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HomeMy WebLinkAboutRBPR-05-2016-23838.TIF �S3A THIS IS NOT A PERMIT Case # RBPR-05-2016-23838 G• Q CATAWBA COUNTY HEALTH DEPARTMENT 0 . . r�o r. f 0 1r'"' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ' :Fuze 1842 sM Residential Building Plan Review - Building New _ •o o f {4� 1 IMPROVEMENT- AUTH_CONST - NEW WELL 0' d .o Applicant ROBERT MORGAN, 14101 BLACK FARM RD, HUNTERSVILLE NC 28078 H:7045823818 C:7045823818 HOME:7045823818 Owner DORIS RHYNE, 5147 HICKORY GROVE RD, GASTONIA NC 28056 H:704-866-0158 C:704-678-1160 HOME:704-866-0158 NAME TO APPEAR ON PERMIT Robert Morgan SITE ADDRESS: 5093 LAKEVIEW CIR, SHERRILLS FORD NC 28673 PIN # 460604923839 NAME of SUBDIVISION: ASBURY PARK Lot# 7 Section/Block B PROPERTY SIZE: Square Feet Acres 0.55 DIRECTIONS: head south on Southwest Blvd, left W C St, continue on 16S/left Campground Rd/continue onto Slanting Bridge Rd/ right Keistlers Store Rd/left Barkley/left Lakeview Cir/property on left PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: new single family dwelling w/ basement 66 x 67 Existing IP - house much larger Applicant requesting repair exempt Old permit for this address applicant say no house/system ever there?? **house must meet 15ft side setback 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? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF vacant EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 4 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 66 x 67 #OF NEW BEDROOMS:: 4 BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED?Yes Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO 09-ehapplication 05/12/2016 08:05 Page 1 of4 tig•• CATAWBA COUNTY Case It RBPR-OS-2016-23838 yQ �.4 Public Health Department Subdivision ASBURY PARK Q �e „y, Environmental Health Division PIN# 460604923839 �'a4-. PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 /i842 t NAME ON PERMIT: (ROBERT MORGAN), 14101 BLACK FARM RD, HUNTERSVILLE NC 28078 ( Robert Morgan) Site Address: 5093 LAKEVIEW CIR, SHERRILLS FORD NC 28673 Property Size: Square Feet Acres 0.55 Directions: head south on Southwest Blvd, left W C St, continue on 16S/left Campground Rd/continue onto Slanting Bridge Rd/ right Keistlers Store Rd/left Barkley/left Lakeview Cir/property on left 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 AREA1 '...1{iFECNAMEII.Nr�dlifj liL: •.• d I`j'I'���IIf1JIIIII i "AI`��l Phil AMOUN'T�l+ " r I I �1�a]DATE ini l Authorization to Construct Fee (New/Expansion) 05/11/2016 $300.00 Fee Improvement Permit Fee 05/11/2016 5150.00 Well Permit& Inspection Fee 05/11/2016 $300.00• 'It Ili�Ili s a IiIITOTAliIFE'' l ; ; o it 1�IIIM114. 1I'Il' `IIII ' tl��i illEliall,l r. I n1�u I. I�(k� �LV�nI Is75o 00 II i�L I it r. I W„s szuziltJd1WfS a .k• , ,iiiam Wi1;Wr- nalnlo.rr qualtGC ,.,;WU„nl ir'r:mW1 r 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) 09-ehapplicanon 05/12/2016 08:05 Page 2 of4 THIS IS NOT A PERMIT Case # RBPR-05-2016-23838 try GH CATAWBA COUNTY HEALTH DEPARTMENT D • - t D •PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES /842 sM Residential Building Plan Review - Building New 0•o o y 1 IMPROVEMENT - AUTH_CONSTY- NEW WELL o' d, Applicant ROBERT MORGAN, 14101 BLACK FARM RD, HUNTERSVILLE NC 28078 H:7045823818 C:7045823818 HOME:7045823818 Owner DORIS RFIYNE, 5147 HICKORY GROVE