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HomeMy WebLinkAboutRBPR-04-2016-23669.TIF v�€YAI .G THIS IS NOT A PERMIT Case # RBPR-04-2016-23669 <� "'Ir L CATAWBA COUNTY HEALTH DEPARTMENT D LI. • ro. vl dm O r. ft14 ° PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES { \842 sM Residential Building Plan Review - Building Addition a ff. fa to IMPROVEMENT - AUTH_CONST - EXPANSION a 1 n p it. ; _ ••211 l� Ap plicant BROYHILL WILES, INC, 3808 DONSINONE DR, DURHAM NC 27707 C:9193069959 KENTB a BROYHILLWILESINC.COM Owner MATTHEW COHN, 4541 LOOKOUT DAM RD,CATAWBA NC 28609 8:8583542854 C:704-822-6497 SALESrdSUBSTANCEINCORPORATED.COM NAME TO APPEAR ON PERMIT Matthew Cohn SITE ADDRESS: 4541 LOOKOUT DAM RD, CATAWBA NC 28609 PIN # 377302663313 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet Acres 26.05 - DIRECTIONS: HWY 321S/HWY 16 N/RT OXFORD SCHOOL RD/STRAIGHT TO LOOK OUT DAM RD /DRIVEWAY ON RT AFTER TREE NURSERY PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY• . 600 WATER SUPPLY: Private Well DESCRIBE WOR -addition to existing dwelling (3 bedrooms) 48 x 27 (360GPD Existing home is 2 BdRms. (240 GPD) Total 600 GPD SITE INFORMATIO 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? Yes Are there any easements or right-of-ways on this property? Yes Property Easements Description: driveway& power line APPLICATION FOR: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF single family dwelling & metal building EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: House 50 x 70 NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 4 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: additon 48 x 27 #OF NEW BEDROOMS:: 3 BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED?Yes Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: YES OTHER: INNOVATIVE: ANY: Other described: 1:9-chapplicution 04/I8/2016 10:50 Page I 01.5 CATAWBA COUNTY Case a RBPR-04-2016-23669 �^� Public Health Department Subdivision h L 4 . I" Environmental Health Division PIN# "?Y 377302663313 "•nr~' PO Box 389. 100-A Southwest Blvd,Newton,NC 28658 /g.2 .� NAME ON PERMIT: (MATTHEW COHN),4541 LOOKOUT DAM RD, CATAWBA NC 28609 ( Matthew Cohn) Site Address: 4541 LOOKOUT DAM RD, CATAWBA NC 28609 Property Size: Square Feet Acres 26.05 Directions: HWY 321S/HWY 16 N/RT OXFORD SCHOOL RD/STRAIGHT TO LOOK OUT DAM RD /DRIVEWAY ON RT AFTER TREE NURSERY 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. Date: Signature ofApplicant 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 AREA2 grist 'flrf t I h,iP I I i Ito fl{r n�t's�Mtls.', tjl pay �dii 1I1fA,`' r I t h"1li"II":�� kFEENAME �f�t�ll�ili�llf ��is ;1 lf�i�l l�I�)µ�,. ,thliitG��ll�tLilsDATE{I �I�lls FEED �I� � � � � I ���� E�i I I MOUNTLI Authorization to Construct Fee (New/Expansion) 04/15/2016 $300.00 Fee Improvement Permit Fee yy 04/15/2016 8150.00 • a 40100 V llllI $ 51•COILa 3'`,,i������lltQllLfa'.:_...