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HomeMy WebLinkAboutRBPR-09-2016-24689.TIF ,tyl3A •G THIS IS NOTA PERMIT Case # RBPR-09-2016-24689 Q 0 1. -1- CATAWBA COUNTY HEALTH DEPARTMENT 0' 41• •'11:1 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Y 1842 sM Residential Building Plan Review - Building New 9 •o o r, •T 1 IMPROVEMENT - AUTH_CONST r o - o VeAd V-0-1105 Contractor SAME AS OWNER, , Owner ALAN WATERS, 510 4TH AV NE, CONOVER NC 28613 C:828-320-0222 OTHER:828-320-02 NAME TO APPEAR ON PERMIT Alan Waters SITE ADDRESS: 9230 COOKSVILLE RD, VALE NC 28168 PIN # 265804900097 NAME of SUBDIVISION: Lot# 1-2 Section/Block PROPERTY SIZE: Square Feet Acres 729 DIRECTIONS: 10 W to Cooksville Rd on right before bridge (after Old Shelby Rd) PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 600 WATER SUPPLY: Private Well DESCRIBE WORK: Accessory Dwelling being built now to live in while home is under construction. Accessory Dwelling will be 40x80 w/ 1 BdRm (240 GPD) Future House will be 40x100 w/ 3 BdRms (360 GPD) Total = 600 GPD Septic previously issued WLS2008-00707 - Extension Expired on 7/31/16. 3200 sq ft accessory building with living quarters with 1 bedroom /approx 800 sq ft- originally permitted as accessory building (BLDR-12-2013-044180) *****future house will have 3 bedrooms**** Well permit issued &drilled - Not Finaled : WELL-11-2013-044122 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 foundation of 2 buildings (permits have expired) EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: Acc Dwelling 40 x 80, future house 40x100 #OF NEW BEDROOMS:: 1 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-chapplication 09/08/2016 14:57 Page I of 4 S4 ; CATARBA COUNTY Case# RBPR-09-2016-24689 .v AIL Public Health Department Subdivision 4 ®' Y Environmental Health Division PIN# 265804900097 e-. PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 t8,2 :. NAME ON PERMIT: (ALAN WATERS), 510 4TH AV NE, CONOVER NC 28613 ( Alan Waters) Site Address: 9230 COOKSVILLE RD, VALE NC 28168 Property Size: Square Feet Acres 7.29 Directions: 10 W to Cooksville Rd on right before bridge (after Old Shelby Rd) 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 AREA2 �flllll�Pallllr��I �1�lli �P7"1421 1 1 1i(r"t11ltl 'I' 11r��fl����{ 1lI I �Ill�l��' <8lllill�upniitiltlullmmlll VFEENAMEI* t I „I,,�Eg,,�rl;g�;�CII ll i1J1hala IIL 1ppe DATEi f tIFEEiAMOUNTj,: Authorization to Construct Fee (New/Expansion) 09/08/2016 $300.00 Fee ^•Improvement Permit Fee 09/08/2016 $150.00 ' NI TON:ft0t 11110111111111. 11111qpi ^( 1111101{I1111 .- $a . hi 0 I J n. I WpIl9ma-,'• '-a..?S• w nxt 4Ill,''5ltlp l .ai lblUf hltathilliPtk 4ffildi 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-ehapplication 09/08/2016 14:57 Page 2 of4 aTHIS IS NOTA PERMIT Case # RBPR-09-2016-24689 ,, CATAWBA COUNTY HEALTH DEPARTMENT ❑� r rr; •',*0 �~' c PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES r eV; \/842 sM Residential Building Plan Review - Building New eg ` •o N A 'T 1 • IMPROVEMENT - AUTH_CONST 0 c ; Contractor SAME AS OWNER, , Owner ALAN WATERS, 510 4TH AV NE, CONOVER NC 28613 C:828-320-0222 OTHER:828-320-0211 NAME TO APPEAR ON PERMIT Alan Waters SITE