RD, GASTONIA NC 28056 H:704-866-0158 C:704-678-1160 HOME:704-866-0158 NAME TO APPEAR ON PERMIT Robert Morgan SITE ADDRESS: 5093 LAKEVIEW CIR, SHERRILLS FORD NC 28673 PIN # 460604923839 NAME of SUBDIVISION: ASBURY PARK Lot# Section/Block B PROPERTY SIZE: Square Feet Acres 0.55 DIRECTIONS: head south on Southwest Blvd, left W C St, continue on 16S/left Campground Rd /continue onto Slanting Bridge Rd/ right Keistlers Store Rd/left Barkley/left Lakeview Cir/property on left PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: **house must meet 15ft side setback **new single family dwelling w/ basement 66 x 67 *"*existing IP - house much larger/applicant requesting repair exempt- old permit for this address appliication say no house/system ever there?? 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? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF vacant EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 4 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 66 x 67 #OF NEW BEDROOMS:: 4 BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED?Yes Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE. ANY: YES Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO E9-ehapplication 05111/2016 17:10 Page I of 4 v,• CATAWBA COUNTY Case# RBPR-05-2016-23838 x n 2 Public Health Department Subdivision ASBURY PARK 6 .-_,3, 9 Environmental Health Division PINli 460604923839 PO Box 389, 100-A Southwest Blvd,Newion.NC 28658 18.2 su NAME ON PERMIT: ( ROBERT MORGAN), 14101 BLACK FARM RD, I-IUNTERSV ILLE NC 28078 ( Robert Morgan) Site Address: 5093 LAKEVIEW CIR, SHERRILLS FORD NC 28673 a Size: Square 0.55 Property uare p S Feet Acres Directions: head south on Southwest Blvd, left W C St, continue on 16S/left Campground Rd /continue onto Slanting Bridge Rd/ right Keistlers Store Rd/left Barkley/left Lakeview Cir/property on left 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 AREA1 [!FEENAME frI' { DATE FEFArMOUNTY Authorization to Construct Fee (New/Expansion) 05/I 1/2016 $300.00 Fee Improvement Permit Fee 05/11/2016 $150.00 Well Permit& Inspection Fee 05/11/2016 $300.00 ''iii i` r :` TOTAL FEES - ° r� $750.00;y i li i 1.---,.:1 1S= 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 05/11/2016 17:10 Page 2 of 4 CATAWBA THIS IS NOT A PERMIT O1/T 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 Existing Facility ❑ Property Address 5093 Lakeview Cir - Subdivision Asbury Park Sherrills Ford,NC 28673 Lot# 7 Acres 0.538 Section/Block/Phase Driving Directions to Property head Son Southwest Blvd.L on W C St.slighty Ron W D St,continue onto NC-16 Buisness S. L on Campground,Continue onto Slanting Bridge Rd,Ron Keistiers Store Rd,L on Barkloy.L on Lakeview Cir, property on the left NAME TO APPEAR ON PERMIT? ❑Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name Robert Mark Morgan Address 14101 Black Farms Rd. Huntersville,NC 28078 Phone 704-582-3818 Cell Phone 704-582-3818 Owner Contact Information Name Doris C Rhyne Address 5147 Hickory Grove Rd. Gastonia,NC 28056 Phone 704-866-0158 I Cell Phone 704-678-1160 Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site"G" #of Bedrooms •1. Structure Dimensions #of Occupants Basement ❑ Yes ❑ No Basement Fixtures 0 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. DYes D No Does the site contain any jurisdictional wetlands? res Cl No Does the site contain