__ $rL�.n JIkhWU!:L.allhfla�ll:!4G1pil1.i __..:L:;eIJ1u0liII11Illlhli!6kl I . aitufamis ,dAtu'1ir8uffilatith.".S5 FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-ehapplicar ion 04/182016 10:50 Page 2 of 5 AJ$A - arr THIS IS NOT A PERMIT Case # RBPR-04-2016-23669 t a CATAWBA COUNTY HEALTH DEPARTMENT p: ;:c.::19 'vy `C PLAN REVIEW APPLICATION FOR.ENVIRONMENTAL SERVICES l p ti3t• . ' 842 sM Residential Building Plan Review - Building Addition �, •a. _to .4 IMPROVEMENT - AUTH CONST - EXPANSION • .d, Applicant BROYHILL WILES. INC, 3808 DONSINONE DR, DURHAM NC 27707 C:9193069959 KENTB @BROYHILLWILESINC.COM Owner MATTHEW COHN. 4541 LOOKOUT DAM RD, CATAWBA NC 28609 B:8583542854 C:704-822-6497 SALES @SUBSTANCEINCORPORATED.COM NAME TO APPEAR ON PERMIT Matthew Cohn SITE ADDRESS: 4541 LOOKOUT DAM RD, CATAWBA NC 28609 PIN # 377302663313 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet Acres 26.05 DIRECTIONS: HWY 321S/HWY 16 N/RT OXFORD SCHOOL RD/STRAIGHT TO LOOK OUT DAM RD /DRIVEWAY ON RT AFTER TREE NURSERY PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 600 WATER SUPPLY: Private Well DESCRIBE WORK: addition to existing dwelling (3 bedrooms) 48 x 27 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? Yes Are there any easements or right-of-ways on this property? Yes Property Easements Description: driveway& power line APPLICATION FOR: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF single family dwelling & metal building EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 50 x 70 NUMBER OF EXISTING BEDROOMS:. 2 #OF OCCUPANTS: 4 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 48 x 27 #OF NEW BEDROOMS:: 3 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: YES OTHER: INNOVATIVE: ANY: Other described: E9-ehapplication 04/18/2016 09:29 Page 1 of 5 $A CATAWBACOUNTY Case# RBPR-04-2016-23669 i� Qublic Health Department Subdivision 6 � Environmental Health Division PIN# 377302663313 1## PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 is 2 a. NAME ON PERMIT: (MATTHEW COHN),4541 LOOKOUT DAM RD, CATAWBA NC 28609 ( Matthew Cohn) Site Address: 4541 LOOKOUT DAM RD, CATAWBA NC 28609 Property Size: Square Feet Acres 26.05 Directions: HWY 321S/HWY 16 N/RT OXFORD SCHOOL RD/STRAIGHT TO LOOK OUT DAM RD /DRIVEWAY ON RT AFTER TREE NURSERY 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. 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 AREA2 FEENAME DATE FEE AMOUNT Authorization to Construct Fee (New/Expansion) 04/15/2016 5300.00 Fee Improvement Permit Fee 04/15/2016 5150.00 -TOTAL FEES 5450.00 •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-ehapplicafion 04/18/2016 09:29 Page 2 of 5 V 1J ,• _ 1 4\ 1 lueu$1'!. t phi CATAWBA COUNTY HEALTH DEPARTMENT L<)UNT � ,� Application for Environmental Services Page I D,!3 7(4° Improvement Permit,, Authorization to Construct Septic Repair ❑ Septic Malfunction ❑ Septic Expansion r►: New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility ❑ // Property Address 'YS1 l L.� ,FTt7, ' a4 Subdivision FL/; 3773 02-66 33/3 a Lou •• • • 6- _1 ' Lot# Acres I Sec ion/Blo k/Phase ( �� Driving Directions to Property 1470 fnS/- 7 � (� - t24rc Sdeo 1 �c,a 1-Je }o �. 2-'t rll s 2 t o bon, RI -2o1 /7, t r,3f/- - c1,r1vLY1%m NAME TO APPEAR ON PERMIT? Owner L, Applicant ❑ Contractor I Applicant Contact Information KPn}t 0b/byti;11w,Ies;n , ,awl Name Bt-t, yl".. `ll U 7e2 c - Ke--- f ij e ` pr`aid eJ Address 3500 D,ivl&,v% 011c, `brAre. ;Dvrt,.rw. • A)Cl- -2--7 70-7 Phone 90%- 306 - /9 •j Gl' Cell Phone 9/9- 30G- aP3 27 Owner Contact Information Name f ,# (0L 14 Address ys'/! L•00L atiF Aotti.4 Rel. . Oa-Fal.,J(zc. , /UL LRC�1 Phone esg— 5--z-j- Zg si [ Cell Phone aS-- yc- /— wry Contractor Contact Information Name '&o y 1,-4 f UUJ i JC I' Ttnr• . Address /1.