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HomeMy WebLinkAboutRBPR-05-2016-23865.TIF • THIS IS NOT A PERMIT Case# RBPR-05-2016-23865 L, III ci CATAWBA COUNTY HEALTH DEPARTMENT Cho iCI %447 Y PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ' ,.,'�. 17-'�; 1842 s. Residential Building Plan Review- Building New . •a • r IMPROVEMENT- AUTH CONST REPLACE WELL - Ai "-. 1: 4itSt ` 1 'h , EXPANSION - ■ BANDO Er NT Contractor SAME AS OWNER,, Owner JAMES"MICHAEL" STRICKLAND, 1 136 TORRENCE CIR,DAVIDSON NC 28036 C:704.692-3874 Paid By ALYSON STICKLAND, 1136 TORRENCE CIR,DAVIDSON NC 28036 NAME TO APPEAR ON PERMIT JAMES "MICHAEL" STRICKLAND SITE ADDRESS: 4869 TRESTLE LN.DENVER NC 28037 PIN # 460604545994 NAME of SUBDIVISION: CRESCENT LAND AND TIMBER CORP Lot N 138 Section/Block PROPERTYSIZE: Square Feet Acres 1.1 DIRECTIONS: Campground Rd, left on Catawba Burris,Right on Bankhead,left on Trestle Ln,left on driveway PRIMARY CONTACT; Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK:*8/23/16:per Michael Strickland revise to 3 BR**New site built home, 5 bedrooms, 95x98, no basement, attached garage with finish bonus room *Old House to be removed. Existing system will require:expansion. Homeowner stated that their is new lines on the property that he believes may not have been permitted. Well on property. 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: Duke Power ROW APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF 2 bedroom house(to be removed) EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 30x27 NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: New 95x98 house w/attached garage #"OF NEW BEDROOMS: 3 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: YES i E:9-duippl icati 08/31./201.6 12:32 Pagel or8': ,p. * CATAWBA COUNTY Case/1 RBPR-45-20 16-23865 .7r.�� Public Health Department x;8:1 x Subdivision CRESCENT(LAND AND TIMBE < --^^v t Environmental health Division PINff 460604545994 PO Box 389.100-A Southwest Blvd,Newton.NC 28658 NAME ON PERMIT: (JAMES"MICHAEL"STRICKLAND), 1136-TORRENCE;CIR, DAVIDSON NC 28036 (JAMES"MICHAEL'STRICKLAND) Site Address: 4869 TRESTLE LN,DENVER NC 28037 Property Size: Square Feet Acres 1.1 Directions: Campground Rd,left on Catawba Burris,Right on Bankhead,left on Trestle left on driveway APPLICATION FOR WELL ABANDONMENT ABANDONMENT TYPE: Drilled 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 re •••.'== or he proper identification ag labe'ng of all property lines and corners and making the site accessible so that a =te sit -„...�,fon c pe” - ed. Date: ?i S I / J Signature of Applicant or Agent _ -_ _ An Environmental'Health Specialist will contact you withi"recking:days •fitly i If you need further information or assistance please call 828-466-7291 AREA1 SETBACKS: 30'setback off the lake instead of 50'due to lot being created before 7/1/01 FEENA'ME iii r,'�f,,t kli c Hr #a 6 .., ,f t >#`II( t; .t DATEllitt3n 'i'FECAMOUNNa!.f i� Authorization to Construct Fee(New/Expansion) 05/13/2016 $300.00 Fee Improvement Permit Fee 05/13/2016 5150.00 Well Abandonment Fee 08/31/2016 5100.00, Well Permit&Inspection Fee 08/31/2016 $300.00 t At t rI E p:' �u t}� �t4: 0f1i> a TOTL FEES ltd llili bi s.vl1 il; r r �S(## 174 vSg50 n Y j t t S �. ',/ta W7 r ,1 11YiW ^CE` . ^�' ,. P? t , ti 1 I`• r h .t G n u 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) fJ-clfappl'ratioon 08131/2016 12:32 Page 2 of 8 1/41.1. CATAWBA COUNTY , �� y 100A SOUTHWEST BLVD ETA NEWTON, NORTH CAROLINA 28658 RECEIPT d pmt H U WevP ? PHONE: 828.465.8399 rite �G' Wednesday, August 31, 2016 /842' sM www.catawbacountync.gov PAYOR: Stickland, Alyson PAYMENTS TRANSACTION NUMBER: TRC-809945-31-08-2016 PAYMENT DATE : 08/31/2016 PAYMENT TYPE: Credit Card 171413453 INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-332200 Well Abandonment Fee $100.00 08'x16 33220010al C.