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HomeMy WebLinkAboutEHPR-03-2016-23350.TIF BA !G THIS IS NOT A PERMIT Case # EHPR-03-2016-23350 CATAWBA COUNTY HEALTH DEPARTMENT 0 • fl o e VI " PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES � Is 2 sM Environmental Health Plan Review - OSWP '0 REPLACE WELL '^ } Owner ROBIN LITTLE,4755 ROCK BARN RD, CLAREMONT NC 28610 C:828455809I NAME TO APPEAR ON PERMIT Robin Little SITE ADDRESS: 4755 ROCK BARN RD, CLAREMONT NC 28610 PIN # 376301168024 NAME of SUBDIVISION: Lot Section/Block PROPERTY SIZE: Square Feet 23,958.00 Acres 0.55 DIRECTIONS: Go past Rock Barn Golf Course about 1 mile, House is on the Left towards Oxford School Rd. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY : Private Well DESCRIBE WORK: Replacement Well Permit' Currently tied into a neighboring well. Old well on property has very little water. 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, Carport, Bldg EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: House, Carport 12x24, Bldg 12x20 NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION 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: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: YES F9-ehapplicaiion 03/08/2016 13:50 Page I of 4 e CATAWBACOUNTY Casco EHPR-03-2016-23350 .e Public Health Department Subdivision Q 'j Environmental Health Division 376301168024 PIN# PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 I8 q2 n. • NAME ON PERMIT: ( ROBIN LITTLE),4755 ROCK BARN RD, CLAREMONT NC 28610 ( Robin Little) Site Address: 4755 ROCK BARN RD, CLAREMONT NC 28610 Property Size: Square Feet 23,958.00 Acres 0.55 Directions: Go past Rock Barn Golf Course about 1 mile, House is on the Left towards Oxford School 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 an b ing of all property lines and corners and making the site acce ibl so that a complete site aluation can be performed. Date: 3 / Ji Signature of Applicant or Agent r /� 1 r A 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 it a k 5 g t-.4x w S Y e ru lf at _ $ xmL 7 EENME. m : iigii s }ayr DATE lFEEAMOUNI•R401, oti o,t : 6 Well Permit& Inspection Fee 03/08/2016 $300.00 ,41",r r'T OTAFE f r k F ri a e y t #i4 l t` 300 00 . rt t 3 Y .*P.,..4 lh:r `r t a, n $ x= n � a `t%aa:.a, '1,_ ,r 111rraB..:Z,`i.:a w- is/I tti liiii z 1 ue ialit /WS& '3!� ,o5si5': -nt .,Jrssti 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) 119-eliapplicatiou 03/08/2016 13:50 Page 2 of 4 cATA\ V BA THIS IS NOT A PERMIT . COUNTY ' ,,,,.. - .. CATAWBA COUNTY HEALTH DEPARTMENT N n Application for Environmental Services Page 1 Improvement Permit n Authorization to Construct n Septic pair n Septic Malfunction n Septic Expansion n New Well Permit _ Replacement Well Well Abandonment❑ Well Repair n Existing System Inspection (Pre-Approval Required) Application is for New Construction n Existing Facility At Property Address Li 'I% 1 1 D I"- I A 1J Subdivision �� a{emn** M c i'DJ 0 Lot# Acres � Sec ion/Block/Phase ,c Driving Directions to Property �(4 SS I V Q C� O-rp f--� C'OleS e, 1 (l'L1 A fi —€ 1 1 I D-. IYv 1 )t n11 1e,-t'`} vr\,cd- Cx d ckw/ koc , NAME TO APPEAR ON PERMIT? ErOwner n Applicant n Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information I I Name _,\6kjir\ l-I 7,+-,'2.- n Address `ti55 ( oc_ (A,ot(r, K Lk)d Gl(t ,tPlop* /0C n .A00 Phone (%') - L�j- C739 ) Cell Phone Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? VI Owner n Applicant n Contractor Description of Existing Structures on Site e _ r aganrie #of Bedrooms *t ;Z Structure Dimensions Fa _ # of•ecupants _ Basement ❑ Yes No Basement Fixtures ❑ Yes No \ ( 49 i zy The Applicant shall notify the local health department upon submittal of this application if any of the following apply to 7 the property in question. If the answer to any question is"yes", applicant must attach supporting documentation. ❑ Yes No Does the site contain any jurisdictional wetlands? YesVo Does the site contain any existing wastewater systems? ❑ Yes E No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes DNo Is the site subject to approval by any other public agency? ❑ Yes iiNo Are there any easements or right of ways on this property? Describe Existing water supply in use IiIndividual Well n Community Well Ti Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** n 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 ❑ Conventional ❑ Innovative ❑ Other ❑ Any cATAV Y BA THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence n New Residence n Addition to Residence #of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement ❑ Yes n No Basement Fixtures ❑ Yes n No ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling n Yes n No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence# Units #Bedrooms per Unit*j Total # Bedrooms *t Structure Dimensions H Food Service Specify Type # Seats Floor Space -Entire Food Service Facility (Sq Ft) # Employees per Shift #of Shifts Dining Area(Sq. Ft.) n Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Church # of Seats Kitchen n Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ,Individual Well ❑ Semi-Public Well n Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug n Unknown Well Repair Requested n Yes n 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. t 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 AgentRt0 �I Date /C31/ gyp Printed Name of Owner or Agent��O Ohl J LIT l �P Catawba County Environmental Health j /76......„„,....„.„. cr, c) c, pa. 0 ' / rt, ft J txY \ k s ^S, ; rip •.C1 .-Y OJ 0 ) of \ Q° 1 Ct� i 40 * (100) ��' SNP /J 04 (175, '"`/ Q <>7). \ \ Parcel: 376301168024, 4755 ROCK BARN RD 1 in=50ft CLAREMONT, 28610 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 03/08/2016 Parcel Report Page 1 of 1 • Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 376301168024 Owner: LITTLE ROBIN M Parcel Address: 4755 ROCK BARN RD Owner2: City: CLAREMONT, 28610 Address: 4755 ROCK BARN RD LRK(REID): 66341 Address2: Deed Book/Page: 3292/1071 City: CLAREMONT Subdivision: State/Zip: NC 28610-8524 Lots/Block: / Last Sale: School Information: School District: COUNTY Plat Book/Page: Legal: Elementary School: OXFORD Middle School: RIVER BEND Calculated Acreage: .550 Tax Map: 2414 06002 High School: BUNKER HILL Township: CLINES School Map State Road #: 1709 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: OXFORD Zoningl: R-30 Building(s) Value: $66,100 Zoning2: Land Value: $10,100 Zoning3: Assessed Total Value: $76,200 Zoning Overlay: WP-O Year Built/Remodeled: 1950/2015 Small Area: ST STEPHENS/OXFORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710376300J Building Details 2010 Census Block: 2016 WaterShed: WS-IV Protected Area 2010 Census Tract: 010101 Voter Precinct: P27 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. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=376301168024&typ=P 3/8/2016 li CATAWBA COUNTY HEALTH DEPARTMENT N o Q /L 9 (7(X 465-8270 • • Lot Evaluation ' Improve t Permit Repair Permit Completion Permit Owner/Agent \ i </ f) /�1 e Phone Address Subdivision Section/Block • Lott/ Lot S"ze. , Directio s: i ��. ��. — .. ! — A .•.,i /' — . < _ ._ // a I / a' �i _._.. t ' • Facility,: House_ Mobile Home Business_ Other: ' Zoning Approva ye)/no /1 _ _ Multi-family_ Other . 1005 Repair Area yes/no Bedrooms 3 Seats Employees . GPD Flow Application Rate Hot Tub or Spa yes/no Special Fixtures . REPAIR NOTICE: REPAIRS. MUST BE WITHIN Basement yes nee ‘ ,Basement Plumbing yes/no . 30 DAYS OR DAYS FROM DATE OF Water Supply: Private x Public_ . PERMIT. . . . . . . - wxwxwxx Type of System: Trench X Bed System_ Other (Specify) Tank Size: Septic Tank 1000 Pump Tank Nitrification Fie_1414 Total Square Feet 900 Depth of Stone I // Bed Size Trench Width 3 Y T Total Length of All Trenches 3 a O Number of Trenches Y y �yy • Individual Trench Length /L5/ /3/j/�5/_ Feet on Center 9 / Maximum Trench Depth 30�� Distance of 'Nearest Well "1 ,5b!' ••t aluatio. • • -es/no (Void After 24 months) Topo 5 5 Slope I Sketch•of � ion •ys -s Design - Final Texture f'# I 1 Structure 1191 I IL--") .I z �I may Min. d 1 C �_� 7( Soil Wetness i ' '• I r :I-• Soil Depth AC " I I Restric. Hoz. at`ff " I u I Available space &/nol 6 • Overall Class S * U I . I Comments: I I 1A110I(`( I i I I I I ----- 0 I 3 ' • I I "/DSPermit Date 0 (Improvement '- rm',i voi• . +ter 60 months) m ���� Owner/Agent .Y/l`�/a'�<..' � Sa itaria A. ---- Installed Bv■mi £Sflt Date • A Sanitar' :n .( 6 1_--.. 2 • ■ (Note any changes/informati• -;in red or by sketdh on `bac r ysp'A CATAWBA COUNTY ��. � 100ASOUTHWESrBLVD �x _ NEWTON,NORTH CAROLINA 28658 RECEIPT Into, PHONE: 828.465.8399 U 3r" Tuesday, March 8, 2016 1842 Ski www.catawbacounpmc.gov PAYOR: Little, Robin PAYMENTS TRANSACTION NUMBER: TRC-633927-08-03-2016 PAYMENT DATE : 03/08/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-325948 Well Permit& Inspection Fee $300.00 TOTAL PAYMENTS : $300.00 EHPR-03-2016-23350 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 4755 ROCK BARN RD, CLAREMONT NC 28610 Owner ROBIN LITTLE, 4755 ROCK BARN RD, CLAREMONT NC 28610 C:828455809I **NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 03/08/2016 13:48 Page 1 of 1