* g Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner Applicant ❑/Contractor Description of Existing Structures on Site Z-$zdrevw }fvJ Se. F (�'�e-tu( LSD r/d:�_ #of Bedrooms *t Z- Structure Dimensions SaX7c) #of Occupants Basement, ❑ Yes E./.-No Basement Fixtures ®iYes• K3<0 The Applicant'shali notify the local health department upon submittal of this application if any of the following apply to the property 91 question. If the answer to any question is "yes",applicant must attach supporting documentation. 0 Yes No Does the site contain any jurisdictional wetlands? / 117'Yes ® o Does the site contain any existing wastewater systems?-S pIrc., 4-pons uvv���,`Cpr7�t„ 0 es No Is any wastewater going to be generated on the site other than domestic sewage? c' Is the site subject to approval by any other public agency? S Yes C No Are there any cements or right of ways on this property? Describe it)e ltla/ 3 � p4„ Existing water supply in use Individual Well U Community Well Li 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): (sy,stems can be ranked in order of your/preference) CBAccepted ❑ Alternative La•Conventional ❑ Innovative ❑ Other ❑ Any r ri „ (D A n13 13 n rGruvu r J COUNTY CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Pro sed Facility Type 3 [Primary Residence ❑ New Residence d itipn to Residence # of New Bedrooms *t Project Description 3- &,�u0 ant /fit Structure Diimme ions 443 X 2-7 #of Oct pants Basement L� Yes ❑ No Basement Fixtures of ® 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 Li 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.) U 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 ❑ 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. 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 transferable. 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. 1 understand that lam 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 performed. Signature of Owner or Agent A .._� Date A//z �/1� Printed Name of Owner or Agent Kevt-4" kit!r 5 v 11 -1✓ah" Aya 'I C 1 . I I / 1 I 1 I I I nmy 1 la I 1 1 M 1 •P I i I ■ Ic..n 7 p r:28 1 1 I 1 / -1. 1 Ir I I � A 1 T.I I I r � � 1 !p I + I La ^I 1 1 rt I 11 i- �- t 1 'a I + ti150 Q ((,E�f i la/ 1 m. 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A � ; i DRAWN KY'. 5T[ DAL%, 1 1/20/15 # 1 I CHECKED BY: - SCALE: 65 Rom) Highlands Log Structures,Inc. JIHI,i,1 The Cohn Residence o lir,dlo r NOTICE 26299 Harrison Road = 1511 �� 1 = _ ."-- Abingdon,VA 24212 11pp11i i'i; 4541 Lookout Darn Rood 1;ii1111.1I Catawba. NC 28609 - -•w��,^ •--+-•.-- I I i Ia°i'{ ; rc Y II Iii it se, aR4kc,:=: '2'-azifttrti III]o = i) ril a∎ I, al ,®C*Zsl,f I wank f D � ° I_ri t d ai o , e e i_ ( ;3 Ili i ' I f4 lit 1, ;1 �3�.°.V Ij Sri Itil L__ --- 'i 9 am. ---x ,. , i j _ — ari "I- — t6.'.,'a /. 111; �' - li a Iti^u,K42, (11;9114. _ --`-I'1.; % 1 sari d� qqtp o } d 6 Fiu i .A 4 S 's'v 1 •�4 I z I F -Ix nd1!u' JYiv^ "u` 'C' / CS'„S,rt""M1`-w�[�,v It ?F � f1 I t'� i 7< .y.1 ili 5 L$ S I ' b i-_.—I - -I I I OR.PR BY 5R RATE 1111005 ILO aIaxeu In. .x.IS: A5 NOTW Highlands Log Structures,Inc. �`:iil�6i1 ritLil t The Co hn Residence It-it J.NOTICE —.„V.....- 26289Hrn6O04212 'lid(�yiydi�E ANOgdon.VA 24212 Zii pi 4541 Lookout Dam Rood � x111101 I.. S Cataw0a. NC 28609 :..........