Loading...
HomeMy WebLinkAboutEHPR-03-2016-23331.TIF fig: 41� THIS IS NOT A PERMIT Case # EHPR-03-201 6-23 33 1 Litti�„ y CATAWBA COUNTY HEALTH DEPARTMENT 0 . ;-1 'el t 0 in "° PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES F { 842 sM Environmental Health Plan Review - OSWP o. o o o-}t 0 IMPROVEMENT # * . CI Owner ROBERT& ELIZABETH WELLER, 901 BROOKMEADE DR, WINSON SALEM NC 27106 C:336462741I RWELLER @TRIAD.RR.COM NAME TO APPEAR ON PERMIT ROBERT & ELIZABETH WELLER SITE ADDRESS: 5026 KISER ISLAND RD, TERRELL NC 28682 PIN # 461604725626 NAME of SUBDIVISION: KISER SUNSET KEYS 1 Lot#32 & PT 31 Section/Block PROPERTY SIZE: Square Feet 43,124.40 Acres 0.99 DIRECTIONS: HWY 150, Kiser Island Rd, Hosue is on Left just beyond Lee Point Rd PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: IP to determine if attached garage addition is possible w/septic expansion required. Existing home is 3 BdRms. Permits on file are repairs & do not indicate sizing. Adding an attached garage to the home 30x25 w/ 1 bedroom. House Septic Total 4 BdRms 480 gal/day Home also has a 1 BdRm guest house w/sperate septic system on the 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? No Are there any easements or right-of-ways on this property? No APPLICATION FOR: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF House, Pool w/concrete, Guest House, Well House EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: House 75x32, Pool 25x45, Guest 30x30, Well 6x6 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 30x25 attached garage w/BdRm #OF NEW BEDROOMS:: 1 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: P9-ehapplication 03/07/2016 10:55 Page 1 of 4 sp CATAWBA COUNTY Case A EHPR-03-2016-23331 . . Public Health Department Subdivision KISER SUNSET KEYS 1 —^- r Environmental Health Division p1Nip � �` 461604725626 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 !g¢2 w NAME ON PERMIT: ( ROBERT& ELIZABETH WELLER), 901 BROOKMEADE DR, WINSON SALEM NC 27106 ( ROBERT& ELIZABETH WELLER) Site Address: 5026 KISER ISLAND RD, TERRELL NC 28682 Property Size: Square Feet 43,124.40 Acres 0.99 Directions: HWY 150, Kiser Island Rd, Hosue is on Left just beyond Lee Point 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 identificationfinq labeling of all property lines and corners and making the site a ssible so th a complete site eval ation can be erformed. Date: 3-- �42 Signature of Applicant or Agent re, �}IQl1� 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 Pak sa y„tilE r " -'§r r c 5 s. .'IT Ofa�e �� tht5 L-FEENAME: YpSulls� ;!g� ,y 7t rati* . k�Hai . enDATE ;,�r FEEAMOUNTIL Improvement Permit Fee 03/07/2016 $150.00 n r n n TOTAL FEES a g"J„Il xl 5 'y 5150 00'r9E 7 acrq"'• � ' ; ..4»?a,.::c�u9Ks i:�.�`.„r�,€�.v-x�esntw:�.t�p�, x4z.ae:..a.-�u ,.: �w 2;w�;a. 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 03/07/2016 10:55 Page 2 of 4 CATAWBA THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH. DEPARTMENT aorn eeo,m. - Application for Environmental Services Page I Improvement Permit DI Authorization to Construct ❑ Septic Repair❑ Septic Malfunction ❑ Septic Expansion New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair C Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility ❑ Property Address 5026 Kiser Island Rd Subdivision Kiser Sunset Keys Lot# 32 Acres 1 Section/Block/Phase Driving Directions to Property 3 miles after turning from 150 onto Kiser Island Rd. Left hand side just beyond Lee Pt road. NAME TO APPEAR ON PERMIT'? ® Owner ❑ Applicant ❑ Contractor Applicant Contact Information Namc Robert&Elizabeth Weller ONVe Ce n(1�� cc CGok Address 901 Brookmeade Dr,Winston-Salem,NC 27106 �.. Phone336-462-7411 Cell Phone same Owner Contact Information Name same as above Address Phone Cell Phone RECEIVEU Contractor Contact Information Name MAR 07 ZOIb Address Phone Cell Phone CATA 3N COUNT` tNVIRONMENTAI HEALTH WHO WILL BE THE PRIMARY CONTACT? ❑® Owner ❑ Applicant n Contractor Description of Existing Structures on Site 2-Story 2700 sq ft home wfth attached garage. L-y tcs woe # of Bedrooms *t 3 Structure Dimensions 75X32 approx #of Occupants 2 1�`� ' h(30 Basement ❑ Yes ® No Basement Fixtures 0 Yes a No I-ad 7c yC1= ,A\v((L`n o(i. ifigm The Applicant shall notify the local health department upon submittal of this application if any of the following apply to S cite the property in question. If the answer to any question is "yes", applicant must attach supporting documentation. r M\ D Yes ID No Does the site contain any jurisdictional wetlands? O Yes ® No Does the site contain any existing wastewater systems? 0 Yes 0 No Is any wastewater going to he generated on the site other than domestic sewage'? ® Yes U No Is the site subject to approval by any other public agency? 0 Yes "n No Are there any easements or right of ways on this property? Describe Existing water supply in use U Individual Well LI Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes 0 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 ® Conventional ❑ Innovative ❑ Other ❑ Any CATAWBA THIS IS NOT A PERMIT coin CATAWBA COUNTY HEALTH DEPARTMENT ,,,,„,,..,,u,, Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence 0 Addition to Residence #of New Bedrooms *t 1 Project Description Potential addition of attached garage with possible new bedroom above Structure Dimensions 30X25 #of Occupants same Basement ❑ Yes CI No Basement Fixtures 0 Yes 6; No U Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing.9 Yes ❑ No Describe Plumbing Needed U Multi-Family Residence# Units #Bedrooms per Unit*t Total # Bedrooms *j Structure Dimensions U Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sy Ft) #Employees per Shift #of Shifts Dining Area(Sq. Ft.) U Business Specific Type of Business Retail Floor Space #of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Church#of Scats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type E. Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ 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 he confirmed by rooms identified on house plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system size increase in the future. t If structure is plumbed but no bedrooms,calculated design Clow 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 fir(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. I � J Signature of Owner or Agent ---4-6A V1��"C/ Date - • Printed Name of Owner or Agent g-C\2 e_CA— 5. 03 c.--I ( e sr Catawba County Environmental Health s_.„ ,,,, . : , w.',4"61.-::, a rL`_r - 12'58 •f 24'42 `• // .€ Septic 1 Fie Main , Tank / / ' 25 / Pool /30 10 Waterline?/ / sr (house / Guest • / 4 k metre. Ten �. • Get Hee 55 / 1 45gj / , \ 1 oX 1 1'u5 1 is, N. / ‘.. \ lir r li- y ,, .;ter.' .41 v ' -.•.t",. .t•' +•v I { A 1 t.' , (1 •At 4 ley r 'a ': 'ION- k, <: 5626 `4 . ./ , • 1\ t I . .' t 1''. N -- 6546 • #'....:, „:„-;/Y Katherine Harris From: rweller @triad.rr.com Sent: Tuesday, March 08, 2016 3:59 PM To: Katherine Harris Subject: Re: Site Plan Attachments: drawing lines .jpg Dear Ms. Harris, I attached your drawing along with an aerial shot from GIS, and I have done my best to show the proposed addition- it's southeast corner would be 10" from the lot line. The well is shown as a dot, and this well serves both the main house and guest house. Since we have only lived there 8 years, I am not certain