjw.;is„tc::!..;4a: `}„impac 'sfr}zii,,,S33 :.t 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-ehapplication 03/01/2016 12:02 Page 2 of 5 CATA\ ® THIS IS NOT A PERMIT cou r ` � 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❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction J Existing Facility ❑ Property Address 1300 Fox Dairy rd. Subdivision Newton N.C. Lot# 1 Acres 2.001 Section/Block/Phase Driving Directions to Property From Hwy. 10 turn right onto Ballscreek then a left on Love rd.Go apx 2 miles&take a right onto Fox dairy rd. property is apx. 1/4 mile down on the left @ intersection of Fox dairy&Walling Dr. NAME TO APPEAR ON PERMIT? ❑ Owner ® Applicant ❑ Contractor Applicant Contact Information Name Christopher Todd Burchell Address 3781 Anderson Mt. Rd. Maiden N.C. 28650 Phone Cell Phone 828-851-0301 Owner Contact Information Name Eyan Townsed Address P.O. Box 651 Claremont N.C. 28610 Phone Cell Phone 828-729-9215 Contractor Contact Information Name N/A Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner I:I Applicant ❑ Contractor Description of Existing Structures on Site WA # of Bedrooms *t Structure Dimensions #of Occupants Basement ❑ Yes ❑ No Basement Fixtures a Yes ® No The Applicant shall notify the local health deportment upon submittal of this application if any of the following apps to pp y Y� upon any a apply the property in question. If the answer to any question is "yes", applicant must attach supporting documentation. © Yes 0 No Does the site contain any jurisdictional wetlands? Yes 0 No Do"S the site contain any existing wastewater systems? ® Yes a No Is any wastewater going to he generated on the site other than domestic sewage? CI Yes A No Is the site subject to approval by any other public agency? 0 Yes ❑No Are there any easements or right of ways on this property? Describe Walling Dr. Existing water supply in use Individual Well Community Well Ll 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) ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other B Any CATAWBA THIS IS NOT A PERMIT Coos Y CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type 0 Primary Residence ❑ New Residence ❑ Addition to Residence #of New Bedrooms *j' 3 Project Description 3 bed, 2 bath, &2 bay attatched garage single story family home Structure Dimensions 751x75'w/decks # of Occupants 3 Basement ❑ Yes D No Basement Fixtures ® Yes O7 No ❑ Accessory Structure(s) Describe N/A #of New Bedrooms *j' if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑ Yes n No Plumbing ❑ Yes ❑No Describe Plumbing Needed i Multi-Family Residence# Units N/A #Bedrooms per Unit*j' Total#Bedrooms *j' Structure Dimensions U Food Service Specify Type N/A # Seats Floor Space-Entire Food Service Facility (Sq Ft) # Employees per Shift #of Shifts Dining Area (Sq. Ft.) Li Business Specific Type of Business N/A Retail Floor Space # of Employees per Shift # of Shifts ❑ Other Facility Type Specify N/A If Church# of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type III Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ No Describe Calculated Design Flow, Corm._(_ .- I Ad:iiti tau i,f'_Emaiien nisy Ise is r-ke d s :..ef-end mi ..sgn flow o v�i iLriili ear:ttC5. This>n.v2 will determined red du ri^n C^;5n_ nt:nn with on-site staff. *Arty rocs that ..ill be intended for s:lcc :nf,zt the. ..._ of eea . .... ea or for fiiture ccessidesraticn. should ld be noted as a bedroom and counted on all applications. The unmhcr ofbe.droomsv- ! !...- o. by �ederh . . confirmed � .:r•+d' fir,. s.e...,...,.. v:JJ:"sv at the ttucC 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 pc:ruh must be issued with the Authorization to Construct. SYSTEM REDESIGN AND/OR RETRTP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) Improvement Permits issued as a result of this inf reaati•us arc valid for S years oy or may be oat c.a it ng under crt.is sp..-62-:2:1 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 arc transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the prc2used faeility. -I lisi-ct;cud.:1'...; .c.iii.,:si_u,,usi-:,iti.f," 1,:sit:she::Illnusuicui pro., ..d Iscrein is;1rue,complete_nd cori ect Aftt.ilorizk2d county and state officials arc granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I a77 solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a ccm*naete ei c.,...Iteition in',e performed. Signature of Owner or Agei Date J" /— X0 Printed Name of nwn e" oc t � / i,5 4phcc .. _7 - . gyp' CATAWBA COUNTY ran O IOOA SOUTHWEST BLVD RECEIPT NEWTON, NORTH CAROLINA 28658 a a PHONE: 828.465.8399 U `S ®a►°° mc' Tuesday, March 1, 2016 1842 sm www.catawbacountync.gov PAYOR: Burchell, Christopher PAYMENTS TRANSACTION NUMBER: TRC-629833-01-03-2016 PAYMENT DATE : 03/01/2016 PAYMENT TYPE: Credit Card 158672296 INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-325730 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EHPR-03-2016-23296 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 1300 FOX DAIRY RD,NEWTON NC 28658 Applicant CHRISTOPHER BURCHELL, 3781 ANDERSON MOUNTAIN RD, MAIDEN NC 28650 C:828851030I ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner EVAN TOWNSEND, PO BOX 651, CLAREMONT NC 28610 C:828-729-9215 receipt 03/01/2016 12:02 Page 1 of 1