„�,�,� •- •W^ €l,F At i 1 1 • I 1 _% ..1 TL I ,fil I +� , , 41 I p ' ° o ii N .. r --t it ?'4p---la-- .'E' © �: T :0a ® N 111 �M---- -T g - 7 . - a. a-' ei 25 -4E2 '--' '® _I_ z , Z---t li, I, ©� `,4 IL) u: - © $I 0 5 i I--- I -i, 1, 1 Imo , 4-t r tl 1.1 LE 1 - ' ' (71.1 I 3-^" — r-- ----� r — v rJ I 1 ' I -- _ m IV 1 li - g 1 II '-[ _.1 i -ear i 7 �j rir- ij 8 01 4L1((''' . I 4, f i2 1 'r--L 4 _ I �r=-9 ale ® ., e 35 - mo__-IF. _ __ _=__.._ - I-mil i.t 1p F q 5y 35f I - .-_� 15 I 11 I 11 1 r 11° -==_ s� 6FF @bhs a, 4 1 E . :R - I � ---- -- E --- -` I ;,: 1 it L i i a l• DRAWN Pr: sr D.OI'. 1(/2015 # 1! dl: �\^ oacxeo WV: - 5c.¢: As NORD Highlands Log Structures.Inc. III`i'1�1i j The Cohn Residence 4 q i ! r CZ NOTICE 26289 Harlson Rood Abingdon.VA 2412 ' ��vllll 1t 4541 Lookout Dam Rood "'� `-"—'�— 1111/11111 + 15 c�.C� —it llitili Catawba, NC 28609 •-,._., -.... - I. h�l I Catawba County Environmental Health J ) \ -.._ Aso I '•., 4, ,... zr 4ij�4�r`It�4�t�ltl4;u Pr r_ S‘...%- ---. �.� ••••.... 350.23 i �M . II II II ill! 11:..----7/7 \IL yo Ili ...... 1 .... 0 • a I i .n Parcel: 377302663313, 4541 LOOKOUT DAM 1 in=150ft RD CATAWBA, 28609 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. Coovriaht 2014 Catawba County NC Catawba County Environmental Health • tip' ----N___„,...„, a \ eeo °so 9,5.5 • oo ti8 coot - 'Piss \ ( q R) so! El Ail) :„ 1\10 Hi1/4Ni: • 7 , doer„.....„:7tx.; r J` `Sr 4 /i1Se-- —Aii. a la 1((ki „..s I r cosilmi‘I I I M ill I 111 I II I I I M I Wril I ik- - ---1 I air. i. Parcel: 377302663313, 4541 LOOKOUT DAM 1 in=300ft RD CATAWBA, 28609 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. Coovrioht 2014 Catawba County NC Parcel Report Page I of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 377302663313 Owner: COHN MATTHEW Parcel Address: 4541 LOOKOUT DAM RD Owner2: COHN NICOLE S City: CATAWBA, 28609 Address: 4541 LOOKOUT DAM RD LRK(REID): 11574 Address2: null Deed Book/Page: 3252/1251 City: CATAWBA Subdivision: null State/Zip: NC 28609-8231 Lots/Block: null/ null Last Sale: $286,500 on 2014-08-12 School Information: Plat Book/Page: School District: COUNTY Legal: OFF LOOKOUT DAM RD RD1006 Elementary School: OXFORD Calculated Acreage: 26.050 Middle School: RIVER BEND Tax Map: 011 Y 01010 High School: BUNKER HILL Township: CATAWBA School Map State Road #: 1006 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: CATAWBA RURAL Zoningl: R-40 Building(s) Value: $251,100 Zoning2: null Land Value: $90,500 Zoning3: null Assessed Total Value: $341,600 Zoning Overlay: WP-O Year Built/Remodeled: 2004/null Small Area: ST STEPHENS/OXFORD Current Tax Bill Split Zoning Districts: null/null Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2008-03-18 Building Permits for this parcel. Firm Panel #: 3710377300K Building Details 2010 Census Block: 3009 WaterShed: WS-IV Protected Area 2010 Census Tract: 010101 Voter Precinct: P27 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. ©2016, Catawba County Government, North Carolina. All rights reserved. P/4 50phceiP t' §/3g ford._e y;si s (Qoo& ? ) * IPS U http://gis.catawbacountync.gov/nomap/parcel_report.php?key=3 773 02663 3 1 3&typ=P 4/12/2016 '-'4, 1kr Le CATAWBA COUNTY HEALTH DEPARTMENT Posk' • • Telephone (828)465-8 71 TDD (828)465-8200 WLS # 01- CI 27!U IP x AC /N Rpr Print. • 0 r Prmt.. Sy . Type 9W Well Print. X Replacement Well Well Rpr Prmt. Owner/Agent < JAS�t fll • )<L4 P Phone Address Subdivision Sec ion/Block/Ph se LoW Lot Size 'Sections iWA • - / CA- • 74 -ffll..n•.