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HomeMy WebLinkAboutEHPR-06-2016-24029.TIF �3A �G THIS IS NOT A PERMIT Case # EHPR-06-2016-24029 Ars tr;AU CATAWBA COUNTY HEALTH DEPARTMENT C•• r 2 D v WV 0 44!" PLAN'C PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 sit Environmental Health Plan Review - OSWP 't g}°' o o f IMPROVEMENT a -: o• Owner JAMES & KATHY HANSON, 134 PRESEVE WAY, MOORESVILLE NC 28117 C:7047373303 NAME TO APPEAR ON PERMIT James & Kathy Hanson SITE ADDRESS: 4890 MOORE ST, SHERRILLS FORD NC 28673 PIN # 461601355447 NAME of SUBDIVISION: CRESCENT LAND AND TIMBER CORP Lot# 50 Section/Block PROPERTY SIZE: Square Feet 35,719.20 Acres 0.82 DIRECTIONS: Hwy 16 South, Left on Hwy 150, Right on Slanting Bridge Rd, Left at Drena, Right on Giles , Right on Moore St,4th house on the Left. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 600 WATER SUPPLY: Private Well DESCRIBE WORK: Existing 2 BdRm House on property will be moved & become an Accessory Dwelling. Building a New 3 BdRm House w/ Pool 60x35 w/Concrete. Possibly use existing system &expand or whole new system. Total-600 GPD Will also need a new well. 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: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF 2 BdRm House, Shed EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 37x40, Shed 10x15 NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: House 60x60, Pool w/concrete 60x35 #OF NEW BEDROOMS:: 3 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: 139-rhapplicaton 06/06/2016 11:44 Page 1 of 4 saA CATAWBA COUNTY Case# EHPR-06-2016-24029 ' Public Health Department p Subdivision CRESCENT LAND AND TIMBE < ;,(y , Environmental Health Division PIN# 461601355447 7'41 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 /g4 s. NAME ON PERMIT: (JAMES&KATHY HANSON), 134 PRESEVE WAY, MOORESVILLE NC 28117 ( James & Kathy Hanson) Site Address: 4890 MOORE ST, SHERRILLS FORD NC 28673 Property Size: Square Feet 35,719.20 Acres 0.82 Directions: Hwy 16 South, Left on Hwy 150, Right on Slanting Bridge Rd, Left at Drena, Right on Giles , Right on Moore St,4th house on the Left. 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 .nd rules. I understand that I am solely responsible for the proper identification d lab ling of all property lines and corners and making the site acc=. Ible so that a,•omplete site evaluation can be performed. Date: ((I (,' �� Signature of Applicant or Agent f ,i,..4,,,. .,ji An Environmental Health Specialist will contact you within 5 work' g days of application date. If you need further information or assistance please call 828-466-7291 AREA1 �FENiM EUj ' t i "l � � 1r 0 Il !i 'ilrl1 iT E " IFEAMOUNiT t•i o il @ ; i_ lu DA " •'t-1 Improvement Permit Fee 06/06/2016 5150.00 7 a�`P I IOTA ]1 'u ESjIVlVl liliiiiiiiliIi 1ll+i�I"" - r to ' " ' ' $rso 00 1 � I� (I r r. . I�I�l�l�{�r,�IIIIIIIiI�' �II�I� I a*'� iii � dlii.liItIii6iro iltf'e vieuIIWLtlhWIWtWWIfGU,Ilii: _ teiijja .wtm1LUm U6Alluuc "'*senwlnt$sr.4tv111 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-ehapplicatUon 06/06/2016 11:44 Page 2 of 4 CATA\`\, I. A THIS IS NOT A PERMIT �1 counir CAT^ CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permit Authorization to Construct U Septic Repair n Septic Malfunction❑ Septic Expansion ❑ New Well Permit ❑ Replacement Well El Well Abandonment❑ Well Repair n Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction IT Existing Facility n 4, Property Address / �/a 1416 6 /E ST Subdivision — Lot# Acres Section/Block/Phase Driving Direction/to Property / Cu' '�� y I ' 6 a P /1 ' .. G' l e _ if IR c- %pre 53 NAME TO APPEAR ON PERMIT? F vl Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name we; 61,1 Kh rim 14-04 Address 1/4f i0 i%o,,gc ST Phone 70 if, 737 , 13 03 Cell Phone Contractor Contact Information Name Address Phone �� Cell Phone WHO WILL BE THE PRIMARY CONTACT? M Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site 906 52 frA HOM - # of Bedrooms *t a Structure Dimensions 2 1/%6 p o7,?