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HomeMy WebLinkAboutRBPR-08-2016-24438.TIF a,ty$ • THIS IS NOT A PERMIT Case# RBPR-08-2016-24438 CATAWBA COUNTY HEALTH DEPARTMENT D:^ r f0 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICESIrr`rk.1 ' ` /842 so Residential Building Plan Review - Building New ;o1'!o. ' o IMPROVEMENT- AUTH_CONST `��.:rte� •1.0" Applicant * FISHER CONSTR CO., CARROL (DANNY FISHER), 614 N MAIN ST, SALISBURY NC 28144 B:7046336124 C:7042025110F:7046337898 DANNY@CARROLFISHER.COM Contractor * FISHER CONSTR CO., CARROL (DANNY FISHER)'; 614 N MAIN ST, SALISBURY NC 28144 B:7046336124 C:7042025110F:7046337898 DANNY@CARROLFISHER.COM Owner PEBBLE BAY OF CATAWBA LLC, 614 N MAIN ST, SALISBURY NC 28144 B:0 NAME TO APPEAR ON PERMIT * FISHER CONSTR CO., CARROL (Danny Fisher) SITE ADDRESS: 7374 BAY COVE CT, DENVER NC 28037 PIN # 460603341009 NAME of SUBDIVISION: PEBBLE BAY PH 5 Lot# 222 Section/Block PROPERTY SIZE: Square Feet Acres 1.06 DIRECTIONS: NORTH CATAWBA BURRIS RD TO BANKHEAD RIGHT ON SALLY BROOK RIGHT ON BAY COVE PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Community Well DESCRIBE WORK: BUILDING NEW 4 BEDROOM HOUSE 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? No 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 LOT EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 76X61 #OF NEW BEDROOMS:: 4 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: • • E9-ehapplication 08/03/2016 16:41 Page I on y.A CATAWBA COUNTY Case RBPR-08-2016-24438 a Public Health Department PEBBLE BAY PH 5 . ii ? Subdivision C -`-ti s 4 Environmental Health Division � � v' PIN# 460603341009 ' ` - EO Box c. 389, 100-A Southwest Blvd, Newton. NC 28658 -184 • NAME ON PERMIT: * FISHER CONSTR CO., CARROL ( DANNY FISHER), 614 N MAIN ST, SALISBURY NC 28144 * FISHER CONSTR CO., CA Site Address: 7374 BAY COVE CT, DENVER NC 28037 Property Size: Square Feet Acres 1.06 Directions: NORTH CATAWBA BURRIS RD TO BANKHEAD RIGHT ON SALLY BROOK RIGHT ON BAY COVE 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 FF.ENAME ` DATE FEE AMOUNT Authorization to Construct Fee (New/Expansion) 08/03/2016 $300.00 Fee Improvement Permit Fee 08/03/2016 $150.00 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-ehapplication 08/03/2016 16:41 Page 2 of 4 _ .. _ . l �AT[��'6�7'lA TI-LIS IS NOT A PERMIT �u�T . , �� CATAWBACOUNTY HEA LTN.DEPAR-TENT „�;„��o—� Application PorLmu'oninentalServ�icc/sPage 1 Improvement Permit ❑ Authoriuitioa to Construct Septic Repair❑ Septic Malfunction❑ Septic Expansion ❑•New Well Permit 0 Replacement Well ❑ Well Abandonment 0 Well Repair ❑ Existing System Inspection (Pre-ApprovaltRequired) ❑' Application is for New Construction ❑ Existing7Facilitty `❑ Property Address-737Ae. �� Snbdivtsmti`CC� ��41Q acs. ciDP�V� e Z � Lo[#' 2ZZ Acres it)5(cf Sectibn/BlocldPh tsc —.-• ''S, n Driving Directions to Property 0 t £ ' - - ...a_-- �C, 'etc nia '- 0Y1 NAME TO APPEAR ON PERMIT? , vner r r.pplicant ontractor- Applicant Contact Information Address la Phone \.