-= Vdelliiee?rrriit&{Ins6ection"ihed1211( ' 'rf, l's R$3_00!005 TOTAL PAYMENTS : $400.00 RBPR-05-2016-23865 CASE TYPE: Residential Building Plan Review WORK CLASS: Building New SITE ADDRESS: 4869 TRESTLE LN, DENVER NC 28037 Owner JAMES "MICHAEL' STRICKLAND, 1136 TORRENCE CIR, DAVIDSON NC 28036 C:704-692-3874 Paid By ALYSON STICKLAND, 1136 TORRENCE CIR, DAVIDSON NC 28036 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Contractor SAME AS OWNER,, receipt 08/31/2016 12:31 Page 1 of 1 'THIS IS NOT A PERMIT Case# RBPR-05-2016-23865 CATAWBA COUNTY HEALTH DEPARTMENT u qE) -1:110-F1 a? -t :fr PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES /41 sm Residential Building Plan Review - Building New .ta -ft,tx le a i IIVIPROVEMENT- AUTH CONST- EXPANSION II ■ Ail 9C) Contractor SAME AS OWNER,, , Owner JAMES"MICHAEL"STRICKLAND, 1136 TORRENCE CIR, DAVIDSON NC 28036 C:704-692-3874 NAME TO APPEAR ON PERMIT JAMES "MICHAEL" STRICKLAND , SITE ADDRESS: 4869 TRESTLE LN,DENVER-NC 28037 PIN# 460604545994 NAME of SUBDIVISION: CRESCENT LAND AND TIMI3ER CORP 138 Seclion/13lock PROPERTY SIZE: Square Feet Acres 1.1 DIRECTIONS: Campground Rd,left on Catawba Burris,Right on Bankhoad,left on Trestle Ln,left on driveway PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER.DAY: 360 WATER SUPPLY: Private Well DESCRIBE WOR 8/23/16,per Michael Strickland revise to 3 BR *New site built home, 5 bedroorns, 95x98, no basement, 'attache. garage Wi ims •onus room *Old House to be removed. Existing systernArvill require expansion. Homeowner,stated that their is new lines on the property that he believes may nothave been permitted. Well on property. 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: Duke Power ROW APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF 2 bedroom house(to be removed) EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 30k27 NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: New 95x98 house w/attached garage #OF NEW BEDROOMS::BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: Pr-chapplicrition 08/23/2016 16:49 Paso 1 of 4 - - CATA�YBA COUNTY Case# RBPR-05 20,16=23865 z .Public llealth Department CRESCENT.LAND AND TIMBE t� Subdivision ( a 0 Environmental Health Division PINK '.: PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 4606Q4545994 NAME ON PERMIT: (JAMES"MICHAEL"STRICKLAND), 1136.TORRENCE CIR,DAVIDSON NC 28036 (JAMES"MICHAEL"STRICKLAND)` Site Address: 4869 TRESTLE LN,DENVER NC 28037 Property Size: Square Feet Acres 1'1 Directions: Campground Rd,left on Catawba Burris,Right on Bankhead,left on Trestle Ln,left on driveway Improvement Permits issued as a resultaof 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 fórthe 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 r - • •ers an a • responsible for the proper identification,,a7 labeling all property fines and corners and making the site acce E'+ at a complete site evaluation can i- •erformed Date: j Signature of A 1icantorAgent 4711 iron Specialist contact within � pltcation°date. r[f you eedtfurternformafionor ass stanceplease 828 466 72 91 = AREA1 SETBACKS: 30'setback off the lake instead"of„5Q'due to lot being created before 7/1/01 . 