any existing wastewater systems? es 0 No Is any wastewater going to be generated on the site other than domestic sewage? D Yes 0 No Is the site subject to approval by any other public agency? D Yes a No Are there any easements or right of ways on this property? Describe Existing water supply in use • Individual Well • Community Well • 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 Sys em ype(s): (systems can be ranked in order of you/preference) o Accepted ❑ Alternative .Conventional Innovative ❑Other 'Any 3 i 2 CATAWBA THIS IS NOT A PERMIT ___ CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type Primary Residence ❑ New Residence ❑ Addition to Residence #of New Bedrooms 't 4 Project Description new home Structure Dimensions 66'W x 6TD #of Occupants 4 Basement ❑ Yes ❑ No Basement Fixtures 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 U Food Service Specify Type #Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift #of Shifts Dining Area(Sq. Ft.) L Business Specific Type of Business Retail Floor Space #of Employees per Shift #of Shifts L 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. 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 � W6,/ 1/ 6- Date 5/i6(1 e2 Printed Name of Owner or Agent (201n- ti IAA& Gin Catawba County Environmental Health } I r V'14 Uu 11 v uiJ. I.'rp•1,IIIIN�I0 t le ya441;-J 1l„tat d'd • ?-4 rllAlt 1 ♦. ,fitri �1},, p'l f f ',ri W I 4f'P 11 11y1 @G� i i VII .. Y r IIHni 10dn17 I jl4 + "y`' i q r, 1 , try 1 JIB[ g0,n , stn pll 114 r 'I u� ': orttt„itp�acpr I. r��lr 1 :trip.r l l 1! ' M{ U2 p.m.sat�Ofi s.' Y�14'904011 ii ii I iL 1 igArd1C+. ro ®P 1° , A0 11,Q �. O .... ` Ia� rt'l�. �, § � 5ro1i min n19m :lir . eily sc w,p+�,Ar . R•. 1,r .,dti, $$.iiikl ,atl,�p m�p�tkAt+6+ r b��tlt '* N,ryE,N� Pkll !t, * 1 t v ra'S u'�tia+.'. �`rN' I ;1. ..0'.11,.11 �9 pRf VkdEdari ',fe"Ih r y_,A,t,lr� '.?.:°1ttl' g"J AI1m4l. , tthil _. s t;°"�.�' MYI Ii4149710pt111 ..1° "54.00 *,..- �"� 11 ' Iw�1 1i 7 �I 11. :lift cj3�u6r 75.04 r C Ia' 05 r w � EC 1 A 4- ? �r r 4 EBEL) ,78 or 4.4 00 t It : ,tio• 4 00 \ Vrn � X02 0 1,901 Parcel: 460604923839, 5093 LAKEVIEW CIR 1 in=50ft SHERRILLS FORD, 28673 This map/report product was prepared from the Catawba County,NC Ceospatlal Information Services. Catawba County has made subslanael ofl ons to ensure the accuracy of location end labeling Information contained on this map or data on this report.Catawba County promotes and recommenr, the independent verification of any data contained on this madreport product by the user.The County of Catawba,its employees,agents,antl arise fry this cl map/report shall not be the use Ihefreolnbyy armall erson damages,loss or liability,whether direct.Indirect or consequential which arises or may Copyright 2014 Catawba County NC 04/25/2016 Catawba County Environmental Health N I F Nm i I i I 1 11 F 1 I I y 1111 kl P ,L1`44 '' l I'll ' i. 1 ' lI 1 , k tll I I� , i ' 11 i lr Iris 111 I rilr.'l I1,,, '1r1 y `1 r «f'+i ,tI 1 41, r , � ' I„ w F1 b%: h I 11 III l .r 1 1 till' 1 1 I � 111 " �;i°� a , f l a l ;>y+'S III �i 1 jjll F I e II" I!• tip *l, �r/,11 + II4'p. 1,i , , t,c,-'4 NI� y1 I (� �. t �� i p.%ra 1, 1 1 '� ?-4,47:411I, 1 t waa. a t l �� 1 , d 4�, 0.lp i 1I (-4.,, i 1� I I 4,,,,I•444:11 ,„ i0-,, .-r, yg JI� �i R441,i f I I 1 hk .'(4,i 4 ,4 111i• I I ! 1'1111 � 7! � f k ' 1,114 I ;hl Itlwt l .