(- 'll` i� \ �r I�pp • . ' - �t oiaa.aL7 OwCoutact L ct, matron -� 111011triartagilt,..111701104 nat.. 411111 ,„ Phone Contractor Contact Information ' Name Address Phone' _ '`Cell Phone 7 WHO WILL BE THE PRIMARY CONTACT'?' SUwner Lp Iicant �F Co tractor Des#iption of Existing"Stivctures on Site V>:21\�.e'' `I ...i , ofBedrooin *j' f..-le Structure Dintensions'`7(-h K ii Sc Occupants Basement D Yes ' ri:T, o Basement I ixtures p:Yes: . 1. . The Applicant?shall notify the local health depiihint nt upon submittaltof this lippliclatiodif,any of the following apply to liattach supportmg documentation. the property m uestion. IF the answer to any question is"yes”, ,cant titusf O Yes 04o, Does the site contain any'jm isdidtibthil wetl ands? Yes p•-•451 Does the site:contatn any.;eXistmg wastewater systems?t , O Yes pIq/d Is any wastewater going to be generated on the site other than domestic sews ? y To is thesnc subject to approval by any other public agency? ! •r•J ; g,� 0 off' `J y? Describe t r.• � �}Yes o Ar•e there any easements or nght of ways on this Existing water,supply in use•, El lndnrdual Well ommuntty Well L Semit,PubliC Well` Is a ubhs e•water u l ilable?** ❑ Yes' 0 No • If a ,❑ County/City/Township Wzler-Erne ,,,,. P PpY available?. pplynig for iin Improveinent Permit at • ic'ise`IndtcateDesired,System Type(s):, P (systems can be ranked in order of your ference) i❑ Other �Any • ❑ Accepted 0 Alternative n oventional ,, 0 Innovative, 4 ;. • _ .,i _ d •�,!,ttt�i.0 ' fit,wt _ ''afi` AnA g 7f TRIS IS NOT A PERMIT cot vary CATAWBA COUNTY HEALTH DEPARTMENT ,,,,,c;;;;;;—., Application For Environmental Services Page 2 Pro i sed Facility Type ' I Primary Residence Er New Residence ❑ Ad�ition to Residence # of New Bedrooms *t Project Description -v) Structure Dimensions T7bof Occupants Basement ❑ Yes No Basement Fixtures t'Yes p(No ❑ Accessory'Stincture(s) ,Describe - # of New Bedrooms *t if applicable Structure D mensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed U Multi-Family Residence if Units #Bedrooms per Unit*t Total#Bedrooms *t Structure,Dimensions ❑ Food Senice Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) # Employees per.Shift #of Shifts Dining,t\rea(Sq. Ft) ❑ Business Specific Type of Business Retail'Floor Space #of Employees per Shift #of Shifts ❑ Other Facility Type Specify Yes If Church of Seats Kitchen ❑ ❑ No If Daycare Specify Occupancy . # Application for Well Co'nstructioti/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested Oyes ❑ No Describe Calculated Design,Flow, Commercial,t Additional information maybe required to determine design flow from certain facilities This value}vill'bc determined during consultation with on-site staff. *Any room that will be intended for sleeping at the dine of construction or for figure consideratioi should be noted as a bedroom and counted on all applications. The-number•of bedrooms will beconfirmed by rooms identifiedon house plans as a bedroom atthe 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. ** IfNo,a well permit must be issued with the Authorization to ConstrucL SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) Improvement Permits issued,as aresult of this information are valid for 5 years or may benon-expiring under certainspecified conditions.An