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HomeMy WebLinkAboutEHPR-03-2016-23394 (2).TIF �$ .% THIS IS NOT A PERMIT Case # EHPR-03-2016-23394 Q� CATAWBA COUNTY HEALTH DEPARTMENT Cl l. . .J CI ° ` PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES • 'r ti 1842 SM Environmental Health Plan Review - OSWP �o`- ro o �I: NEW WELL 3 CI o f 40.1.. . Applicant TIMOTHY MILFIORNE, 2061 COLLIE TR, VALE NC 28168 C:828238I225 Owner LORA WOODRUFF MILT-IORNE, 2061 COLLIE TRL, VALE NC 28168 C:8282381225 NAME TO APPEAR ON PERMIT Lora Woodruff Milhorne SITE ADDRESS: 2061 COLLIE TR, VALE NC 28168 PIN # 267903227456 NAME of SUBDIVISION: Lot# 2-CC Section/Block PROPERTY SIZE: Square Feet 20,473.20 Acres 0.47 DIRECTIONS: Hwy 10 from Newton, Right onto Providence Church Rd, about 3 miles Right onto Collie Trail, Double wide at the end of the Road. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: New Well Permit. Existing water supply is neighbors well. Wanting well on the property to sell it. 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: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF Dbl Wide, 3 Bldgs EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 44x33, 2 Bldgs 8x10, 12x16 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO E9-chapplication 03/15/2016 09:13 Page I of 5 a:,• CATAWBA COUNTY case a EHPR-03-2016-23394 N' to n, Public Health Department Subdivision 6 6C:�'r® ,r Environmental Health Division PIN# 267903227456 -S. PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 1� :v NAME ON PERMIT: (LORA WOODRUFF MILHORNE),2061 COLLIE TRL, VALE NC 28168 ( Lora Woodruff Milhorne) Site Address: 2061 COLLIE TR, VALE NC 28168 Property Size: Square Feet 20,473.20 Acres 0.47 Directions: Hwy 10 from Newton, Right onto Providence Church Rd, about 3 miles Right onto Collie Trail, Double wide at the end of the Road. 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 cemplete site evaluation can be performed. Date: 3- 1 S— I b Signature of Applicant or Agent —75.1-y, In.A.\1p1"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 AREA2 FEENAME` _� �� g i 4ai Ii�D6 4 f. iir 'gkscr, xm F r^ �p5 LEFE a._,Stkf :ti,j, . #ff4 :�-f..s Ji�„,DATEY,SJ FEE AMOUNT 'I Well Permit& Inspection Fee 03/15/2016 $300.00 rTOTALFEES '3' Yis v?.rn4 ux?t4 , zi :ube,i+¢a r ��ti a 5 , 1I rti x k .i $300 00 R ar.r3tst 1 t:1 9111E.,&`.ta" .:.K 61WEIEME .,=rai. ff616E s '-'"tOtt:, fl�zd urtns661r-ftirE 66En'+.IN 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) P9-ehapplication 03/15/2016 09:13 Page 2 of 5 C rrAwBA THIS IS NOT A PERMIT COUNTY Y . CATAWBA COUNTY HEALTH DEPARTMENT `'''ti sue'' North Z Application for Environmental Services Page I Improvement Permit n Authorization to C nstruct n Septic Repair n Septic Malfunction n Septic Expansion ❑ New Well Permit Replacement Well n Well Abandonment❑ Well Repair n Existing System Inspection (Pre-Approval Required) Application is for New Construction n Existing Facility,. 4, Property Address a�1 tall Q V L 71 A/e -/Vt, Subdivision Lot# Acres I !� Section/Block/Phase Directions to Property kry�J∎( /0 6�-J C=lI\.,4- 1-4QL NAME TO APPEAR ON PERMIT?Owner n Applicant ❑ Contractor Applicant Contact Information Name , //p//2, / Address e26� r,/,?e, y //c% i(Jc Phone Cell Phone qm- '-- /aac- Owner Contact Info Name Address a C�9-it M •\ loiw Co l � t 1 IZ l V K) r NO Phone �a,t�- 93 c- /J..? c Cell Phone Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? n Owner n Applicant n Contractor Description of Existing Structures on Site #of Bedrooms *t _ Structure Dimensions r--1L-Iti..6 #of Occupants Basement ❑ Yes'NI No Basement Fixtures ❑ Yes No 9 . iipzI 1 ?x t co /.