Loading...
HomeMy WebLinkAboutEHPR-08-2016-24464 (2).TIF `a13Ar, THIS IS NOT A PERMIT Case# EHPR-08-2016-24464 CATAWBA COUNTY HEALTH DEPARTMENT + .••o . .0 vr �'° PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES - . ' 1842 SM Environmental Health Plan Review - OSWP ° ti• U + +v IMPROVEMENT x`'ry Owner BRIAN MAJOR, 4183 ANDERSON MOUNTAIN RD, MAIDEN NC 28650 1-1:828-428-8926 C:828-446-7481 HOME:828-428-8926 NAME TO APPEAR ON PERMIT BRIAN MAJOR SITE ADDRESS: 4199 ANDERSON MOUNTAIN RD, MAIDEN NC 28650 PIN # 367704515065 NAME of SUBDIVISION: Brian and Patr4icia Major Lot# 2 Section/Block PROPERTY SIZE: Square Feet 54,450.00 Acres 1.250 DIRECTIONS: Hwy 16 S, Right Anderson Mtn Rd, approx 1 mile property on right PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP for property subdivision 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? No Are there any easements or right-of-ways on this property? Yes Property Easements Description: 15'drivewayeasement APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 27.5 x 60 #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: Other described: F9-ehapplicatlnn 08/08/2016 11 59 Page I of 4 its � CATAWBA COUNTY Calc# EHPR-08-2016-24464 24464 .�ru.9'� �� Public Health Department Subdivision Brian and Patr4icia Major 4 FJWeli K Environmental Health Division PIN# 367704515065 °'a" PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 18¢2 iM NAME ON PERMIT: (BRIAN MAJOR),4183 ANDERSON MOUNTAIN RD, MAIDEN NC 28650 ( BRIAN MAJOR) Site Address: 4199 ANDERSON MOUNTAIN RD, MAIDEN NC 28650 Property Size: Square Feet 54,450.00 Acres 1.250 Directions: Hwy 16 S, Right Anderson Mtn Rd, approx 1 mile property on right 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: Ar . ; Signature of Applicant or Agent (-5,L44,,-1 `, ,f 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 I FEENAME (idiJii' ntll�i II FIi 'u4��LF�l'��IIIl6i�iiritwirm i��lariiiiiii�1liDATE I�j�i6Lv1 PPR Ii;EIAMOUNTd�C Improvement Permit Fee 08/08/2016 5150.00 �( I!r7I 1 'iiia TOTAE!F.EES e 1 i 1 t E • dill 11 ll I t ��. I au ili iIgS150 00Fr gtif 1t 1 '1'11 1 . ,• ili1111ltNill• nu lumthiIIaallylhatnhllfminut, iiiiltitzu 1NtUU1II it1Iuii2Fl 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) [9-ehapplication 08/08/2016 11:59 Page 2 of 4 CATAWBA e THIS IS NOT A PERMIT COUNNT?C1V V 1J`1 CATAWBA COUNTY HEALTH DEPARTMENT ,,,,,,, a Application for Environmental Services 2 KIP Page I Improvement Permit) Authorization to Construct ❑ Septic Repair❑ Septic Malfunction ❑ Septic Expansion New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair n Existing System Inspection (Pre-Approval Required) ❑ q I get Application is for New C�otnstrucctiion ' Existing Facility ❑ ' \, Property Address 1}'tt AAtehri tics )' 1 n4' 1 Subdivision � C A e Lot# z Acres / , . S. Section/Block/Phase Driving Directions to Property rA A p N , e. �/(. S 9 /t% !ri rt" A'NA. e L.( !'2 )qJ' A Re1 / cfs7 — c. 2 / Mlle. flN Sic/ AD . NAME TO APPEAR ON PERMIT? ❑ Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name Rrl<lK' Marr ,y` Address '//�'3 A_IU t5 SO/v Mt, M . la/A /V s) L', 2fr; 5.,e) Phone Q — 44; g: 7924 Cell Phone en... Via - 7y f 1 Contractor Contact Information Name Address Phone Cell Phone ' WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site V (...0'}- # of Bedrooms *j' 3 Structure Dimensions a 7 X 6 0 #of Occupants 2 Basement ❑ Yes 53 No Basement Fixtures a 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. © Yes 0 No Does the site contain any jurisdictional wetlands? ® Yes EI No Does the site contain any existing wastewater systems? 0 Yes 0N Is any wastewater going to be generated on the site other than domestic sewage? CI Yes ©No Is the site subject to approval by any other public agency? . c� FP Yes ri No Are there any easements or right of ways on this property? Describe /C Ottoec 4'( GA`s'. Existing water supply in use (i Individual Well LJ Community Well ❑ Semi-Public Well AQekr ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes ❑ No If applying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) `� Accepted ❑ Alternative 0 Conventional 0 Innovative ❑ Other 0 Any C A rrA A THIS IS NOT A PERMIT COODUNTh_L7V V 1JL , CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms 3 Project Description tel e q u / /1P ff o art e . Structure Dimensions v1 5)( 6e 0 # of Occupants 2 Basement ❑ Yes 0 No Basement Fixtures ® Yes Rt No Accessory Structure(s) Describe • #of New Bedrooms *f if applicable Structure Dimensions • # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing Yes E No Describe Plumbing Needed Multi-Family Residence# Units #Bedrooms per Unit*j Total # Bedrooms *T Structure Dimensions Food Service Specify Type #Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift #of Shifts Dining Arca (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 ❑ Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type E Individual Well ❑ Semi-Public Well n Community Well Abandonment Type In Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ No Describe Calculated Design Flow, Commercial j' 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. f 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 0e �JeE - Date AA/ — /l 4' Printed Name of Owner or Agent / Y'p' CATAWBA COUNTY ,+" I00A SOUTHWEST BLVD NEWTON, NORTH CAROLINA 28658 RECEIPT ,�"'`mip, � PHONE: 828.465.8399 \U y Monday, August 8, 2016 is 42 SM www.catawbacountync.gov PAYOR: MAJOR, BRIAN PAYMENTS TRANSACTION NUMBER: TRC-771952-08-08-2016 PAYMENT DATE : 08/08/2016 PAYMENT TYPE: Credit Card 169785897 INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-331347 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EHPR-08-2016-24464 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 4199 ANDERSON MOUNTAIN RD, MAIDEN NC 28650 Owner BRIAN MAJOR, 4183 ANDERSON MOUNTAIN RD, MAIDEN NC 28650 H:828-428-8926C:828-446-748 I ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 08/08/2016 11:58 Page I of I