� ff - . `0 dJ �. C o- i_c4- a a44-a. " 1 - C.1- d U at cS" .tas 1»t 0 leek • .,ez^ /n %4- k5i int Property Addres• 4.6`tl'1 LCC/C1.r aflvt at %1" %fn Facility. Hous Mobile Home Business Multi-family Other Pin Number 3773 O z(e 33/3 Other / Zoning Approval t! H Bedrooits N Seats N Employees Application Rate GPD Flow Hot Tub o -Spalle Special Fixtures Basement ye'S 100% Repair Area yes/no Basement Plumbing yes/no Water Supply. Private Well Public Semi-Public ****4************************************************************************************************************************ Type of System: Trench X Bed Pump Pump/Panel Panel LPP Oytherr z 2,5-y.-3 Septic Tank Size )000 _Pump Tank Size /' Nitrilicalion Field. Total Square Feet p Depth of Stone �Z/� Bed Size Trench Width 3 ..f -, Total Length of All Trenches Number of Trenches 6p; 2.. Trench Length /+ Len ) /1)t/ / / Feet on Center g / 9 Maximum Trench Depth .36 Distance of Nearest Well /SO fir *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* ********************************************************************************************************'****************** Topo ( % Slope / Texture 0,91.- / Structure B- SJ1Z3 Clay Min. 1' 1 Soil Wetness --- " Soil Depth 4:k 1l 1 Restric Hoz at — Available space yes/no 7;9 Overall Class S 125 U I r Comments I 1' to - a rr. +ze ct�(sle440 ev ( v us srz I ll C Well a fa Filter Required i I Riser required when ie kJ tankis more than 6 5C�— — —� t inches deep. **NO GUARANTEE R W• RRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** *************************************************************************************************************************** *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility An Authorization to Construct is valid for (5) five years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. The siting of the well by the Health Department staff is to provis e protection from kni m poss. le sources of contamination. No volume of water is guarante•d at any site by the Health Department. Permit Date / 7-O s EHS _� • 4 are Owner/Agent_ / Jk /P Septic Tank Installed / . J� o/trair/ Date 3'4-- 4: EHS cl". in, ___ Well Installed By Be- Ps Well Grout Approval Date 7-7- 3 / Well HeadUApproval Date ,y- /d Date Sample Collected Date of Results Results EHS `3 ''��� �,.-y� _ White Office Yellow Owner/Agent Pink Building Inspection Autpoi4ation to Construct a• CATAWBA COUNTY Case# IMPV-08-2012-030732 "��® 2 Public Health Department Subdivision . G -- ' Environmental Health Division PIN# 377302663313 `�' PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT# I¢ .2 w NAME ON PERMIT: MATT COHN, 4541 LOOKOUT DAM RD, CATAWBA NC 28609 0 ' ,o:�.f 0 Site Address: 4541 LOOKOUT DAM RD, CATAWBA NC 28609 `• n . •Property Size: Square Feet 1,134,738.00 Acres 26.05 1 l0 0 . - ,r, Directions: HWY 321S/ HWY 16 N/ RT OXFORD SCHOOL RD/STRAIGHT TO LOOK OUT DAM RD /^yo�rr ` DRIVEWAY ON RT AFTER TREE NURSERY .'' .. Improvement Permit _INITIAL SYSTEM EXISTING Facility: Primary Residence - house Permit Category: Other Bedrooms 2 WATER SUPPLY: Private Well Basement? No Basement Plumbing? No INITIAL SYSTEM SPECIFICATIONS Permit Valid: Expires In Five Years: _X_ No Expiration: Projected