Authorization to Construct issued by this department is valid for(5) five years.floin.the date issuedand is not transferable; lmproveinentPetmits'and Well Permits are transferrable. Permits may be the information'on this application, site plans or intendedmse changes for the proposedfacility. I have readthis 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 tun solely responsible for the proper identification and labeling of all property linesandcorners and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent _ Datee g '3 Printed Name of Owner or Agent �_.✓ l\� v �,� V" 1 ,:� I-- 0 O N O spy' 6a/ \� \B / \ r \ O \ \ N C 4 %. N „o 40010111\IIIIIIIIIIIII.c. ?'"c-' • gip' 1 o ° a \ Vi \ / , \ F T \ N m_ rO ti Or—No 4 M i Os s m� N � i mom. N � \ D N 2 U v \ \ \ - PLAT NORTH M oaawi.uc =aoJec: N rceerahCI oe N. e" / r LOT 222 PEBBLE SITE PLAN BAY CARROL FISHER CONSTRUCTION 1IIII\ g .. rvn , N. ! N. l mance.n. ro.Pn.rnr.� e.w , . Catawba County Environmental Health 7 • .-0,4 u)\I"\\ /1 // 413 • f • NI • / 16533 ad s • • O 149.60 Parcel: 460603341009, 7374 BAY COVE CT 1 in=50ft DENVER, 28037 This map/repos 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 08/03/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 460603341009 Owner: PEBBLE BAY OF CATAWBA LLC Parcel Address: 7374 BAY COVE CT Owner2: City: DENVER, 28037 Address: 614 N MAIN ST LRK(REID): 803089 Address2: Deed Book/Page: 2725/1727 City: SALISBURY Subdivision: PEBBLE BAY PH 5 State/Zip: NC 28144-3644 Lots/Block: 222/ Last Sale: School Information: Plat Book/Page: 65/145 School District: COUNTY Legal: LOT 222 PEBBLE BAY PHASE 5 PL 65- Elementary School: SHERRILLS FORD Middle School: MILL CREEK 145 Calculated Acreage: 1.060 High School: BANDYS Tax Map: School Map Township: MOUNTAIN CREEK State Road #: Tax/Value 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: Land Value: $35,700 Zoning3: Assessed Total Value: $35,700 Zoning Overlay: CRC-O,WP-O Year Built/Remodeled: / Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710460600J Building Details 2010 Census Block: 4017 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. 0332- �\ 2p1 Catawba County Government, North Carolina. All rights reserved. �� � � ^ Y � U La) yAI http://gis.catawbacounty nc.gov/nomap/parcel_report.php?key=460603341009&typ=P 8/3/2016 " Catawba County Public Health � A. .i W'4 N 4 & t `' G�t www.catawbacountync.gov/environmentalhealth COUNTY r --,- �� f4e Environmental Health P.O. Box 389, 100-A South West Blvd., Newton, NC 28658 � ''� North Carolina Phone (828) 465-8270. Fax (828) 465-8276 Memorandum To: Pebble Bay of Catawba, LLC From: Michael Cash, Environmental Health Supervisor Date: August 11, 2014 Subject: Permit Extension Addendum for Expiring Septic Permit at 7374 Bay Cove Ct. Denver, NC; Catawba County Permit WLS2006-01541 In accordance with State Law 2010-177, effective August 5, 2010, your Improvement Permit referenced above, expiring October 9, 2011 is granted an extended expiration date. Your new expiration date will be October 9, 2015. This Addendum will remain with your existing permits on file. Please note that only the Improvement Permit is transferable to any future owners of the property and that the permit is valid only so long as the property boundaries, site plan, site conditions, and wastewater flow remain unchanged. u n I(^ "Leading the Way to a Healthier Community" gP °Meath ;; 7,:—.):::),s, CATAWBA COUNTY N 7; .