of the line from well to house or the actual septic field locations, although the repair permits you have on file show fields for both structures. Let me know if you need more information. I put tape and flags to show the proposed addition, and the well has a fake rock covering it so is quite obvious. Robert Weller 5026 kiser island rd Terrell, NC 28682 ---- Katherine Harris <KHarris @CatawbaCountvNC.gov>wrote: > Please mark the proposed garage with dimensions, along with how far off the front or back property line and one of the sides that the addition will sit. Also please mark with an X the well location. Please indicate the location of the house's tank & lines and the same for the guest house. > If you have any additional questions please call me at 828-465-8270. > Thank you, > Katherine Harris > Administrative Assistant I > Environmental Health > Catawba County Public Health > 100A Southwest Blvd > Newton NC 28658 > 828-465-8270 > 828-465-8276 fax > The information contained in electronic transmissions is confidential and may be subject to protection under the law, including the Health Insurance Portability and Accountability Act (HIPAA). An electronic transmission is intended for the sole use of the individual or entity to whom it is addressed. If you are not the intended recipient, you are notified that any use, distribution or copying of the message is strictly prohibited. If you received a message in error, please contact the sender immediately by replying to the email and delete the material from any computer. 1 Catawba County Environmental Health----ii� f ��� trt, • t I '�1$ t 4 1�� b} � .l� ,a t '�' ar .. t b s14�fi , .. 2/ 7,58 24 42 is ' e" v4 ¢� 2564 w l 1p °*/ cb Q * / try / / as 2•pp / vT 1\ / / fit Or / N/ a0 / \ b CY c / / eh GP / / NO / / / ".I) / 1141 l,+$ / 'CO /J/V / tit; , ® / Parcel: 461604725626, 5026 KISER ISLAND RD 1in=50ft TERRELL, 28682 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 03/07/2016 Catawba County Environmental Health —mot . __ . , 101104-. /f. ..,.1. . 1 ' 1 . Lk". 11., f. ' •.' 71 „ 2r Air S�18 t . i .I . 'r lir . . • . ` "5 l F 4 -011 tikiihotV .4., , yy,, .0 7` r AY 7:jillh'' ' ..., ... -- �} 1 �' 1 5032 O 501 - ^a 4 \eh, .01 - \ , .1 " a-Nr - — . , . t cwt V - y j�`.•_.f. j T ,.'!,. ,\ �,''. ` �... Ir \ - re \ . . P . .. _ . ,. , :\,„ .., . . • t,!hr 1? r - 3 '7'j1l ate. . tia l �' \. O 'M1 t. Parcel: 461604725626, 5026 KISER ISLAND RD 1 in=60ft TERRELL, 28682 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 03/07/2016 r�- ILIY-c- . _ _ . • , . • 9 . _ - / No- . ,,,,,,„ 1:3 . \Ic 0 0 ' ' ,. .... . ■i.1111 a -CD 171 MI — - sa. 4 7 14 4 _ 4 1 -1 e F a 8 E a 11 �g s 1r 10 _ 39 14 8 21 30 24 10 C 10 21 A 32 D 32 16 6 6 46 24 I $83 3, I Iii" 7 .?‘I PI. , , --- - ' illi, ', it 1 -.- -, , ! ,., a n s - c: ° - :40' N.r. t 14 1 1:1 - ' , k-. " r ) i I - 1-- - , IT - r , :ii., . ,,, , -,..c., :1- 7 _.,_ 1 " i ii t le- - i 4111111111111111•111111•111111111111111/0 r- March 2, 2016 Katherine Harris Catawba County Health Department Environmental Health 100A Southwest Blvd Newton, NC 28658 Dear Ms. Harris, I have enclosed a completed application for septic expansion, if needed, for the property address 5026 Kiser Island Rd,Terrell, NC. In 2015 we purchased adjacent property and expanded the lot from 0.75 ac to 1 acre. We are in discussion with builders to consider adding an attached garage on the southern side of the existing home, with a room above which we would consider using for a 4th bedroom. All of these plans are preliminary, and an evaluation of what might be needed from the septic standpoint is part of our considerations. When we spoke on the phone, it did not