4 t , E rBE EEN/ME -a �� I4 , r z ATE : �FE A MO �,, -_, _ ..:1, a ;" . �t >C L 6.,, _. . a �a Authorization to Construct Fee (New/Expansion); 05/13/2016: $300.00 Fee Improvement Permit Fee 05/13/2016 $150.00 }s"`a 0 � GT rAt4 t " JP7 kit ,,,,,,e , �F Vain a4 1,, vAY W`•, J0c0b` CM= T. : P.,.,o U, gi f wsl; .at..t Gaij�a--,i 3 i42rk.Vz� ?'iy G �.0 ..rrV ,2MfXaa.r■ ca,i'thwentwatr%11, :`a,x,111.t..,, FEES ARE NON:-REFUNDABLE ONCE A SITE VISITIS MADE OR WORK ON A PLAN REVIEW'IIAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) I i E9-ehapptication 08/23/2016 16:49 Page 2 o1'4 I I vaY A �G THIS IS NOT A PERMIT Case # RBPR-05-2016-23865 d '"`" Pe y CATAWBA COUNTY HEALTH DEPARTMENT f0 wd "- 5' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES a o-•' 1842 94 Residential Building Plan Review- Building New o o u v t 0.W A IMPROVEMENT- AUTH CONST- EXPANSION -o: o, ;, a • 0 -''r _ti. ,�� Contractor SIIME ASOWNER„ Owner JAMES "MICHAEL" STRICKLAND, 1136 TORRENCE CIR, DAVIDSON NC 28036 C:704-692-3874 NA T ON PERMIT JAME "MICHAEL" TRICKLAND SITE ADDRESS: 4869 TRESTLE LN, DENVER NC 28037 PIN # 460604545994 NAME of SUBDIVISION: CRESCENT LAND AND TIMBER CORP Lot# 138 Section/Block PROPERTY SIZE: Square Feet Acres 1.1 DIRECTIONS: Campground Rd, left on Catawba Burris, Right on Bankhead, left on Trestle Ln, left on driveway PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GA S-PER DAY: 600 WATER SUPPLY: Private Well DESCRIBE WO14 New site built home, 5 bedrooms, 95x98, no basement, attached garage with finish bonus room *Old House to be removed. Existing system will require expansion. Homeowner stated that their is new lines on the property that he believes may not have been permitted. Well on property. 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 Descriptioncuke Power ROW} APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF 2 bedroom house (to be removed) EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 30x27 NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: New 95x98 house w/attached garage #OF NEW BEDROOMS:: 5 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: P9-ehapplirninn 05/16/2016 08'20 Page 1 of4 CATAWBA COUNTY Case# RBPR-05-2016-23865 Public Health Department Subdivision CRESCENT LAND AND TIMBE 4 Environmental Health Division PIN# 460604545994 - PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 Ig.2 vM NAME ON PERMIT: (JAMES "MICHAEL" STRICKLAND), 1136 TORRENCE CIR,DAVIDSON NC 28036 ( JAMES "MICHAEL" STRICKLAND) Site Address: 4869 TRESTLE LN, DENVER NC 28037 Property Size: Square Feet Acres 1.1 Directions: Campground Rd, left on Catawba Burris, Right on Bankhead, left on Trestle Ln, left on driveway 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 SETBACKS: 30' setback off the lake instead of 50' due to lot being created before 7/1101 EEiNAM_E d,li r . 'rljiJli' �Nlld ,i,t li�1� 11�w1 l` 119E IDATE! ;,) FEE1rrAMOUNTigi Authorization to Construct Fee (New/Expansion) 05/13/2016 $300.00 Fee Improvement Permit Fee 05/13/2016 $150.00 i 1II[1ITOTAL FEESIIE<'hh^;. ,:��",���i ��rdt �I,,��. '1'1IiIIII lHlJ% ii�![Vlllsasobo', 1 . IIuIIIIINI `OAgWI iluP' - ,,Ntlii 9r .dWPJW1100'M c ..,u(LuWIIWU°UWI CNiilIC11„ 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) 1-9-elmpplication 05/16/2016 08:20 Page 2 of4 `Jy,A .G • THIS IS NOT A PERMIT Case # RBPR-05-2016-23865 i� 2; • Q : CATAWBA COUNTY HEALTH DEPARTMENT D ; i D .- PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES P .. 1842 SH Residential Building Plan Review - Building New aoo IMPROVEMENT- AUTH CONST- EXPANSION # �; Contractor SAME AS OWNER. , Owner JAMES STRICKLAND, 1136 TORRENCE CIR, DAVIDSON NC 28036 C:704-692-3874 NAME TO APPEAR ON PERMIT JAMES STRICKLAND SITE ADDRESS: 4869 TRESTLE LN, DENVER NC 28037 PIN # 460604545994 NAME of SUBDIVISION: CRESCENT LAND AND TIMBER CORP Lot# 138 Section/Block PROPERTY SIZE: Square Feet Acres 1.1 DIRECTIONS: Campground Rd, left on Catawba Burris, Right on Bankhead, left on Trestle Ln, left on driveway PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 