ADDRESS: 9230 COOKSVILLE RD, VALE NC 28168 PIN # 265804900097 NAME of SUBDIVISION: Lot# 1-2 Section/Block PROPERTY SIZE: Square Feet Acres 7.29 DIRECTIONS: 10 W to Cooksville Rd on right before bridge(after Old Shelby Rd) PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 600 WATER SUPPLY: Private Well DESCRIBE WORK: 3200 sq ft accessory building with living quarters with 1 bedroom /approx 800 sq ft-originally permitted as accessory building (BLDR-12-2013-044180) ""*"future house will have 3 bedrooms"*" 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 foundation of 2 buildings (permits have expired) EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 40 x 80 #OF NEW BEDROOMS:: 1 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 09/08/2016 13 50 Page 1 of 4 .4(5: N CATAWBA COUNTY Case# RBPR-09-2016-24689 ftinc, Public Health Department Subdivision d ; r ) y Environmental Health Division PIN# 265804900097 `IJV i, i PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 \84 sM NAME ON PERMIT: (ALAN WATERS), 510 4TH AV NE,CONOVER NC 28613 ( Alan Waters) Site Address: 9230 COOKSVILLE RD, VALE NC 28168 Property Size: Square Feet Acres 7.29 Directions: 10 W to Cooksville Rd on right before bridge (after Old Shelby Rd) 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 acces ib a so that)a co plete site evaluation can be performed. Date: erg,' g�-.2O/ Signature of Applicant or Agent 2 et) 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 AREA2 FEENAME = , = DATE, 'FEE AMOUNT Authorization to Construct Fee (New/Expansion) 09/08/2016 $300.00 Fee . Improvement Permit Fee 09/08/2016 $150.00 TOTALFEES • `° $45000 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 09/08/2016 13:50 Page 2 of 4 CArAV\ �g� THIS IS NOT A PERMIT COUNTY CATAWBAHEALTH DEPARTMENT • .0.— Application for Environmental Services Page 1 Improvement Permit Authorization to Construct Septic Repair I Septic Malfunction Septic Expansion ❑ New Well Permit U Replacement Well ❑ Well Abandonment _ Well Repair I I Existing System Inspection (Pre-Approval Required) Application is for New Construction '61, Existing Facility ❑ Property Address 9,23 J Subdivision Gale Pc. now Lot# Acres Section/Block/P/h ��ase) /� u (begs urn �Z Li ero,„5 ore/ 74,/47 /Ld- op,e_ /JN,'re Oso Driving Directions to Property /hit 1�[J t NAME TO APPEAR ON PERMIT? cFr Owner n Applicant n Contractor Applicant Contact Information Name iglaA/ &a1 r5 Address 51D 414-04,c NP. &waycr NC Phone I Cell Phone 8,2hw S20r 022 Z Owner Contact Lrformation Name S e *s Au r'c Address Phone I Cell Phone Contractor Contact Information Name Address Phone I Cell Phone WHO WILL BE THE PRIMARY CONTACT? tKOwner E. Applicant in Contractor Description of Existing Structures on Site aria" If of Bedrooms *j / Structure Dimensions # of Occupants a Basement I I Yes No Basement Fixtures 0 Yes fit 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. ©YesNo Does the site contain any jurisdictional wetlands? © Yes In No Does the site contain any existing wastewater systems? E3 Yes No Is any wastewater going to be generated on the site other than domestic sewage? %Yes 'No Is the site subject to approval by any other public