- Public 1148th Department Case# WLS2006-01541 i Enviromitantal Health Division Subdivision PEBBLE BAY PHASE 6 , ; PO Bos 389.IOWA Southwest Blvd,Newton.NC 28655 Sect/BUPh/Lot# 222 • .„„_� t828146.)-8270 FAX(828)465-8276 "PDD C823)465-8200 PIN# 911460601164071-222 Applicant/Owner PEBBLE BAY OF CATAWBA LLC Site Address: ROAD B (PEBBLE BAY PH 5) DENVER NC -5 -`Cr5 'L 1 Property Size: SF 1.05 ACRES -".,` Directions: CATAWBA-BURRIS RD/ RT BANKHEAD/ RT SALLY BROOK q I �,/ Improvement Permit 1\." Permit Valid For: Five years DC No Expiration Facility(Residential): House IN House X Mobilo Home Multi-Family Bedrooms 4 New? �Addilion? Projected Daily Flow 7f g.p.d Water Supply Private Well? Public? k" Semi-Public? Basement: N Basement Plumbing: N 't HGolTub/Spur( N/ Special Fixtures (explain): Proposed Wastewater System:— c25 .6 12[C4 kc I'f'^ Type: 3 /6- Proposed 6 Proposed Repair: Yip 01350 29dLAt'f3vr .3¶3/G Permit Conditions: Owner or Legal Representativ Signaturreej_J It lA tom' --- Date: . "4Ji4 _ Authorized State Agent: - n I �-v� 1 C Date: - - /p/I p(o 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 13uildino 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 'Caws and Rules for Sewage Treatment and Disposal Systems' (ISA NCAC ISA .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. Authorization to Construct Wastewater System (Required for Building Permit' * .See site plan and additional attachments (- ) Proposed Wastewater System: Type: Wastewater Flow g.p.d New Repair Expansion Soil LTAR: g.p.d./1t2 Type of Facility: Basement: N Basement Plumbing: N HoiTub/Spa: N Special Fixtures (explain): Wastewater System Requirements Tank Size: Septic Tank gal Pump Tank _ gal Grease Trap gal Drainfield: Total Area: sq ft Total Length: ft Maximum Trench Depth in Trench Width It Minimum Soil Cover Minimum Trench Seperation ft Distribution: Distribution Box SeridhDistribution Pressure Manifold LPP Other Additional Specifications: Authorized State Agent: Date: Permit Expiration Date: 1 Jane read and accept the specifications and all conditions of this permit as indicated. Owner or Legal Representative Signature: Date: Form B rAndno n0FnmvV..Lanvv.m, 11' CATAWBA COUNTY %�' -p>��,'. Public ldth Department Case 4 WLS2006-01541 '/ .�rl S\-1 Environmental Health Division Subdivision PEI313 LE BAY PHASE 5 PO Box 389, l00-A Southwest Blvd.Newton.NC 28658 Sect/BUPh/Lot 4 722 • ( 28)4K65-8270 FAX(828)465-8276 TDD(828)465-8200 PINK 911460601164071-222 Applicant/Owner PEBBLE BAY OF CATAWBA Site Address: ROAD B (PEBBLE BAY PH 5) DENVER NC Property S SF 1.05 ACRES Directions: CATAWBA-BURRIS RD/RT BANKHEAD/RT SALLY BROOK © Improvement Permit El Authorization To Construct El Well Permit SITE PLAN (1W 361 0 1; Le-AN Arc 025`/o 2ec✓Ac 5y5lew.. Q.")d b Repair k as Punp /-6d S 10 Scale Roil-ice. System components represent approximate contours