600 WATER SUPPLY: Private Well DESCRIBE WORK: New site built home, 5 bedrooms, 95x98, no basement, attached garage with finish bonus room, *Old House to be removed* 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 2 bedroom house (to be removed) EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 30x27 NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: New 95x98 house with attached garage #OF NEW BEDROOMS:: 5 BASEMENT? No BASEMENT FIXTURES? PLUMBING REQUIRED?Yes Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: - CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-chapplication 05/13/2016 17:07 Page 1 of 4 49A • CATAWBA COUNTY Case# RBPR-05-2016-23865 Anw 2 Public Health Department Subdivision CRESCENT LAND AND TIMBE _fl G ; , Environmental Health Division S, PIN# 460604545994 15 PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 /8.2 sM NAME ON PERMIT: (JAMES STRICKLAND), 1136 TORRENCE CIR, DAVIDSON NC 28036 ( JAMES STRICKLAND) Site Address: 4869 TRESTLE LN, DENVER NC 28037 Property Size: Square Feet Acres 1.1 Directions: Campground Rd, left on Catawba Burris, Right on Bankhead, left on Trestle Ln, left on driveway 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 a • es. I understan• . .m solely responsible for the proper identification and lab ling all property lines and corners and making the site accessib- • - a con:ete site evalua .. can be performed. Date: 'c--- /3 I(o Signature of Applicant or Agent An Environmental Health Specialist will contact you within 5 . V.mg days of application date. If you need further information or assistance please call 828-466-7291 AREA1 SETBACKS: 30' setback off the lake instead of 50' due to lot being created before 7/1/01 `FEENAME. DATE FEE AMOUNT .t Authorization to Construct Fee (New/Expansion) 05/13/2016 $300.00 Fee Improvement Permit Fee 05/13/2016 $150.00 ..q 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) F9-chapplication 05/13/2016 17:07 Page 2 of 4 CATA BA THIS IS NOT A PERMIT COUNTY y �.- CATAWBA COUNTY HEALTH DEPARTMENT esah .\ Application for Environmental Services Page 1 Improvement Permit f authorization to Construct. Septic Repair n Septic Malfunction n Septic Expansion New Well Permit Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility 7 1 Property Address L bid 9j re-es7Le LAl Subdivision F 1.)(-N Vc-re NL Zto5 - Lot# Acres i ' Section/Block/Phase Driving Directions to Property -Grvj P &C 0L , I • 4 P•1/4/ ;Pi :Li ' (2-1(7 1-Fr OA) $/ • 01-EA-I L__ --F-I onI TK&StL_E- LA) L E-Fr of.) 134.1veW47! NAME TO APPEAR ON PERMIT? Owner n Applicant n Contractor Applicant Contact Information Name Address Phone Cell Phone 1 Owner Contact Information Name M l C.WAG L S r C lt-Lf b Address l 13(T TD R2-c )4_e- ( )R-L L - 'n/q-(!) j, SOA1 Phone '9-0'{ to g 2 3 g PK Clell Phone SAitt C- Contractor Contact Information Name License# Address 5 A-1146- Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? `4 Owner ❑^Applicant ❑ Contractor J�,`Description of Existing Structures on Site -1()IJ — -}13 \'�3P ��P(�(7bt �+ # of Bedrooms *j' —',2/ Structure Dimensions 1c al-' # of Occupants Basement ❑ Yes �f No Basement Fixtures Yes E o The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property riuestion. If the answer to any question is "yes", applicant must attach supporting documentation. El Y•s • Does the site contain any jurisdictional wetlands? eap It. s. Does the site contain any existing wastewater systems? ❑ •es L' • Is any wastewater going to be generated on the site other than domestic sewage? AYes III Is the site subje t to approval by any other public agency? ❑ Yes o Are there at easements or right of ways on this property? Describe Existing water supply