agency? O Yes EitNo Are there any easements or right of ways on this property? Describe Existing water supply in use ® Individual Well n Community Well ❑ Semi-Public Well In 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): \I (systems can be ranked in order of your preference) v ❑ Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other Any t)l l airtr5 Cf A-nai ATI-IIS IS NOTA PERMIT COUNT) CATAWBA COUNTY HEALTH DEPARTMENT „o„„ _ .; Application for Environmental Services Page 2 Proposed Facility Type Primary Residence boil)/Residence n Addition to Residence # of New Bedrooms *t 3 Project Description • Structure Dim nsions 1-',C /00 # of Occupants Basement Dim , No Basement Fixtures rj Yes RNo I Accessory Strbcture(s) Describe 41. ' 1u_ s s e • • , 0 _ a Ok-) # of New Bedrooms *f if applicable / Structure Dimensions 'lo Ar 8° �[ # of Occupants 2-, Accessory Dwelling Z.Yes E No T PlumbingrV Yes n No Describe Plumbing Needed Multi-Family Residence#Units #Bedrooms per Uinit*t Total#Bedrooms *t Structure Dimensions U Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) 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 ❑ Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type n Individual Well n Semi-Public Well E Community Well Abandonment Type L Drilled n Bored E Dug n Unknown Well Repair Requested _ Yes U 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. j If structure is plumbed hut no bedrooms, calculated design flow is required. **If No, a well permit must be issued with the Authorization to Construct. SYSTEM REDESIGN AND/OR RETRO 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 comers and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent £ Date _Sri)/ 020/(o Printed Name of Owner or Agent y✓ kh. ey$ Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 265804900097 Owner: WATERS ALAN W Parcel Address: 9230 COOKSVILLE RD Owner2: WATERS ELIZABETH B City: VALE, 28168 Address: 510 4TH AVE NE LR K(R EI D): 100979 Address2: Deed Book/Page: 2913/1712 City: CONOVER Subdivision: State/Zip: NC 28613-1615 Lots/Block: 1-2/ School Information: Last Sale: School District: COUNTY Plat Book/Page: 60/191 Legal: LOT 1&2 PL 60-191 Elementary School: BANOAK Middle School: JACOBS FORK Calculated Acreage: 7.290 High School: FRED T FOARD Tax Map: School Map Township: BANDYS State Road #: 1105 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: COOKSVILLE Zoningl: R-40 Building(s) Value: $0 Zoning2: Land Value: $40,200 Zoning3: Assessed Total Value: $40,200 Zoning Overlay: WP-O,FPM-O Year Built/Remodeled:/ Small Area: PLATEAU Current Tax Bill Split Zoning Districts:/ Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: Building Details 2010 Census Block: 1005 WaterShed: WS-Ill Protected Area 2010 Census Tract: 011802 Voter Precinct: P2 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 eft tarts 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. e, Ilt `t (2goo Cx l It �T I ci http://gis.catawbacotuntync.gov/nornap/parcel_report.php?key=265804900097&typ=P 9/8/2016 Catawba County Environmental Health • } t / 1 le.\.t \\\ \:\:: \\\\ i '73.13 li Lk? . 8 24.81 ilk 4.4 • E \:1 . 