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HomeMy WebLinkAboutEHPR-05-2016-23848 (2).TIF �13A THIS IS NOT A PERMIT Case # EHPR-05-2016-23848 trifle a CATAWBA COUNTY HEALTH DEPARTMENT .v O 441' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES j 842 sM Environmental Health Plan Review - OSWP oo c • REPLACE WELL Owner BRUCE& SHEILA MOSTELLER, 1178 BOLTON RD, CATAWBA NC 28609 B:8283226545 C:8282412092 NAME TO APPEAR ON PERMIT Bruce & Sheila Mosteller SITE ADDRESS: 1178 BOLTON RD, CATAWBA NC 28609 PIN # 379004732903 NAME of SUBDIVISION: Lot it 2 Section/Block PROPERTY SIZE: Square Feet 143,312.40 Acres 3.29 DIRECTIONS: 1-40 East, Right Oxford School Rd, go through town of Catawba, Left onto Hudson Chapel Rd &go past the church, Right onto Bolton Rd &go past Welcome Baptist Church,Yellow house on Left. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: WATER SUPPLY: Private Well DESCRIBE WORK: Replacement Well -Water is muddy. House & Shop on the property. The Shop used to be a Barber Shop but is not currently being used for anything at this time. The well will supply water to both. 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: House OTHER DESCRIPTION: DESCRIPTION OF House, Shop, Bldg EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: House 26x54, Shop 72x30, Bldg 25x25 NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? 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?: YES 89-ehapplic■lion 05/12/2016 16:09 Page 1 of4 CATAWBA COUNTY Case# EHPR-05-2016-23848 .7 tIni Public Health Department Subdivision iJu �* Y Environmental Health Division PING/ 379004732903 r"'tl"• PO I3ox 389, 100-A Southwest Blvd,Newton,NC 28658 /g 2 m NAME ON PERMIT: ( BRUCE B. SHEILA MOSTELLER), 1178 BOLTON RD, CATAWBA NC 28609 ( Bruce & Sheila Mosteller) Site Address: 1178 BOLTON RD, CATAWBA NC 28609 Property Size: Square Feet 143,312.40 Acres 3.29 Directions: 1-40 East, Right Oxford School Rd, go through town of Catawba, Left onto Hudson Chapel Rd &go past the church, Right onto Bolton Rd &go past Welcome Baptist Church, Yellow house 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 an labeling of all property lines and corners and making the site acces i e so tat a complete sit ev ation can be performed. Date: -j//g/(90/%' Signature of Applicant or Agent 6 Q 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 LFc,iillllhllIh9lil .I P„. Ip11iIIIIIFtat+ {'1ddtl t: ll [. tuI, "IInl :jmililiIlllm'i EENAME - LIE illibill Ihi' r � !" i. C1 I �o DATE1ll ..:: �i�FEEAMOUNTA a. Well Permit & Inspection Fee 05/12/2016 $300.00 i rl1oTa ;EEdE ,, ,k,h;aai ' lu Ya :.11Ih11lIIl1I a I61f i�lillI $s oo'oqU;. : � I s . u11 IWIW :,villiu44uu'WuW` uVlpaVhWrM A .,ti d.^aWlhOWLWCi WUtalI &nin mAtIiluUliu(x 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 05/12/2016 16:09 Page 2 of 4 CATABA THIS IS NOT A PERMIT CO �] UNT]' ''a CATAWBA COUNTY HEALTH DEPARTMENT N..,hc Application for Environmental Services Page 1 Improvement Permit Authorization to Construct 111 Septic Repair Septic Malfunction El Septic Expansion I I New Well Permit n Replacement Well Well Abandonment n Well Repair ❑ Existing System Inspection (Pre-Approv I Required) ❑ Application is for New Construction ❑ Existing Facility Property Address // 78p ,6°/ton 0 Subdivision iA l 441 / . ;Jest At Lot# Acres Section/Block/Phase *_ Driving Directions to Property L - iig is-a-0- to Ox Po r c!? sn i ct /R 4, t u n 3-y t t.-0,'n F- Into hun OFCa.fa whet, tor✓i af ter a //PieuJ) thr2vg-k ttOwn i.e Lef-{ ort chapel QQd, impoustf/Urli/2,, Lho/e/Iap7;5TeA1 a✓eh tv✓n orL NAME TO APPEAR ON PERMIT? ❑ Owner ❑ Applicant n Contractor /30?to h A d O �a-S 4/ekomC pl`%sY �eh Applicant Contact Information Pct 5't g vR v )' rC7 /e/Jow`tt ac6POn 4-‘27ef Name Address Phone Cell Phone Owner Contact Information y�� K_ NameT).tleest J1 ;Cr ap /flasA°//�° r Address //7f .c&;)(,,/70 Ad p Phone c0 dl—o Lu 10a., ,c c90-6 6, / Cell Phone ffOhie(gdgn op0 .�rZ9 Contractor Contact Information u/OT K( Fo8) 3-;), -654'S Name License# Address _ Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? in Owner n Applicant ❑ Contractor Description of Existing Structures on Site at k _ &_,„ I Al_ # of Bedrooms *t Structure Dimensions ner # of Occupants Basement ❑Yes }"` No Basement Fixtures ❑Yes g]No 3 , n,,,` , W7c,x J 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 NI No Does the site contain any jurisdictional wetlands? 