in use h Individual Well [ Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes No If ap lying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s): (s ems can be ranked in order of your preference) - Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other X Any CATAWBA THIS IS NOT A PERMIT ,`COUNTY CATAWBA COUNTY HEALTH DEPARTMENT „o„„ Application for Environmental Services Page 2 Proposed Facility Type He-Primary Residence New Residence ❑ Addition to Residence # of New Bedrooms *t 5 Project Description N&w I}ok 5 BR Structure Dimensions I5 n- )( '10 #of Occupants i 3 Basement I I Yes f %4'No Basement Fixtures ❑ Yes o ❑ Accessory Structure(s) Describe # of New Bedrooms *I- if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing C Yes I No Describe Plumbing Needed Multi-Family Residence#Units #Bedrooms per Unit*t Total #Bedrooms *j Structure Dimensions I 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 n Individual Well n Semi-Public Well ❑ Community Well Abandonment Type n Drilled n Bored ❑ Dug Unknown Well Repair Requested I I Yes I 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. 1- 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 Date .Sh3'16 Printed Name of Owner or Agent M f L1-f Al--t. STR-1 C LJJI.13f wn4 1 G4 944S n b ' O , N �< o 1 m �1 m o w 6 \, Oil 4 it aii A, "c s 0 , 0, 9n, \ _ o L2--�,r G I0 o� \ . ,4„, ( v ^ 411 o / I (+ o � 1J/ °� _ ` 6 " _�`_ _ •I ___, ` tt 9S- /\ 9 -d \ , r ' so c.)oA p 'e9-=:-..,---------,,,\ ./ /_ J19.i1t, %Oi L nl / -.. c.-- �P 1. "��� ,' II p atc \� " I�� . o i I ;.2° 3 `v z L-/ II 11L I 112111 I I 1 2 IEI WI>IDI bl.l 1"°""` ...e,,.,...„,.«,.,..,K I Catawba County, North Carolina This map product was prepared from the Catawba County,NC,Geospatial Information System. 1 N Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map.Catawba County promotes and recommends the independent verification of any data contained on this map 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 product or the use thereof by any person or entity. • • Selected Parcel Number: 4606-04-54-5994 1 inch=50 feet • P • repared for: 20 . 81 1 •_ �:;. ' .:::.::::::: Ali 4. . \:::,`.,1 is ••1 .• 7 �t a � ' , 1 ®A ACT `� - `x E'�� ` " ,, X59 /.:::., , ..00- , . li /> Tfat l62l767 .. .. .. -4,... if coA,r 2 .. .. 1 :. . . n p. . .:.: - -. f .... CP • 0 . . . . . THIS IS NOT A LEGAL DOCUMENT' DateSaved;lf =•014 Tim::433:09=PM" 1 • Parcel Report Page 1 of 1 • Parcel-Report---Catawba-County-NC Parcel Information: Owner Information: Parcel ID: 460604545994 Owner: STRICKLAND JAMES MICHAEL Parcel Address: 4869 TRESTLE LN Owner2: STRICKLAND ALYSON ONSRUD City: DENVER, 28037 Address: 1136 TORRENCE CIR LRK(REID): 17956 - Address2: null Deed Book/Page: 3209/0388 City: DAVIDSON Subdivision:-CRESCENT LAND AND TIMBER State/Zip: NC 28036-9410 CORP Lots/Block: 138/ null School Information: Last Sale: $355,000 on 2013-09-09 School District: COUNTY Plat Book/Page: 16/21 Elementary School: SHERRILLS FORD Middle School: MILL CREEK Legal: LOT 138 PLAT 16-21 High School: BANDYS Calculated Acreage: 1.100 Tax Map: 017 X 34138 School Map Township: MOUNTAIN CREEK State Road #: null 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: $129,500 Zoning2: null Land Value: $215,600 Zoning3: null Assessed Total Value: $345,100 Zoning Overlay: CRC-O,WP-O,FPM-O Year Built/Remodeled: 1973/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: 4016 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 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. al ©2016 Cat�wbaGovernment, North Ca;�olina. All rights reserved.0�11 - p fir, / gx 1 517-11 V�'1 � bI�c�frCo .