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 -0 No Does the site contain any jurisdictional wetlands? %Yes ([ 1 No Does the site contain any existing wastewater systems? ❑ Yes '19 No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes 'E7 No Is the site subject to approval by any other public agency? ❑ Yes 'E] No Are there any easements or right of ways on this property? Describe _ Existing water supply in use n Individual Well _ Community Well n Semi-Public Well El County/City/Township Water Line Is a public water supply available? ** n 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,/❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other ❑ Any cATA ]BA THIS IS NOT A PERMIT COUNTY - 1J CATAWBA COUNTY HEALTH DEPARTMENT �tlYi „e ` Application for Environmental Services Page 2 Proposed Facility Type n Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures n Yes ❑ No _ Accessory Structure(s) Describe # 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 n Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift #of Shifts Dining Area(Sq. Ft.) H Business Specific Type of Business Retail Floor Space #of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Church # of Seats Kitchen n Yes n No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type XIndividual Well n Semi-Public Well Community Well Abandonment Type n Drilled n Bored n Dug n Unknown Well Repair Requested I I Yes n No Describe 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. j 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 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 m /� J ile. Date Printed Name of Owner or Agent Catawba County Environmental Health ^i / A cm V O 0 /, 78.22 pr 20;08 100.13 *. OP COLL - • ji3 1r 1) _____ 5.80 . c5 c, : g�1 `v 175.91 crS' r, coo III .90• 487.15 Parcel: 267903227456, 2061 COLLIE TR VALE, 1in=50ft 28168 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 03/15/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 267903227456 Owner: WOODRUFF LORA Parcel Address: 2061 COLLIE TR Owner2: City: VALE, 28168 Address: 2061 COLLIE TRL LRK(REID): 100546 Address2: Deed Book/Page: 2943/1982 City: VALE Subdivision: State/Zip: NC 28168-8868 Lots/Block: 2-CC/ School Information: Last Sale: School District: COUNTY Plat Book/Page: 68/2 Elementary School: BANOAK Legal: LOT 2 CC PL 68-2 Calculated Acreage: .470 Middle School: JACOBS FORK Tax Map: High School: FRED T FOARD Township: BANDYS School Map State Road #: Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: COOKSVILLE Zoningl: R-40 Building(s) Value: $57,200 Zoning2: Land Value: $5,500 Zoning3: Assessed Total Value: $62,700 Zoning Overlay: WP-O Year Built/Remodeled: 2008/ Small Area: PLATEAU Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710266800J Building Details 2010 Census Block: 2009 Watershed: WS-III Protected Area 2010 Census Tract: 011802 Voter Precinct: P2 Agricultural District: PROXIMITY Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. ©2015, Catawba County Government, North Carolina. AM rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=267903227456&typ=P 3/15/2016 e re,05t. 05397 C A T A W E A COUNTY HEALTH E P A WI'M E N T ,// (704) 465-8270 Lot Eval. Improve. Permit /�Repair Permit_Cert. of Comp. Permit Oper. Permit Owner\Agent L THE.P-, M�sL-L- I'-IS Phone 3 zz -(25S03 Address Q -s , pox 2:•s-W / \pLE 2-' to$ Subdivision :coI4N w occ_-ri ...::u S.j�T 1 Section/Block/Phase Lot# Z--a Lot Size\ 1• o-+'z- Ac. Directions: ion, M O4. ?RoViDEMCE C14QtCH+ 'gyp O� CoLLIE TQA:u. I LAS o 'R T LOT x., ic-++i Facility: House Mobile Home )' Business_ . Other: Zoning Appro_v140/no #,Z4'3Un.207 Multi-family Other . Tax Map # 1/A26-/-/(( Bedrooms r Seats Employees . Application Rate • V GPO Flow Sao Hot Tub or Spa xes/Special Fixtures . 100% Repair Area yes/no REPAIR NOTICE: Basement yes C Basement Plumbing ye (hip . REPAIRS MUST BE WITHIN 30 DAYS OR Water Supply: Private X1; Public_ . DAYS FROM DATE OF PERMIT. Type of System: Trench /' Bed_Pump_Pump/Panel_Panel_LPP_Other Tank Size: Septic Tank 'I, oar'• CrtN"-0U Pump Tank n Nitrification Field: Total Square Feet 4100' Depth of Stone IL Bed Size Trench Width 3 C9 " Total Length of All Trenches -S ao' Number of Trenches 3 Individual Trench Length OD/ tot/ ICTh/ / Feet on Center 9 Maximum Trench Depth 7-4 4 Distance of Nearest Well Lot Evaluation: Approved yes/no (Void After 24 months) Topo ? -10 % Slope Sketch of lot Evaluation Site - System Design - Final Texture ec.Pr - . . Structure 6,c' Clay Min. - /1 V Ra*'-T 4 Soil Wetness :J/,a " _ Soil Depth 44"� l (_I Restric. Hoz. at:-'/n " V ZS #)— _ Available space '2r.