� Ii I R' 'rNhi4 � ( XyA� I � I ' , i ( 'Ski f , , 1 Md,I11 1 . 1, .,11 j1111 if . � r I 1'lS11 r ; s2' HI:, ,.1 �•d "" I4 I { r N: f11'py��4A ° 'Lill 1 ..� ( 444•4‘,..11 l�l� I III 11 t'.di i� iN' , l Vx3'a,yy V 1 v 0114 I I l ii�i"I„I I 75.00 I p,e I Ii.r l 1 �rn} 77.30 X11 III t..s 1� f o III II '� r. �IjI V qyl I ji .'a' `r j I ii,,,,, , o 11111 1 x J $ 55.0 91 1 fill • 1 \ \S\Ss\ 61R w 1 3 o A 102, 11902 Parcel: 460604923839, 5093 LAKEVIEW CIR tin=50ft SHERRILLS FORD, 28673 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 05/10/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC • Parcel Information: Owner Information: Parcel ID: 460604923839 Owner: RHYNE DORIS C Parcel Address: 5093 LAKEVIEW CIR Owner2: null City: SHERRILLS FORD, 28673 Address: 5147 HICKORY GROVE RD LRK(REID): 19222 Address2: null Deed Book/Page: 3013/0338 City: GASTONIA Subdivision: ASBURY PARK State/Zip: NC 28056-7690 Lots/Block: 7/ B School Information: Last Sale: School District: COUNTY Plat Book/Page: 11/118 Elementary School: SHERRILLS FORD Legal: LOT 7 PLAT 11-118 Middle School: MILL CREEK Calculated Acreage: .550 Tax Map: 018BX 01008 High School: BANDYS Township: MOUNTAIN CREEK School Map State Road #: 2684 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoningl: R-30 Building(s) Value: $0 Zoning2: null Land Value: $242,400 Zoning3: null Assessed Total Value: $242,400 Zoning Overlay: CRC-O,WP-O,FPM-O Year Built/Remodeled: null/null Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: null/null Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710460600J Building Details 2010 Census Block: 4030 WaterShed: WS-IV Critical Area 2010 Census Tract: 011504 Voter Precinct: P41 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 lot 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. J ©2016, Catawba County Government, North Carolina. All rights reserved. °APO 1 _ h l )204- txe t gevarn Ha) Sc,\ )0kAr, -)OlcA l erm It-- in6s 6,1 n evri\-here http: /gis.catawbacountync.gov/nomap/parcel_report.php?key=460604923839&typ=P 5/10/2016 - ---:•:,. —...,o, ,,,, —s i9 • us N I- - t M1 • , S j o 1 ^ '' g's rl c V y. t : .. i 3. a e a 9 $ NA-IObV,J Q8 �9a • • `aq 210 z n L� -" : - Q tt p W d mP N rc Q W . A J $y • 1 Iv a o: . cpu _ L m �a a Oo .. 0 O > >. { $ v fQ` - Q YO } . i � I • W V Z - fu- 01 Q W U„. ,_ 0 •: -1—n ' ' ' . l'• . . a . ,0 0 8'‘'.,' gV U Z i *o 3ol , 9 C . ms t V9 . e C " 1, ;e J •1 F -..... ee 4 a Q a . ''a. irt\ v _ M1 of.ee 3t. rn i `ate . ... • 4 . CATAWBA COUNTY HEALTH DEPARTMENT NEWTON , NORTH CAROLINA COMPLETION PERMIT FOR SEPTIC TANKS PERM-IZT. "N° 0 116 0 pp���,�� DATE : .25 /tS' OWNER &/) ,,C,O, e!] ADDRESS lerc-02 , 'y /92-N .,c62,74/. ZJ1/X. BUILDING CONTRACT A UVL.SIpN �°, tj r r it �I ��yibO/f` LOCATION a„, /-`1`:41i/ e4,4 . 6.. ,-f. - sL:,OJOT # 7 LOT SIZE 3.0, OD n± BLOCK OR SECTION HOUSE (J.,"-- MOBILE HOME ( ) BUSINESS ( ) OTHER ( ) FHA-VA LOAN ( ) SEPTIC TANK: (SIZE /pap GALS) WATER SUPPLY: NO. BEDROOMS 3 NO FIXTURES 2 INDIVIDUAL r/ PUBLIC GARBAGE DISPOSAL UNIT:YES ONO 4--)--- IF WELL, TYPE : BORED DRILLED ,,,DUO AUTO WASHING MACHINE : YES ( -) 110 ( ) DISTANCE FROM SEPTIC TANK OR NEU/ RESf NITRIFICATION FIELD: /p n SQ ..5D.FT. POLLUTION: � 41--- FT. 1) NUMBER OF LINES /o SEPTIC TANK INSTALLED BY: 2) LENGTH AND WIDTH OF LINES C'We,.,Z') )>/ ,.A -u p<0 / (/ . PERMIT FEE $ a) BEDS STEM (L.)