/0/ #of Occupants 2 Basement f{ Yes �LV o Basement Fixtures ® Yes o .i 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 ITYKo Does the site contain any jurisdictional wetlands? Yes ako, Does the site contain any existing wastewater systems? D Yes L➢'�lo Is any wastewater going to be generated on the site other than domestic sewage? Yes rkNO Is the site subject to approval by any other public agency? O Yes 13No Are there any easements or right of ways on this property? Describe Existing water supply in use Individual Well ❑ Community Well ❑ Semi-Public Well County/City/Township Water Line Is a public water supply available? ** ❑ Yes -XNo 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) V ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other Ay CATAWBA THIS IS NOT A PERMTT un CATAWBA COUNTY HEALTH DEPARTMENT a ,,,,„„ Application for Environmental Services Page 2 Pro osed Facility Type Le Primary Residence ❑ New Residence n Addition to Residence # of New Bedrooms *t 3 Project Description // FJB"9' Structure Dimensions o it 'd ' # of Occupants a Basement In Yes No Basement Fixtures 0 Yes r]No Accessory Structure(s) Describe ii?adf ois7 G yx J”: !nu✓ G Z-47‘ # of New Bedrooms *1' if applicable 02 Structure Dimensions 3,7 /0' k df/n # of Occupants Accessory Dwelling 1es n No Plumbing +n Yes ❑ No Describe Plumbing Needed l. '1" b �i di 1 Multi-Family Residence# Units #Bedrooms per Unit*j' ' -PC \ — go ' x 3.1- Total#Bedrooms *1- Structure Dimensions 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 ❑ Yes in No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type _ Individual Well n Semi-Public Well TI Community Well Abandonment Type ❑ Drilled n Bored ❑ Dug n Unknown Well Repair Requested ❑ 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. j 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 /I Ap i Date 0/7 Printed Name of Owner or Agent Ok- 14 Yhldstri Catawba County Environmental Health ak rn \ç '( lPPr ' l iI l ' + is..,,Iii I Us �al1 a3'�'4 i g;,.(I '+ it,r,� `�` ■ §§ e, u P , Iy', , 101.97 le''t I i„pry r 't i ' �` .01 Al'1 i le 1 1 ;' }7 im r\\ I& $t "1 1 1111 l ,4 ' ,Ii. -r1 182.45 r 'Tr?. loci: 1', I I .r I , Si 23.96 \ 1 ( I ,al,l, yel� . -glib 11 t; Ii i t: , (t 7 I F N..! K34 < of Ii,W t I ;16,),1 Ce 11,11.1' ' I 1h ' y '. f n1 ` � l� iwf� r p M ( v:i(O � I I '� 'i 14 ,4s �� �i, >i ( .1•41,ii i ! tii(r•.I, d I ;, +t 1.Il ' it .4 � l � t1 �i I ,, f , 4' 11 `G r� a (l ' f h4 (i I�I 199.51 : 11 ht ' 1 17 '9��1i iiiii +`II'l1t4 IPT1i4 ,1411'"4 30 .. /���1 o 411, 4 + 1�; 25.53 I! r III ,l � is 14'� l , l - et 1� , , in s-. , " ,i1110... ,t rc. ro9 IYpt X32 't fliiit'l I '4 pitl 15.06 I+ rr ri' ii �I�,p, t,I 11,. ttII ° 11 „ri,, I IF-A40 , , [Ill H,� �� . ' Z ir....":7"--..... . /1111 iit1,1 It11 1 *AV 'tie III.,' .41I kali" ,III!I }.:.,r ,1'111111 I Ir' , '9,,"51 ,l ., �,'�nil II er, Parcel: 461601355447, 4890 MOORE ST 1 in=50ft SHERRILLS FORD, 28673 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 06/06/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel information: Owner Information: Parcel ID: 461601355447 Owner: HANSON JAMES V Parcel Address: 4890 MOORE ST Owner2: HANSON KATHY City: SHERRILLS FORD, 28673 Address: 134 PRESERVE WAY LRK(REID): 18820 Address2: null Deed Book/Page: 2647/0777 City: MOORESVILLE Subdivision: CRESCENT LAND AND TIMBER State/Zip: NC 28117-6934 CORP