appear that the County had records for septic certification other than the repairs in 1982 and 1989, and that the current septic is likely matched to the 3 bedrooms listed for our home. The property line is marked by chain-link fence, and the well is next to a cinder-block well-house. I will place corner flags on the likely new corners of this new garage. I have also attached a drawing of the potential addition. Please let me know if you need additional information. Regards, Robert Weller 901 Brookmeade Dr. Winston-Salem, NC 27106 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 461604725626 Owner: WELLER ROBERT S Parcel Address: 5026 KISER ISLAND RD Owner2: WELLER ELIZABETH A City: TERRELL, 28682 Address: 901 BROOKMEADE DR LRK(REID): 19686 Address2: Deed Book/Page: 3297/0943 City: WINSTON SALEM Subdivision: KISER SUNSET KEYS 1 State/Zip: NC 27106-3579 Lots/Block: 32 & PT 31/ Last Sale: $895,000 on 2007-12-18 School Information: Plat Book/Page: 13/17 School District: COUNTY Legal: LOT 32 & PT 31 PLAT 13-17 Elementary School: SHERRILLS FORD Calculated Acreage: .990 Middle School: MILL CREEK High School: BANDYS Tax Map: 018FX 01052 Township: MOUNTAIN CREEK School Map State Road #: 1841 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: $342,400 Zoning2: Land Value: $380,000 Zoning3: Assessed Total Value: $722,400 Zoning Overlay: CRC-O,WP-O,FPM-O Year Built/Remodeled: 1963/1982 Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2008-03-18 Building Permits for this parcel. Firm Panel #: 3710461600L Building Details 2010 Census Block: 5025 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. ©2015, Catawba County Government, North Carolina. All rights reserved. ?OD * uns,Ido_rb b6e0ABY,a\ http://gis.catawbacountync.gov/nomap/parcel_report.php?key=461604725626&typ=P 3/7/2016 I r �� •-TAWBA COUNTY HEALTH DEPARTMENT PI/4/1/12 NEWTON, NORTH CAROLINA COMPLETION PERMIT FOR SEPTIC TANKS PERMIT IN°- 611. 6 DATE : c OWNER'?)/U :O 0t ADDRESS At !d r& 4111A _- BUILDING CONTRACTOR SUBDIVISION cm LOCATION 10/Z/L Mr.( 07-.24 '/od ED( LOT LOT SIZE �/ BLOCK OR SECTION HOUSE ( MOBILE HOME ( ) BUSINESS ( ) OTHER ( ) FHA-VA LOAN ( ) SEPTIC TANK: (SIZE GALS) WATER SUPPLY: , / NO. BEDROOMS NO FIXTURES INDIVIDUAL C/ PUBLIC GARBAGE DISPOSAL UNIT:YES ()NO ( ) IF WELL , TYPE : BORED DRILLED DUG AUTO WASHING MACHINE : YES ( ) NO ( ) DISTANCE FROM SEPTIC TANK OR NEAREST NITRIFICATION FIELD: SQ .FT . POLLUTION : FT. 1) NUMBER OF LINES SEPTIC TALI( INSTALLED BY, 2) LENGTH AND WIDT• Ihh' ' " - l ; . , /1/1 d, . L X/ 0 'ERN , a) BED SYSTEM (// CERTIFICATE F C000PI,EBY : t . b) TRENCH SYSTEM ( ) n Lh C -Z• 3) DEPTH OF STONE IN LINES 12. _ REMA ` S ' ADEQUATE FALL (GRADE) ON: 1) BUILD N ' (HOUSE) SEWER LINE : YES (V NO ( ) 2) NITRIFI TION LINES : , PATE INSTALLED: YES (/ — -7,NO ( ) 4 - . PT_C V. • • �� 'f (tixbo 7-iftd, x Fw 0 m F H O ._ Oa � -----.. HEALTH DEPARTMENT COPY I U � i CATtCWBA COUNTY-HEAL. EALTH.-'DEPARTMENT VA / ��U ° /J//IIP//.ROVEMENT PERMIT FOR SEPTIC TANKS �� Per[ci't No. 4 NAME,it OWNER •�w/Lz,6 �/��r',:�'�Q.eP qt DATE 2 —76----7� ADDRESS OF OWNER AP / / a. "LW - -- eft t --PHONE ai NAME OF CONTRACTOR ADDRESS LOCATION • SUBDIVISION LOT NO. SECTION OR BLOCK / I LOT SIZE FHA, VA LOAN HOUSE ( ) MOBILE HOME ( ) BUSINESS ( ) OTHER ( ) 1 . 5,'TIC TANK LAYOUT NO. BEDROOMS ( ) NO. FIXTURES ( ) , GARBAGE DISPOSAL UNIT: YES ( ) NO ( ) 4- 11,-&-u,77- PLUMBING UNDER BASEMENT FLOOR: YES ( ) NO ( ). \-)4.O I /Z ; � SIZE OF TANK LIQUID GALLONS JO j NITRIFICATION FIELD: (` . 