only. The contractor must flag the system prior to beginning the installation to ensure that proper grade is maintained. Do not install system under wet conditions. This permit is subject of revocation if the site : . or site conditions are altered. — 6 4 0 t. nut rued Stale Age'. Date Form C r:Tilaom('Form)VWsooann DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES Sheet ! of / DIVISION OF ENVIRONMENTAL HEALTH PROPERTY ID 4:1:6-0/54// ON-SITE WASTEWATER SECTION COUNTY: C'Ar SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM owNERtetoUe Syy 01kky ocL LL.L APPLICATION DATE %9/-1 6 ADDRESS: to/V A) afe410 Sr .�AGrs 'a'i / DATE EVALUATED:/&‘e.4. PROPOSED FACILITY: PROPOSED DESIGN FLOW(.1949): 5/v) PROPERTY SIZE: l OS LOCATION OF SITE: pb 7yic WalS (-0r aa� PROPERTY RECORDED: WATER SUPPLY: 0 Private ea`Pu l 0 Well 0 Spring 0 Other EVALUATION METHOD: 0 Auger Boring jaJ'it 0 Cut TYPE OF WASTEWATER 6gesivage 0Industrial Process 0 Mixed R '" SOIL MORPHOLOGY l ? OTHER D p t ( 1941)i y PROFILE FACTORSti 1 ,:' ..x:1940 • - ' _ .i. E LAI�-D- • -HORI ..__ '4. ' 194 r� e - - :: ' SCAPE ZON ..ii 1941 tt 6'It 1941 '- ,':SOIL" '-•1943 - .1956 .1944 t. PROFILE'. tt POSITION/ DEPTA ] .SOILa i „_ � '�STRpC7 URFJ , CONSISTE\CEI P ETi\ESS! SAPRO I -RESTR . ..CLASS 'SLOPE% r (LN) TEXTURE MINERALOGY COCOR DEPTA :CLASS HORIZ &ITAR. Iii, Im 7 !w5Vc s« el- PS I-417-- � )< S'cL_ ice' 5-e-if I/Z 1 3' - 35 1 c-if ws5k— s« I Fr I P-5 �- /Felt- 554. 5CL I s�IP Liz — 176, /6 -53 -- I • . 3 4 I DESCRIPTION AITIAL SYSTEM ) REPAIR SYSTEM OTHER FACTORS(.1946): Available Space(.1945) SSITE CLASSIFICATION(.1948): f. Type(s) ' I6741) System �_ EVALUATED BY: p15ho a� OTHER(S)PRESENT: Site LTAR t 3s I • 3_5- COMMENTS: • LEGEND use the following standard abbreviations SOIL CONVENTIONAL LPP MINERALOGY/ LANDSCAPE POSITION GROUP TEXTURE .1955 LTAR* .1957 LTAR* CONSISTENCE STRUCTURE CC(Concave Slope) I S(Sand) 1.2-0.8 0.6-0.4 NEXP(Non-expansive) G(Single Grain) CV(Convex Slope) LS(Loamy Sand) SEXP(Slightly Expansive) M(Massive) D(Drainage Way) EXP(Expansive) CR(Crumb) DS(Debris Slump) R SL(Sandy Loam) 0.8-0.6 0.4-0.3 GR(Granular) ' FP(Flood Plain) L(Loam) SBK(Subangular Blocky) FS(Fool Slope) ABK(Angular Blocky) H(Head Slope) Ill Si(Silt) 0.6-0.3 0.3-0.(S PL(Platy) L(Linear Slope) SiCL(Silty Clay Loam) PR(Prismatic) N(Nose Slope) CL(Clay Loam) R(Ridge) SCL(Sandy Clay Loam) MOIST WET S(Shoulder Slope) SLC(Sill Loam Clay) • T(Terrace) VFR(Very Friable) NS(Non-sticky) IV SC(Sandy Clay) 0.4-0.1 0.2-0.05 FR(Friable) 5S(Slightly 5tkky) SiC(Silty Clay) Fl(Firm) S(Sticky) VFI(Very Finn v.Very Sticky) VS(Very Sticky) 0(Organic) None EFI(Extremely Firm) NP(Non-plastic) 5P(Slightly Plank) *Adjust LTAR due to depth,consistence,structure,soil wetness,landscape,position,wastewater flow and qualify. P(Plastic) NOTES VP(Very Plastic) HORIZON DEPTH In inches below natural soil surface DEPTH OF FILL In inches from land surface RESTRICTIVE HORIZON Thickness and depth from land surface SAPROLITE S(suitable)or U(unsuitable) SOIL WETNESS Inches from land surface;to free wafer or inches from land surface to soil colors with chrome 2 or less-record Munsell color chip designation CLASSIFICATION S(Suitable),PS(Provisionally Suitable),or U(Unsuitable) Evaluation ofsaprolite shall be by pits. Long-term Acceptance Rate(LTAR):gal/day/ft' Show profile locations and other site features(dimensions,reference or benchmark,and North). ii e E I i I t , i 1 ! j _ I _ i — I— I ! -i -.I I 1 it � _' 11 ; l lir l !Li 1 ' . 