4., �� 313. • 1/2\7 \ 2U,70 ( O" / 4ass7p 7 �`.7 - / \ i�''� \ \ s �y}j{QQ _....i��„ l 1.92 Olt 11111: 'Kt \ rik 1 p• 11‘: U' Ii ., � tool iiiipippr 4, `1040r� Parcel: 265804900097, 9230 COOKSVILLE RD lin=150ft VALE, 28168 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 09/08/2016 Catawba County Environmental Health \\\\1/4 ,s‘i ail f,111 ri5 j\ '7313 • 3:.10 .3q 1 ii 187.79 4: '7, c 1i, �� 91.98 l • r. °1 ii i Ni 24.87Atii: i , 9 ` 4, IL„ .,w• w �I qi II NC I. • i 1I..•�1 Ifr II i II 1 /�' at 313.7 20.1 p SII A ilt1. 'L's Igpuul UII411 0:11.1 . u11 �" W�yI 1 i�1 l� J l 21.92 65' 19 1 «lilt„ !witwa n, /dl�.„u l sow 55 5,$0 " •) I• 4 •y3' 1 0° `"7 01 1 "n 1111, 330) G \i,Ihice39.1.34 ;wn1u,"„Iq,; Parcel: 265804900097, 9230 COOKSVILLE RD 1 in=100ft VALE, 28168 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 09/08/2016 • C A:T „ ' Catawba County Public Health e www.catawbacountync.gov/environmentalhealth COUNTY Environmental Health y;,r P.O. Box 389, 100-A South West Blvd., Newton, NC 28658 North Carolina Phone (828) 465-8270. Fax (828) 465-8276 Memorandum To: Alan W. Waters From: Michael Cash, Environmental Health Supervisor Date: November 22, 2013 Subject: Permit Extension Addendum for Expiring Septic Permits at 9230 Cooksville Rd, Vale, NC; PIN#265804900097; Catawba County Permit WLS2008-00707. In accordance with State Law 2010-177, effective August 5, 2010, your Improvement Permit and Authorization to Construct referenced above, expirin 1 31, 2013. is granted an extended expiration date. Your new expiration date will b July 31, 2016. 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. "Leading the Way to a Healthier Community" °Health t o'1-, l.r ry 4L /—�\ CATARBA COUNTY en,,,,_ Case# WLS2008-00707 (Si µV Public Health Department - 1 \ Subdivision I: I EnvimnmemalH Ith Divion \� /f PO Bo.x389,100-A Southwest Blvd Newton,NC 28653 Sect1BL/PhILot r 1-2 \N--:1;11,_1(-4-/- [528)465-8270 FAX(828)365-8276 TDD(823)465-3200 a'(—____ PIN# 265804900097 Applicant/Owner ALAN W WATERS Site Address: 9230 COOKSVILLE RD VALE NC Property Size: SF 7.31 ACRES Directions: 10W/RT COOKSVILLE RD/TO STOP SIGN/STRAIGHT ACROSS AT STOP SIGN/PROPERTY IS ONE MILE ON RIGHT AFTER GOING PAST STOP SIGN (STOP SIGN AT OLD SHELBY) `future house 3 bedrooms/detached garage w/living quarters w/1 bedroom Improvement Permit Permit Valid For: Five years /.../T No Expiration Facility(Residential): House 5eR House X Mobile Home Multi-Family Bedrooms R' New? Addition? — Projected Daily Flow g.p.d Water Supply Private Wet? Public? Semi-Public? Basement: Y Basement Plumbing: Y HotTub/Spa: N Special Fixtures(explain): Proposed Wastewater System: _OS% Rte"`+„n Type: ] I l o, Proposed Repair: fli i, fa asy, 4-J--c.4•of Permit Conditions: --- • Owner or Legal Representative S nature- Date: Authorized State Agent: —14 Date: -)/3 dad The issuance of this permit by the H h 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 Building Inspections requirements are met. This lmprovementPermit is subject to revocation if the site plan,plat or the intended use changes,or if site conditions are altered. The Improvement Permit isnot 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 Di.spmal Systems' (ISA NCAC 18A.1900). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tan k 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: a<ye cet.)-4‘ n Type frijol Wastewater Flow 600 g.p.d New ✓ Repair Expansion : Soil LTAR: / i 53 g.p.d./ft2 Type of Facility: 3e 140r,.1/4. 4- I BK ()u.F-�l-<) 5nreit_(M'.r,. Tyou_,ln� .�1„.� aw.�ll:.,, �,.:3 ) Basement: Y Basement Plumbing: y HotTub/Spa: N Special Fixtures(explain):� Wastewater System Requirements Tank Size: Septic Tank )S°° gal Pump Tank gal Grease Trap gal Drainfield: �� Total Area: /L4 O sq ft Total Length: 43 U ft Maximum Trench Depth a`� in Trench Wdth 11 ft Minimum Soil Coy,r IL a in Minimum Trench Seperation 6 t ft Distribution: Distribution Box Sedal Distribution ✓ Pressure Manifold LPP Other Additional Specification: -* k.zp c II 474 -+J o Ssp4-2<, re%:.. , lop' Fr =may ‘-'-lit IS'E=r,.., 17.ilJ,47 P. a,: , -.i . lo' Cr Pr.p tlylin� Lie� ha_ ntL.11ea o.. .naw0e noT pit, fir: a . r F: II Qs.'-" is-,,sl--I-, fr.A..r Authorized State Agent: G3 cy Date: 7 13 f /Oil Permit Expiration Date: V -1 6t t Zo t3 I have read andaccepr the specifications and all conditions of this panni%as indicated caner or Legal Representative Signature: / adDate: f$f, 5 Form B r:Iti/emwklfornrzlffr7SAmay! • CATAWBA COUNTY Case# WLS200S-00707 44.t.. 4 \!\ Public Health Department Subdivision adi.— -) Environmental Health Division \J` 'IC ' PO Box 389. 100-A Southwest Blvd.Newton,NC 28658 Sect/BL/Ph/Lot# 1-2 -. i ' _,_v_ (328;465-3270 FAX(828)465-8276 T10U/8j$,)4Sij_$=00 a 'a PIN# 265'80000097 Applicant/Owner: ALAN W WATERS 4 ,r,Jl ,L\ Site Address: 9230 COOKSVILLE RD VALE NC Property size: SF LII ACRES Directions: 10W/RT COOKSVILLE RD/TO STOP SIGN/STRAIGHT ACROSS AT STOP SIGN/PROPERTY IS ONE MILE ON RIGHT AFTER GOING PAST STOP SIGN (STOP SIGN AT OLD SHELBY) 'future house 3 bedrooms/ detached garage w!living quarters w! 1 bedroom j WELL PERMIT Proposed Use: Private ✓ Public Semi-Public Other GROUTING DEPTH: MINIMUM 20 FEET SETBACKS: I. BUILDNG FOUNDATIONS 25 Fr. 5. UNDERGROUND STORAGE TANKS 100 FT. 2. EXISTING&PROPOSED SEPTIC SYSTEMS-MIN. 50 FT. 6. STREAMS/BROOKS/CREEKS 50 FT. 3. EXISTING&PROPOSED SEPTIC REPAIR AREA-MIN. 50 FT. 7. LAKES/PONDS RESERVOIRS 50 FI'. 4. SEWAGE PUMP SUPPLY LINE 50 FT ALL.OTFIER POSSIBLE SOURCES OF GROUND WATER CONTAMINATION 100 FT. The well driller must verify all sepeamtions are adhered to before drilling the well. If the well driller is unable to maintain any of the above separations,contact the Health Department at(828)465-8270 before drilling the well. SEE SITE PLAN FOR PERMITTED WELL LOCATION g 7 l3l lab ued By: Permit Issuance Date: Xa 6)44 Customer Signature: WELL INSPECTION: GROUTED DEPTH: 20' DATE: INITIALS: APPROVED CASING: PVC STEEL DATE: INITIALS: CASING HEIGHT 12" ABOVE LAND SURFACE DATE: INITIALS: WELL COMPLETION REPORT RECEIVED DATE: INITIALS: WELL HEAD APPROVED DATE: INITIALS: Well Driller Date Drilled Well permits are valid for 5 years from the date of issuance and are subject to suspension and/or revocation fro non-compliance with appropriate state and local rules and regulations,or if false information was given in order to obtain a permit. Wells shall be constructed in accordance with all state and local regulations and rules. The Well Completion Report must be submitted to the Health Department within 30 days upon completion of a well. • Authorized State Agent Final Approval Date Form D • r:VirlmenA nmuVNUSlnn.ml • ' CALAWBA COUNTY �?