- _. CERTIFICATE OF C . LETION BY: b) TRENCH SYSTEM ( ) St0„;„..4-," 3) DEPTH OF STONE IN LINES /Q "_ REMARKS : ADEQUATE FALL (GRADE) ON: 1) BUILDING (HOUSE) SEWER LINE : YES 0.)/NO ( ) 2) NITRIFICATION LINES : DATE,INSTALLED: 19.7„ u� 2t. ,cpc YES ( NO ( , - - - - - - - - i SEPTIC TANK LAYOU sic. ' 1 a • \ 1 pa o W F H a i O a 1s NEALTH.DgPARTMENT COP Cl. 3 .• . . r:, z.- — — — S \ pERxiiT No. OIDD7 8 PERMIT FEE: yp,n a T PERMIT VOID AFTER 36 MONTHS CATAWBA COUNTY HE H D __ MENT l IMPROVEMENT PERM OWNER OR C$RACTOR; � � DATE: /O. /�'`,{'S--- ADDRESS: Lt._ . .2- / // �:� C PHONE /� g3- o?3 S/7� i LOCATION: p :1 / ! _ - -- /J SUBDIVISION: /1 . /P J LOT 11 SECTION OR BLOCK: LOT S Notified to check wit Zoning Yes ( ) No ( ) Zoning Approval ii �7 House ( t4----Mobile Home ( ) Business ( ) Other ( ) Flow Rate - - _gpd Bedrooms: 3 Bathrooms: 22. Special Fixtures: Other: Basement .- Yes ( ✓r No ( ) Fixtures in Basement - Yes ( ) No ( _- Pump System Ys4.3L.. ( ) Garbage Disposal Unit Yes ( ) No ( ) , Water Supply: Private ( t.4----Public ( ) TA11K SIZE: /D2)b gallons Comments/Special Instructions: _ NITRIFI ATION-FIELD: 4Number of Lines 6 ;Length and width of Lines,, System must be installed as shown. Any '•(a) Bed System /(1A'T a x/2") " changes will be made only with prior Health :(b) Trench -System q6" .Department approval. If unforeseen problems or Trench System 30" X arise during installation, contractor must Total Square Footage . /oRy _??Qpt.,._4f_at4119_t.1 call Health Department, I GERTI V�VE REVIEWED AND AGREE TO THE OVIS ONS ON-THIS PERMIT. Owner/Age S itarian Final approval of this septic tank system sha, ' ,no` way be taken as a guarantee that the system, will function sa : • • any given 'perio• o i . . , - - - - - f±)10--,p �S'YTE-AND-SEP-TIC- ANK-PSI j ,F ( _ 4- - - - . CJ J 6° ')C114" /4- // • 1-74Elle-1 1 l m,,,,gyp 'Health Department Copy ' Site Factor: - Soil Grou• Soil Texture Class Application Rate Slope and Landscape Position U Soil Drainage S - - a , Clay Soil R Depth De S P II' u e Silt Loam 0.6-0.4 Restrictive Horizon .l u Loams Clay Loam - --- -. .. Silt Cla Available Space S U y Y Other - S - °a - U • (Specify) ` Sandy Clay .- Soil Characteristics: S -CAS)—UU ` illa Clays Silty Clay 0.4-0.2 Repair Area Required: Yes ( tJ✓ No ( ) Clay. -- - - - *Bed systems are allowed only in soil Groun III. ' ~ Case ll ,tl CATAWBA COUNTY o 0 L�'IPV-10-2015-066138 ally Public Health Department Tti'c� „ Subdivision Asbury Park <�l p)� Environmental Health Division 14/5: • ' PIN!/ 460604923839 Niiit,ci r PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 rr _n*_. � '� 1.01/I 7 w Y 1 1 NAME ON PERMIT: SUSAN MARTIN, 2656 STEEPLECHASE RD, GASTONIA NC 28056 Site Address: 5093 LAKEVIEW CIR, SHERRILLS FORD NC 28673 Property Size: Square Feet:23,958.00 Acres:.550 Directions: Hwy 150, right Slanting Bridge Rd, left Keistlers Store Rd, left Barkley d, left 2nd Lakeview Cir, 2nd vacant lot on right Improvement Permit Facility: Primary Residence - House Permit Category: New Septic Bedrooms 4 WATER SUPPLY: Private Well Basement? No Basement Plumbing? No INITIAL SYSTEM SPECIFICATIONS Permit Valid: Expires In Five Years: _X_ No Expiration: Projected Daily Flow 480 g.p.d Proposed Wastewater System: 50% REDUCTION Type: IVA-ANY SYSTEM WITH LPP DISTRIBUTION PUMP REQUIRED ***** OPERATOR REQUIRED Permit Conditions: To not grade, drive, or fill over any designated septic area. 