1 + I j ! ! 1 I I I I { 1 1 ) I i i I ( I j 1 IfI ' ! H ! I Il f { iII II ' ; III1 I ! + j1 ` 1 + x-1 IIit1I • 1 F11111 — i 1^. _ Iil ii ... ; '__ i I , 1 ...._.._ _..{.__i ! i DEHNR(ka4'.#) 1 - - Review(#c ) SOIL/SITE EVALUATION Sheet of^ (Continuation Sheet) THIS IS NOT A PERMIT Case tt WLS2906.01541 .ns4, CATAWBA COUNTY HEALTH DEPARTMENT • Application for Environmental Services Improvement Permit? IMPROVEMENT • Septic Service Type: N/A : #C Well Service Type: N/A APPLICANT OWNER CONTRACTOR PEBBLE BAY OF CATAWBA LLC PEBBLE BAY OF CATAWBA, LLC 614 N MAIN ST 614 N MAIN ST SALISBURY NC 28144-3644 SALISBURY NC 28144 NAME TO APPEAR ON PERMIT PEBBLE BAY OF CATAWBA LLC pin#: 911460601164071-222 SITE ADDRESS: ROAD B (PEBBLE BAY PH 5) DENVER NC DIRECTIONS: CATAWBA-BURRIS RD/ RT BANKHEAD/RT SALLY BROOK NAME of SURDI VISION: PFRRI F R&L' PH&SF 5 Lot 222 Sect ion/Block/Phase PROPERTY SIZE: Square Feet Acres I OS Date Planed/Recorded TYPE OF FACILITY: Hal ISP House X Mobile Home Dimension of Structure 60 X 60 Bedrooms 4__ Basement: N Water Using Fixtures in Basement:_N _ No. in Family 9 Whirlpool Tub : N Gal.Capacity: MULTIPLE FAMILY ICES DAYCARE: Number of Children RESTAURANT: Seats Square Feet Dining Area Square Feet Foodstand/Meat Market Floor Space Number of Employees TYPE OF BUSINESS: 1st 2nd 3rd_. OTHER: (Specify) - Do you uniticipate any additions to Facility? N If so. describe: Has any grading,removal,or addition of soil been done to this property? N If so.describe Are there easemenes/right-of-ways recorded on this property'? N Type of Water Supply: Individual Well CormnunityRl X Municipal Semi-Public Monitoring Well Request: N #of wells Name of Site I understand that this is a formal application for a well pen-nit,Improvement permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this properly and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understandthat an Improvement Permit issued as a result of this information is transferable and has no expiration date,but may be revoked if this information,site plans or intended use changes for the proposed facility. A Well Permit and Authorization to Construct issued by this department is valid for(5)five years from the dale issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Date: q 7Ja:OG Signature of Applicant or Agent 01_41.44_ 9 4! / N 4****ed✓✓Ill'******************* *****************************,_«_ ;: ..********** *** *'*a******> (FOR OFFICE USE ONLY) Please Contact_QFORCIF PENf1FRGR•SR between 8 am and 9 am Phone R28-d6S-R272 Zoning Approval: _Yes No Zoning Approval#: Form.A FEES Type Description Date Heceived Amount By ADMN Improvement Permit 09/27/2006 PSO 5140.00 Total: $140.00 *If a permit has to be redesigned and/or RETRIPS made to the property,there is an additional$60 charge r:Vinernar Vorm,VALCnvu.nn