� Case 4 W LS2006-00707 /,9 �,c,A Public Health Department /ii. Subdivision i. -j Environmental Health Division V V17?R// PO Box 389. 100-A Southwest Blvd.Newton.NC 28653 Seel/FL/Ph/Lot 4 1-9 \C__i/ -.'�-- (823)465-8270 FAX(323)465-8276 TDD(S28)465-82110 PINtt 265 8049 0009 7 Applicant/Owner ALAN W WATERS Site Address: 9230 COOKSVILLE RD VALE NC Property Size: SF 7.31 ACRES Directions: 10W1 RT COOKSVILLE RD)TO STOP SIGN/STRAIGHT ACROSS AT STOP SIGN/PROPERTY IS ONE MILE ON RIGHT AFTER GOING PAST STOP SIGN (STOP SIGN AT OLD SHELBY) `future house 3 bedrooms/detached garage w/living quarters w/ 1 bedroom vpen\ FT It.: L.0 ® Improvement Permit 0 Authorization To Construct 0 Well Permit I_ot,.l f1tf(l SITE PLAN C `I� QV ..r pa.... l ,. S0 1 a o r J II J L >, e f'LL H =1 r1 C /p r. tt, c ' W _T o D "' J Lipa it £ CI) IUo ' A 33 � conk5v ` 11� Q� I 1 ' II It 66 Ne L.30_1i e,c.y be_. Ins+.IIeJ a,-0,,, s..r,- 1e-+b��k3 "xi- r... ,,.}..,,.,---) + Rdt : crte Pic;-7 ba.. re-�,r it. r,-miry .,D) :1'.....dl - p 3 I j.•rP,.... Scale r 1 lAi<+._.i Jr.. ,:<.la. f."..y 6e. 14-1u,rnJ 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 plan or site conditions are altered. Aflii rued Stat Agent Date Form C rnneera,r,r„„,nnVLS„p,,.,o- DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES Sheet of DIVISION OF ENVIRONMENTAL HEALTH PROPERTY ID#: ON-SITE WASTEWATER SECTION COUNTY: SOIL/SITE EVALUATION t JLS Loo $ _ 00 .302 for ON-SITE WASTEWATER SYSTEM OWNER: A I c.1 W h-r l APPLICATION DATE ADDRESS: r 36g Il, I-?Dk DATE EVALUATED:7/d(I 3 4 PROPOSED FACILITY:Imo." F a 8R PROPOSED DESMON FLOW(.1949): )TD k I- PROPERTY SIZE: 7. 3 1 LOCATION OF SITE/ 9013 o C u,k.r .. ._ ed (=et PROPERTY RECORDED: WATER SUPPLY: gr Private -0 Public Lf'Well 0 Spring 0 Other EVALUATION METHOD: 0 AygerBoring 0/Pit 0 Cut Ia' 150cko-+' TYPE OF WASTEWATER: td'Sewage 0 Industrial Process 0 Mixed k Sil .......... :SOILMOkP$OLOGY OIlIER ... - .._. ... > (:1941j PROFILE FACT OR5 I .... ... .. .. .. LAND,- H liANDORI 1942 ..- SCAPE 7AV 1941 " 1941 SOIL 1943 1956 1944 PROFILE:: # POSITION/.. DEPTII STRUCTU(tLi CONSISTENCE/ WETNESS/ SOIL SAPRO RESTR CAS SLOPE-/ . ''[:(IN) . ::TEXTURE:-.. ..." MINERALOGY= ....•COLOWEe iiDEP,Tac :::CLASS i .:::HORIZ _::::.ALTAR : LL O- 4 ' ccl. -/Ur t35 a4-tis" ..fes- /S6k. Ss Jr, stoup (r Lit Ps 1 6 iOlD ps 2 3 I 4 " I 1 DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): Available Space(.1945) (2-S P S SITE CLASSIFICATION(.1948): P-S System Type(s) -Q� I i 107 EVALUATED BY: J 8 o V) OTHER(S)PRESENT: site LTAR 135 . 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) 11.0.8 0.6.0.4 NF-XP(Non-expansive) G(Single Gram) CV(Convex Slope) IS(Loamy Sand) SEXP(Slightly Expansive) M(Massive) D(Drainage.Way) EXP(Expansive) CR (Cnnnb)Gmn • DSL(Sand Loam) 0%-0.6 0A-03 CR ular) F?(Debris II Y 55K(Subangular Blocky) FS(Flood lope)) L(Loam) ABK(Angular Blocky) FS(Foot Slope) III SCL(Sandy Clay Loam) 0.6.03 03.0.15 PL(Platy) II Goad SloSlpe) SiL(Silt Loam) PR.