1. Number of lines / Cry 2. Length and width of links: / sy'9 Q- a. Bed System / A- 6 O ft. b. Trench system ft. 3. Total Depth of stone inches GROUNDWATER INTERCEPTOR DRAIN: (IF REQUIRED) - WATER SUPPLY: PRIVATE ( ) PUBLIC ( ) 7) OWNER NOTIFIED TO CHECK ZONING: YES ( ) NO ( ) OWNER AGREES WITH LAYOUT: YES ( ) NO ( ) ue OWNER AGREES WITH SPECIAL INSTRUCTIONS: YES ( ) NO ( ) OWNER OR CONTRACTOR SIGNATURE PERMIT FEE $ ' PERMIT VOID AFTER 36 MONTHS , j SEPTIC TANK CONTRACTOR MUS ALL IMPROVEEN PERMIT ISSU D1BY DETAILS OF THIS PERMIT (LA T) SANITARI• , _r Led V/j,GF' INEALTN DEPARTMENT COPY SOIL CLASSIFICATION: SUITABLE ( ) PROVISIONALLY SUITABLE ( ) UNSUITABLE ( ) SITE FACTORS: 1. SLOPE (%) S PS - U 7. SOIL PERMEABILITY S - PS - U 2. SOIL TEXTURE (12-48 IN.) S - PS - U UNDER 60 MIN. OVER 60 MIN. SANDY, LOAMY, CLAYEY 8. OTHER S - PS - U 3. SOIL STRUCTURE (12-48 IN.). S - PS - U (SPECIFY) 4. SOIL DEPTH (IN.) S - PS - U 9. SOIL SERIES: 5. RESTRICTIVE HORIZONS (IN.) S - PS - U A. CECIL ( ) B. HIWASSEE ( ) (IMPERVIOUS STRATA, ROCK) C. MADISON ( ) D. APPLING ( ) 6. SOIL DRAINAGE - GROUNDWATER S - PS - U E. PACOLET ( ) F. FLOOD PLAIN ( ) (EXTERNAL - INTERNAL) G. 2-1 CLAY SOIL H. OTHER-SPECIFY i i CATAIBA COUNvrY SPAT T � 1 7/1/ Lot Evaluation Improvement Permit_ Hir-Permit letion Perini Owner/ant o4�ri.1. GJ Ph n � j - a�f/ Address rs-p a 4 ���� Subdivision cl, ✓tefl- 41:c, $6?-7 Section/Block Lot # Lot Size ' Directions: , i , - / _ Facility: HousOL obile Home Business : • - : Z.. * g Ap•,:. _ ye o # *..M.:Lt..-family Other : 100% '._.,.ir 4 -s - Bedrooms Baths Seats Employees : GPD ' • Appl •-..ion -- Garbage Disposal Special Fixtures : REPAIR .'4 « FEP• •� 13E-2'•! 30 Basement yes/no Basement Plumbing yes/no : DAYS OR =: Fly! ■ ► OF,'W• i i . Water Supply: Private Public ********#***** Tye of System: Trench Bed System L - th er (Specify) Tank Size: Septic Tank Pump Tank. t. . ' _ Nitrification Field: Total Feet (Op Depth of Stone_ ` ), ' ' Bed Size -p! . 8 Trench Width Total Length of All Trenches Number of Trenches Individual Trench Length / / /_/ Feet on Center Maximum Trench Depth Distance to Nearest Well Sb '1-- Lot Evaluation: Approved Disapproved •* _�; - _Sketch of Lot Evaluation Site - System Design •-- Final - 10 - - — -- - 1 . • V.? ) ... -!....] ° 11 -0 ,a _.?'Ll . t _U x ( hi 1 I 4, PTFF so N '' sysZ t ps Roar- ^ NK , i \ r L. _I 4 ■� a -O a s '^ \ \` `° ' 2' 7 --. :.■ m N � -4 -.44- i 1 r ) \CZ q r— ilS \._ sk _ ************************************** ******************* ********** Permit Date R-/- 8'7 (Lot Evaluation and Improvement Permit void after 36 months) Owner/Agent '� �i' �.e-- At-L2.4"-e4_,,/1/ Sanitarian 67- (,t/- Installed By 4,0( r _j _ , ' Date e//57 Sanitarian /hw ( • e any changes/informati n red or by sketch on back-4tJJ Tbpo S PS U Drainage S PS U Depth S PS U Restrictive Hoz. S PS U Space S PS U Soil S PS U III Loans: Sandy Clay, Silt, Clay, Silty Clay .6-.4 IVa Clays: Sandy, Silty, Clay .4-.2 I WHITE-OFFICE COPY • YELLOW-OWNER/AGENT COPY 1 iirw-'�"�r,�-� ems-frq�•..�+iwa+ r�(�.s�fq . �'MY��- a1 !j� Cb — /3 " 2 3 - /s ) '7") w7 - +z , BA CATAWBA COUNTY '�'' O� 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT PHONE: 828.465.8399 U `� Monday, March 7, 2016 t$L}2 sM www.catawbacountync.gov PAYOR: WELLER, ROBERT&ELIZABETH PAYMENTS TRANSACTION NUMBER: TRC-633128-07-03-2016 PAYMENT DATE: 03/07/2016 PAYMENT TYPE: Check 4264 check received by mail INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-325884 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EHPR-03-2016-23331 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 5026 KISER ISLAND RD, TERRELL NC 28682 Owner ROBERT& ELIZABETH WELLER, 901 BROOKMEADE DR, WINSON SALEM NC 27106 C:3364627411 RWELLER @TRIAD.RR.COM ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 03/07/2016 10:54 Page 1 of 1