� cf ar � 1� C111 ��2r�` 1 I�%,�?i11 Cjq } 1GlCticJ http://gis.catawbacountync.gov/nomap/parcel_report.php?key=460604545994&typ=P 5/13/2016 Catawba County Environmental Health /1/""<7 dr/ / ./:.-------/: : 20.81 ..„,.....",...0/ mb• II J ' ti alpp111:".j. 11�'1 'il' a (i !, s . dlpla,l ,.i ,giii( -4 +tN1P'?° a ;kf- 3 i ch CD ' I Rftt4'1 eiiM' b25,96 I?Mrr P?` d'' 4 1 , ship * clogs,l` i ��p C 1 t. �''' as I p`/a'heyyd F;i( / giii l� IIM1M11o' 111 irek ■ f Iii y it W' I1i (�il f il1.0 , ii (rte"& . ', ti ;I l i lt- } WI i/ h� " ll , if.i ��ir31 l re,Nf I f lli Iliiti 141',gf r'I' .92 '�Q _ 4 �sN ,',1It ` 0 P;i+i ii f��nti i�SrJI,� t, I lilt( I vµity J�.�JJ� . .., p ,�l tl+rt-,.4 , t[S,',411,- '��hl p'ir1t41i .1': g>ri/ 1I}3� 1 I� . 1:17;14)11411•^111.;hikdi. „ �Ilt, �• -ail 1 ih"" I th a'I � ' x`441 11 t i dIl 4.1 ti ,,�ji �i 9 i y _, "`ii i, i nn'_p� t 4 It n ro I ,n at!r}Pt' 1,1 I ih,,,,Pt 4 R I•liiiillii dril 4ii.���hhigl'aiirtti e{f'`ti oilt,7id4,N xi .%,,,.,:-irti'uJ4.r�,'>h'7,,d fi 11N' hat eli ilatahl'ii.4il Atia I ililllh111 ,: i 4 I ke- Parcel: 460604545994, 4869 TRESTLE LN 1 in=50ft DENVER, 28037 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 05/13/2016 • ,� La'1' _ * ' 8 i > = w O � � O �O� O LL, 1 b" U, 1. a' ` :; a + ' Z c o w 2 Y = Q it J e Y /.4. N �' rT' G W h �`+` o .ui '1 s W ti LL ,0 .q of - a 2. � J M, .11' ai H. 1 y W 3. • I" __P- "a Z u Z A ° 1 Z o "}NC! " ¢ p,, L. o "'x 3 v F" : Q o z W ,i^w 5 5 : ^ --,511,' P= i d W o n .a:r 4-or. p Q O m m u m LL �� n T v_ o'Y'` 2 . i. a - 77 xy- w p c '.; LL ci ty,' - ' •id CATAWBA COUNTY HEALTH DEP s t: MENT /��Sacc�-ba3)6 Telephone: (828)465-8270 TDD: (828)465-8200 //"'�No _ - IP AC • Rpr„Prmt. Opr,Prm Sys. Type Well Prmt._Replacement Well ell Rp . Prmt. Owner/Agent - Phon Address ,36, / 4 /5 Subdivision / / - Sectio�y Bloc,, base Lot# __ Lot ize !i//re_. _Directions: 5 i', ' ©f,. . _ . e 0 „It! ,e a en- Q) / 2 Property Address /% ' _ YS e - A.) Facility: House I Mobile Home Business Multi-family . Other: Pin Number 5// _d4' <-52#1 -t5e/rtQ Other . Zoning Approval # #Bedrooms a- #Seats #Employees . Application Rate GPD Flow Hot Tub or Spa yes/no Special Fixtures Basement yes/no . 100% Repair Area yes/no Basement Plumbing yes/no Water Supply: Private Well Public Semi-Public Type of System: Trench Bed Pump Pump/Panel Panel LPP Other Septic Tank Size Pump Tank Size Nitrification Field: Total Square Feet Depth of Stone Bed Size Trench Width Total Length of All Trenches Number of Trenches Trench Length / / / / / Feet on Center Maximum Trench Depth Distance of Nearest Well *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* *************************************************************************************************************************** Text % Slope �W Texture j / Structure �/ �'1 Clay Min. Soil Wetness Soil Depth " Restric. Hoz. at " %� Available space yes/no ��� nu * Nit..." Overall Class S PS U Comments: ) tl` l. / N Filter Required Riser required when • tank is more than 6 inches deep. **NO GUARANTEE OR WARRANTY IS PLIED 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 'cal regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion o e' tallation is put into use. The siting of the well by the Health Department staff is to provide protection from known possible sources o ont nation. No volume of water is guaranteed at any site by the Health Department. . Permit Date d)-a/4i EHS A/-,.S,! / Loa. Owner/Agent Septic Tank Install Date EHS Well Installed By AW/s 7..cmv, Well Gr ut-Approval Date,3-a3-'/ Well Head Approval Date /(_ J Date Sample Collected (` U ^nom /n ,� Date of Results Results EHS�/ /'f-�j/ White-Office Blue-Building Inspection Operation Permit Yellow.,Gwner/Agent Green•Buildi,Q Inspection Autho zation to Construct