(Prismatic) N(I lose pee) N(Rose Slope) CL(Clay Loam) Si R(Ridge) (Silty Clay Loam) MOIST ROT S(Shoulder Slope) Si(Silt) VFR Nay Friebk) NS(Nco-ctickY) T(Tcaacc) IV SC(Sandy Clay) 0.4-0.1 01.0.05 FR(Friable) SS(Slightly Sticky) SIC(Silty Clay) Fl(Finn) $(Sticky) C(Clay) WI New Finn v.Vay Sticky) VS Very Sticky) O(Organic) None ER(Extremely Finn) NP(Noo.platk) . - 5P(Ssgfaly Plastic) • *Adjust LTAR due todepth,consistence,structure,toll wetness,landscape,position,wastewater flow and quality. P(Plastic) NOTES VP Nay Plastic) HOR6ONDEPTH In inches below natural soil surface DEPTH OF FILL In inch, from land surface RESTRICTIVE HORIZON Thickness and depth born land surface SAPRGLITE S(suitable)or U(unsuitable) • SOIL WETNESS Inches from hod surface to free water or inches from land surface to soil colors with aroma 2 or less-record Munsell color chip designation CLASSIFICATION S(Suitable),PS(Provisionally Suitable),or U(Unsuitable) Evaluation of saptolite shall be by pits Long-term Acceptance Rate(LTAR):gal/day/ftr Show profile locations and other site features(dimensions,reference or benchmark,and North). • • • • DENR( #W4) Review( if) �:r— N °r THIS IS NOT A PERMIT Case # WLSE008-00707 /3 t T\ iv,IED/ , CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit? IMPROVEMENT Septic Service Type: AUTHORIZATION TO CONSTRUCT Well Service Type: NEW WELL Water Supply Type: Individual Well Well Use: RESIDENTIAL APPLICANT • OWNER CONTRACTOR ALAN W WATERS 510 4TH AVE NE CONOVER NC 28613-1615 NAME TO APPEAR ON PERMIT ALAN W WATERS Pin#: 265804900097 SITE ADDRESS: 9230 COOKSVILI_E RD VALE NC DIRECTIONS: 1OW/RT COOKSVILLE RD/TO STOP SIGN/STRAIGHT ACROSS AT STOP SIGN/PROPERTY IS ONE MILE ON RIGHT AFTER GOING PAST STOP SIGN (STOP SIGN AT OLD SHELBY) *future house 3 NAME of SUBDIVISbkgicioms/detached garage w/ living quarters w/ 1 bedroom Loth I-o Section/Block/Phase PROPERTY SIZE: Square Feet Acres 7 31 Date Platted/Recorded TYPE OF FACILITY: I louse X Mobile Home Dimension of Structure 40 X 100 • Bedrooms 4 Basement: Y Water Using Fixtures in Basement: Y No. in Family 7 Whirlpool Tub : N Gal.Capacity: MULTIPLE FAMILY RESIDENCE: Units Total Number of Bedrooms 4 DAYCARE:Number of Children RESTAURANT: Seats Square Feet Dining Area Square Feet Foodstand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees_ Ist 2nd 3rd OILIER: (Specify) Do you aniticipate any additions to Facility? Y If so,describeP 0 • 0 -[a F W/ I I VING_QUARTERSLLBFDROOM) Has any grading, removal, or addition of soil been done to this property?N If so,describe Arc there easements/right-of-ways recorded on this property? N Type of Water Supply: Individual Welt X Community Well Municipal Semi-Public Monitoring Well Request: N k of wells Name of Site I understand that this is a formal application for a well permit, Improvement permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this properly for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is transferable and may be eligible for a non-expiring 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 date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or structure location should conform to applicable setbacks. // il )/1 `j('�y Signature of Applicant or Agent ��'40 4 AIan- **************** an k♦ *****n *'h *** Ak .:*** **** * - r:i�Y,:.t#a . :}x:..::.Y. E :y.;.:e.e:k Y: Date: (FOR OFFICE USE ONLY) Please Contact_JASON ROYD between S am and 9 am Phone R28_465-2259 Zoning Approval: _Yes No Zoning Approval if: UDO Zoning R-40 Form A Minimum Setbacks Front 80 FEES Side 15 Type Description Date Received Amount By Rear 30 ADMN Max Light 3J Improvement Permit 7/11/2008 PSO S150.00 CNTR Regale—AC 36t gpd to COO gpd 7/11/2008 PSQ $275.00 SIR Recalc—New Well Pcmit 7/11/2008 PSO $300.00 Total: S725.00 *If a permit has to be redesigned and /or RETRIPS made to the property, there is an additional $60 charge x1s \ CATAWBA COUNTY ❑e pit ' ❑e Case/4 WELL-II-2013-044122 T Cali Public Health Department i- _.14 Subdivision st c, .,- Environmental Environmental Health Division ar-• ? PINK 265804900097 �$-�/ PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 13—#1:11 0 " LOT# 1-2 ti �+5+t '. - 8°. 13 . 'PSR- tY ao13 iCaGIU2 NAME ON PERMIT: ALAN & ELIZABETH WATERS, 510 4TH AV NE, CONOVER NC 28613 Site Address: 9230 COOKSVILLE RD, VALE NC 28168 Property Size: Square Feet 318,423.60 Acres 7.31 Directions: 10 W to Cooksville Rd on right before bridge (after Old Shelby Rd) WELL PERMIT WATER SUPPLY: Individual Well SETBACKS: 1. BUILDNG FOUNDATIONS 25 FT. 2. EXISTING & PROPOSED SEPTIC SYSTEMS MIN. 50 FT. 3. EXISTING & PROPOSED SEPTIC REPAIR AREA MIN. 50 FT. 4 . SEWAGE PUMP SUPPLY LINE 50 FT. 5. UNDERGROUND STORAGE TANKS 100 FT. 6. STREAMS/BROOKS/CREEKS 50 FT. 7 . LAKES/PONDS RESERVOIRS 50 FT. ALL OTHER POSSIBLE SOURCES OF GROUND WATER CONTAMINATION 100 FT. The well driller must verify all setbacks before drilling the well. If the well driller is unable to maintain any of the above setbacks, contact Catawba County Environmental Health at (828) 465-8270 before drilling the well. Grouting Depth: Minimum 20 Feet Casing Height: 12" Above Land Surface All newly constructed private drinking water wells are required to be sampled in accordance with the North Carolina Rules Regarding Private drinking Water Well Testing (15A NCAC 18A .3800). The fee for this sampling is included in the cost of the well permit. It is the applicant or property owner's responsibility to notify Environmental Health when the well is ready for sampling. Water samples will be drawn from an outside faucet unless otherwise specified. Please note that all water samples are taken during one visit. The processing laboratories have different protocols and timeframes for reporting results; therefore, you may receive several different reports concerning your water sample. For questions or more information, please contact Catawba County Environmental Health at(828)465-8270, Robbie Phelps 11/26/2013 AUTHORIZED STATE AGENT APPROVAL DATE E9-ehpennit 11/26/2013 10:11 Page 1 of 3 n Permit# Well-11-13-044122 CATAWBA COUNTY G Name Alan& Elizabeth Waters 4Z Public Health Department Address 9230 Cooksville Rd Environmental Health Division PO Box 389, IOOA Southwest Blvd, Newton NC 28658 PIN# /8 42 y, (828)465-8270 Fax (828)465-8276 TDD(828)465-8200 SITE PLAN J V n 4S i X 2 r 6 *� N - -37 oG J 0 .0 J rl oa Ge C6-73 Scale (' `°