Daily Flow 240 g.p.d Proposed Wastewater System: CONVENTIONAL Type: [IA-CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Permit Conditions: REPAIR SYSTEM SPECIFICATIONS 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 approve 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 the applicant/property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements arc met. This Improvement Permit is subject to revocation if the site plan, plat or the intended use changes,or if site conditions are altered. 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 'Laws and Rules for Sewage Treatment and Disposal Systems' (15A NCAC 18A.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. Megen McBride 08/24/2012 AUTHORIZED STATE AGENT APPROVAL DATE Permit Expiration Date: 08/24/2017 No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department. E9-chpermit 08/24/2012 13:52 Page 1 of 3 IP �RegR- zo1z.- (013 . `I5y i 4x(covt- (am Rd. fr G7 441(v)iv Sfskcrv� WO VISVCaIly fuhciDAln 420( 12 . ?ropoy�l touildii) rusk toe a {+1i,,uM.%w, ac X541, frost, an wcUU ani S 5e is 5-Sknh 4 Yetair area . Y . fron, +. to Nel .vide, grape , cA, ow .41 otJeV Sys}eir G✓ repairare4. Prover kas creeks a a Polder Zinc r�l i .0( - way i b€-tl- arc Inrclrfds of �ee- 0.wa■ 07■ well 4 Sertic. J to Lookodi loam Rd, :rove! •nrewa Propose , y�� garo3G 7150' S"'��" Li 40 X 00 \ ' A5 ° In / 7' [.\O` 11t'Q it 9 r J+ p -F 9 F -o- e.,_..C j ?4' vio I x ,._69. DEPARTMENT OP ENVIRONMENT AND NATURAL RESOURCES Sheet_o1_ DIVISION OF ENVIRONMENTAL HEALTH PROPER.Y ID f: ON-SITE WASTEWATER SECTION COUNTY:. • SOIIIsn'E EVALUATION n�'�lit� m I / I • for ON-SITE WASTEWATER SYSTEM /6!! t PTi 1 AN k APPLICATION DATE �s IZ 26PR 08 2OIZ ADDRESS DATE EVALUATE 20-(Z PROPOSED FACRTTY:.2- 6a.W EROPOSFp DESIGN FLAW(.1949): 240 . PROPERTY sae 24.05 Aens LOCATION OF SITE_49if 1 book.ou Da n. got Lola w PROFFBTY EECDRDFIT. WATFRSUPPLY; E Prime 0 Public N win i s d oma EVALUATION METHOD: M Aug=Bndng 0 Pi! UO3 T OP WASTEWATER: 5 Sawago 0 Industrial Pinar' -0..2 €__ __. — , :.j_' T.ir.17: ter_ ___ii�:. __ -_'T: , 'yam-�.-..^"[::-':_ :�... J _ _ 'yL.IJJ _ E_L•:�.I:IL 1= ti: ..:_ �:::Iif.I^::Y:=�:�'i���yryi3�::^ .. -. ._. "� 1 - _ : s r.-,, :•1 i� _ .. . ..'^lam._ �_� _ y Y _..=--=._._�__�..._ ' P..021:. :7r-�CLLN�'t:��•vl::�I� Yl:t::l::r•':: i394f ..._.._ � Z :{�M::T�i.t'� il:Y. __ ....� ._ .: i_-2E. '}!T_L C'. LJ.N 1:;. ilitl itlnt� :L:O: = —.-.:.'_–: It ., ELM_c«.• :y�..5, 'y_iwii r ji i...t_.. ......._....__ _ _ _.._.i._ —•'—•- 3_ _ t .s_ _. -y..�.�y y.{..._ il.:6"?!:: c : :::ti sic::::_:. _ -_:.itT. ____ _ Y:::CL-. . ��LC..I : siit-_�i:'�_�::C::'1.;1 _fir�._.�.- ::��..._• � _ •_ _ ~ �a� ' =:c^altar �'8.��_ .. .c:::u_ o_ > -ee��-v_ _e �t._._............?=—?.� ���: —i�._� —vJ -r�MN�� _..i�Rc-.._::_�.y���1M Wy.�� —._ . V'_�sF � �. .iJ 7o_EJ:as';- iL: c 1iii°1i h�.r. ' .6�f;=`�=-i-�.y�1y� vr'.:s._,..�3 -��__: _ .-.a::" D-YO CI CI,/ s -it,c$.kXP - 1 • —A.:- 'ft _- - PS . - 0,3 • •• 2 • . . • 1 3 _ • • . 4 . •- YXIStiM _ - - DESCRIPTION n.. tTALSYrfm RrAntSYSTDJ OMER FACTORS(.1946): SITE CLASSIFICATION( 9 ): Arable SDI=(195) P5 ( M spa=Type+ 1 A EVALUATED BY: Je Marla el . OTHFR(S)PRESENT:, ` • . SAe LIAR 0',3 COMMENT'S: `1 »tfc � .2 r kF $' b°- f•, � 1rt `k lr+Fb �} " 611-0 �part "' "..4:2A/44g4 , v OrpIF/ • • \-IOUSL Y4i We k _s{t ' (N 4D ccv�G,