0 Yes ❑ No Does the site contain any existing wastewater systems? ❑ Yes 14 No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes .,:,N No Is the site subject to approval by any other public agency? ❑ Yes f?`'G�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 J 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 ❑ Any c A rrA jp A THIS IS NOT A PERMIT , COUNTY UN1 wV rl�) CATAWBA COUNTY HEALTH DEPARTMENT „„ Application for Environmental Services Page 2 Proposed Facility Type { I Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement ❑ Yes n No Basement Fixtures Yes n No Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling E Yes ❑ No Plumbing Yes n No Describe Plumbing Needed - 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.) ❑ 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 individual Well n Semi-Public Well n Community Well Abandonment Type n Drilled n Bored ❑ Dug n Unknown Well Repair Requested n 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. 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 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. g ' 5/ /a/i)o/' Signature of Owner or Agent ,/_ . ,/, A. /�/�% . �e�� Date Printed Name of Owner or Agent 1) ; q. yt e ,77o s ifiP //e jr Catawba County Environmental Health 2791.10." • • N' AI) 0,OA • • O • (174) 2 cc: :) (895) Parcel: 379004732903, 1178 BOLTON RD 1 in=60ft 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. Copyright 2014 Catawba County NC 05/12/2016 Catawba County Environmental Health ( .. _ N N 30> v H- i -111 al 279 a IIV� I 133 67 I. r D • 137.94 , , f t_.- 0 z Ili i • 1 - 13 10 ! . 1 0 s , ',I \ „,„, . .„ 4/ Parcel: 379004732903, 1178 BOLTON RD 1 in=150ft 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. Copyright 2014 Catawba County NC 05/12/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 379004732903 Owner: MOSTELLER BRUCE W Parcel Address: 1178 BOLTON RD Owner2: MOSTELLER SHELLA H City: CATAWBA, 28609 Address: 1178 BOLTON RD LRK(REID): 300344 Address2: null Deed Book/Page: 1925/0976 City: CATAWBA Subdivision: null State/Zip: NC 28609-8001 Lots/Block: 2/ null Last Sale: School Information: School District: COUNTY Plat Book/Page: 37/3 Legal: LOT 2 2 PL 37-3 BOLTON RD PL 37-3 Elementary School: CATAWBA Middle School: MILL CREEK Calculated Acreage: 3.290 Tax Map: null High School: BANDYS Township: CATAWBA School Map State Road #: 1831 TaxNalue 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: $45,200 Zoning2: null Land Value: $34,800 Zoning3: null Assessed Total Value: $80,000 Zoning Overlay: DWMH-O,WP-O Year Built/Remodeled: 1971/1974 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 #: 3710379000J Building Details 2010 Census Block: 1006 WaterShed: WS-IV Protected Area 2010 Census Tract: 011503 Voter Precinct: P21 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. \ MIQ\\\°1 (VD http://gis.catawbacountync.gov/nomap/parcel_report.php?key=379004732903&typ=P 5/12/2016 C.N.::::: t ° a N O a LI 0 3 :E. • ,- . vl W r i Rz 'ui, / S..k.... 0- v O c, F V . \ X C C O 01 T tC O n E• z �... � a • a. W 2 `� v c o W J v o - -1 (4 V Y Y Y i _ \ L r td1 NO ti \ O O r Q Q Q < O u p F c '6 cG W • Z o ILl op 0 u J a 4 Q Q M •= nG Z ..< ® � w ° in U I—,. Z u -Z S ° At ° Q o, a, W z O i. , a o N N i Q Q s 3 Z W P — o a Z N Z V W V U• } N c I-Z Z Q. Q d .1 N in d 3 C N W ° 'Cr o O O . . m u N x . .. Q J m 0_ i t = C Q tir..:) O ---- ~ O 3 c O :`- -a c w c N ` ti a U O c LL w aci a S c a O f - X i. ce 1 . U T C y o 1.- > a `o a Y n O L U a `•••••.„....C. w o i^ u �.t ` v c W 11 " T b 3 O C a U �: d -'7t c o c cn O. Ls; 0 \„ - c..0 c o U O fl Z' a Z 1 O F. 6 Y I- U1 E 'p �.. h o O c Q Q 1_ ` 'i ° c 1) v_ O t. 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Z1"••••• 1 a w Z o ° c ° c c 4- U O w . `N g — O ° ii ct L c o O c ° E ea O H S w a y'A CATAWBA COUNTY � 100A SOUTHWEST BLVD 2 NEWTON,NORTH CAROLINA 28658 RECEIPT �, ,;ca, saps PHONE: 828.465.8399 (-) ire C Thursday, May 12, 2016 r 184 sM www.catawbacountync.gov PAYOR: Mosteller, Bruce&Sheila PAYMENTS TRANSACTION NUMBER: TRC-671597-12-05-2016 PAYMENT DATE : 05/12/2016 PAYMENT TYPE: Check 9196 INVOICE NUMBER FEE NAME FEE AMOUNT 05-16-328309 Well Permit & Inspection Fee $300.00 TOTAL PAYMENTS : $300.00 EHPR-05-2016-23848 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 1178 BOLTON RD, CATAWBA NC 28609 Owner BRUCE& SHEILA MOSTELLER, 1178 BOLTON RD, CATAWBA NC 28609 118283226545C:8282412092 **NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 05/12/2016 16 09 Page I of 1