//no f — — — Overall Class ea) U 0— — — — Comments: I _ — — — — — � (�) L:J Ica-€P S`�s-- -wt SU' FRO,A WC-�'�'I 1O ` FRA/�,/�1.07 C.r.1 FS ���g� [,-L�r3 cm., COPT T�(� z•1 rl Fi V'Y_ \� ice$I M-,C. :- 0 Cam V ElAi ( lu A-c ' EP/41-1 Septic Tank Contractors HOST contact the Sanitarian BEFORE ( changing permit. **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN THROUGH THE ISSUANCE OF THIS PERMIT** Permit Date /vt"-c-t4- ?., [Y q 3 (Improveme• - Pe :•jafter 60 months) Owner/Agent 67, ,/' ���a . itarian , �///�/r, - . Installed By Arit �/ d ,ii Date. ZFJ 4.3 Sanitarian Alta _It; - - i (Note any n'anges/informati�• red or by sketc on !ck) g IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY. THERE IS AN ADDITIONAL $25 CHARGE. ' White-Office Blue-Bldg. Insn.. Comn-c Yellow-Owner/Agent Green-Bldg. Inso. I.P. CATAWBA COUNTY S%,• '-'(`�\ Public De Case# WLS200S-00935 " v: Environmental Heapartrth ment Division Subdivision . \\, .EB,J PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 . Sect/BUPh/lMt# PT2B C.°„; (828)465-8270 FAX(828)465-8276 MD(828)465-821)0 PIN# 267903227456 ' Applicant/Owner: LORA WOODRUFF Site Address: 2061 COLLIE TR VALE NC' Form D Property size: SF .44 ACRES Directions: HWY 10/RT ON PROVIDENCE CH RD/LT ON COLLIE TR/LAST HOME ON LEFT `Sharing well next door" EXISTING SEPTIC SYSTEM INSPECTION REPORT Site/System Diagram * Na 111re oG • O r rCe t p r` aa6 ' �, I r6 (°6 • iti st• 44' oo r S c n� t I t_. r 282 tx r �1 L .. • 1 O. (-• PPPr.�.. i a 3 o , c • r Type of Facility: House Mobile Home X #Bedrooms 9 Business Specify Other _ Specify Proposed Additions/Accessory Structures: a Q On,.L)L W"Jc_ kt1y Approved Not Approved Reason Evidence of system malfuneton: YES NO_1" System Type/Description V I 64- Authorized State Agent: DATE: l J f l / iS NOT FOR LOAN APPROVAL Form E r;TidevinrVoi,, ViSnnn.nn rill. Case# EXSY-03-2015-058224 CATAWBA COUNTY Name Lora woodruff Public Health Department Address 2061 Collie Tr,Vale Environmental Health Division PO Box 389, 100A Southwest Blvd,Newton NC 28658 � (828)465-8270 Fax (828)465-8276 TOD(828)465-8200 • EXISTING SYSTEM INSPECTION REPORT Type of Facility: House ® Mobile Home ❑ #Bedrooms 3 Business ❑ Mobile Home Park Re-connection ❑ Other ❑ Specify Proposed Additions/Accessory Structure: 10 x 16 loft barn Approved ❑ Not Approved ❑ Reason Approval Not Required—Applicant Request Only Evidence of System Malfunction: YES ❑ NO ® System Type/Description 2a-gravel trenches Non Compliance Items Noted YES ® NO ❑ (Describe Below) Robbie Phelps 3-3-15 AUTHORIZED STATE AGENT DATE Compliance Items and Notes *The existing system crosses the property line. 'The existing system is less than 5 feet from the house foundation. *There may not be enough room for a full repair unless some of the accessory buildings are moved or torn down. 'This document is not an approval of the existing septic system or repair area. NOT FOR LOAN APPROVAL EXISTING SYSTEM INSPECTION REPORT Site/System Diagram Y`i 1 'C '•'i 0 e � o v Yl I1 L ft pvSJ- y , 1' I I .AIL 0{ lit pin. 1 je■r X00 W.11-1 I - S° NOT FOR LOAN APPROVAL ?A \ CATAWBA COUNTY TT ' IOOA SOUTHWEST BLVD RECEIPT f ,: Y NEWTON, NORTH CAROLINA 28658 a►e,' `C PHONE: 828.465.8399 C.) r ' t Tuesday, March 15, 2016 te t 1842 sM www.catawbacountync.gov PAYOR: Milhome,Timothy PAYMENTS TRANSACTION NUMBER: TRC-637686-15-03-2016 PAYMENT DATE : 03/15/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-326143 Well Permit & Inspection Fee $300.00 TOTAL PAYMENTS : S300.00 EHPR-03-2016-23394 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 2061 COLLIE TR, VALE NC 28168 Applicant TIMOTHY MILHORNE, 2061 COLLIE TR, VALE NC 28168 C:828238I225 **NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner LORA WOODRUFF MILHORNE, 2061 COLLIE TRL, VALE NC 28168 C:8282381225 receipt 03/15/2016 09:13 Page I of I