'This permit Is issued fora 28ft x 51ft four bedroom house. REPAIR SYSTEM SPECIFICATIONS Repair System Required? Required Proposed Wastewater System: 50% REDUCTION Type: IVA-ANY SYSTEM WITH LPP DISTRIBUTION PUMP REQUIRED ***** OPERATOR REQUIRED 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()Felber permits. It is the responsibility of the applicant/property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are 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 Svstems' ('I SA 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. Robbie Phelps 10/28/2015 AUTI IOR IZED STATE AGENT APPROVAL DATE Permit Expiration Date: 10/27/2020 e: No grading or contraction activity is allotted in areas designated f'ar system and repair without approval of the Health Department. amnia 10/25/2015 14:51 Page I of • • Catawba County Environmental Health Taipv- (a-Zots_ 066X38 r • 9 .. _ -.._. - 75.00 ',,..,,._---, • . 77.30 \Z‘y -- � 1ry9/ . fr S�'c. r . � co " � 5087 • I 7 � Y • 57 1 1 ti. Y`''s' NI 60- *.rki b_. I _ qo • o r dL LWL• nli Car.IL &II f `\u i tot! J ro 71- • . 1\0011 * \11\.i �p2,o >91 I I Parcel: 460604923839, 5093 LAKEVIEW CIR tin=50ft SHERRILLS FORD, 28673 This map/report product was prepared From the Catawba County,NC Gecspalial Information Services. Catawba County has made substantial efforts is ensure the accuracy of locaton and labeling Irfortnadon contained on this map or data on this report.Catawba County promotes and raconvnends the independent verification of any data aa,tained on this map/report produd by the user.The County of Catawba,its employees,agents,and personnel.discaim,and shall not be held liable for any and on darnagos.loss or liabitrty,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 Caaswba County NC 10116/2015 . . S3 0 `L.22,@, i� r° w DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES Sled of___. DIVISION OF ENVIRONMENTAL L HEALTH PROPERTY ID M: 011SITE WASTEWATERSECIION COUNTY. SOIUSITE EVALUATION • for ON-SITE WASTEWATER SYSTEM ZZZe y . • OWN�L' Sera /`'."t(h APPLTCATIONDATE ADDRESS: c 91 °) LAO). VI}Y /it DATE EVALUATED: PROPOSED FACILITY: 4 b A- PROPOSED DESIGN FLOW(.1949): II i J . PROPERTY SITE: LOCATION OF SITE:ry PROPERTY RECORDED: WATER.SUPPLY: tl Private 0 PublIc Se Wen 0 SFR'sg 0 Other. EVALIIATIONUETBOD: 0 AugtBe±g OP Fit 0 CR • 'TYPE OF WAflWATER: 91 Sewage 0 adust:•1 Process 0 Waxed .:............... .. ._. :_._"_....:L...E ,_ E _ *_.... ayry,:r•,-../�.y�yyy� y.y� _'[.'. __ —__ i::iii - ::ui :rv:'rner_: uini ici a--. J01L'ML[Mi+OVl 4• A. _ b._ I94ir YROFILEF&CIOI.FS _ 1941 lino ao� �. �GK>;'B �Oh ` r SWLr- ,�,9u � r 5O1L.= 7947' -10$5 a=404-if -P2}Optt:�: l..i _POSitioN D i r.MCF'U SN IEi•F11CW� _ N'E't}LSS� $Olk . kei $ $.TC� ::sI:OP&'x i0 T ,TF Rs h1l 0A1,()C COW re Ate Ct1SS. Ho>riz =x _. __ _,.._ id �:,dam.« :, : �= .�e,.i. .. ... _ .._ .._ '—. 1- • OH y --th p °s i .._ • 1 5 it (K-qt tL 5bk. it-.rr r-f,• • I . _ o-'(.b. . ..&L J-LX -- 1-•F^ f, to • �.o% u— ! r-c1..A rb A ft zP I 3s . . . i • I - 00-12, U- rfu I !p" Yr .re }t- 41J ftLi -1, r6N Ti' r, re 3 y4-51) 1 5- 1 YF,- •- • 9f 4 s ' 3<s- I I • 4 „ I I • ' DFSCRIP37ox NITIAL SYSTEM REPAIR SYSTEM I OTHER FACTORS(.1946): �l A�u'1sM.e Svcs(.1941) S f SITE CLASSIFICATION(.1946): r j S�Type(s) S o°/o so,'•ib or�xc JRJESUa: °1.1 c 1'�c 1r . LShe LIAR v 7,5- , '3 • COMMENTS‘