Lots/Block: 50/null School Information: School District: COUNTY Last Sale: Plat Book/Page: 15/184 Elementary School: SHERRILLS FORD Middle School: MILL CREEK Legal: LOT 50 SEC 32 LT50 PL15-184 PL 15- 184 High School: BANDYS Calculated Acreage: .820 School Map Tax Map: 018 X 32050 Township: MOUNTAIN CREEK State Road #: null TaxNalue 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: $125,000 Zoning2: null Land Value: $326,200 Zoning3: null Assessed Total Value: $451,200 Zoning Overlay: CRC-O,WP-O,FPM-O Year Built/Remodeled: 1964/2003 Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: null/null Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2008-03-18 Building Permits for this parcel. Firm Panel #: 3710461600L Building Details 2010 Census Block: 5028 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. ©2016, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=461601355447&typ=P 6/6/2016 CATAWBA COUNTY HEALTH DEPARTMENT palled Telephone (828)465-8270 TDD (828)465-8200 WLS # 0005- a/c/e 7 Improvement Permit AC Repair Pe nu. P\ Operation Permit. System Type Well Permit. Replacement Well Owner/Agent ,/ Stry Phone Address 5300 3 praaurs Tr Subdivision 61/241/10 Section/Block/Phase Lot# Lot Size •y 2-. Directions © /_+ INMF or i- _ a Thwe, a- R Odes R . /c of- OK) 7e.1r Property Address 1414 kteme 57 Facility- House Mobile Home Business Multi-family Other- Pin Number yK/G_ d/-85-- 5%'{'7 Other Zoning Approval# #Bedrooms -.5 #Seats #Employees Application Rate •35 GPD Flow Hot Tub or Spa yes/no Special Fixtures Basement yes& 100% Repair Are eS no Basement Plumbing yes/no Water Supply- Private Well Public Semi-Public **************t*t**l*******************************************************4. *********ff****************************s***** Type of System: Trench Bed Pump Pump/Panel Panel LPP Other e , Septic Tank Size 045/••5 Pump Tank Size Nitrification Field. Total Square Feet 7 0 Depth of Stone (Or Bed Size Trench Width 36 Total Length of All Trenches d� Number of Trenches Trench Length 87 /67/ 1 / / / Feet on Center cj Maximum Trench Depth 07 e/-.6) Distance of Nearest Well c 1-- *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* *********************************************vjr*"�77r��ry'*. .* ********************************************flit** Topo % Slope �t; ej1114 L 1 , ���� Texture Structure 03� O\� / (�V° Y¢ [AAA Cray Min. ➢. Y Soil Wetness " s or Soil Depth D (Si Restric Hoz at " k 2j • Available space yes/no/ o ,d' e j At Overall Class S PS U r 1C" \ v Comments. �gJ" J / ok �t� �, eiJ ' Pf fir uS a I 5 vD I ci Filter Required ' Riser required when /5/-35 tank is more than 6 Merli c( inches deep. **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** ***********e*******************f**************tit********************************l*************************f************ -An Authorization to Construct is valid for (5) five years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. The siting of the well by the Health Department staff is to provide protection from kno ssibl sources of contamination. No volume of water is guaranteed at any s'te by the Health Department. Are /� Permit Date /Z-L-� EHS !""' e/,/ 9 ` e Owner/Agent Septic Tank Ins ed By Date EHS Well Installed By Well Grout Approval Date Well Head Approval Date Date Sample Collected Date of Results Results EHS White-Office Yellow-Owner/Agent Pink-Building Inspection Authorization to Construct DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES DIVISION OF ENVIRONMENTAL HEALTH Sheet of ON-SITE WASTEWATER SECTION PROPERTY ID#45.-(:)S.-0/907 COUNTY ,j' SOIL/SITE EVALUATION T 1I for ON-SITE WASTEWATER SYSTEM OWNER. ZPrm-e S llan+Sri+J APPLICATION DATE //-30— 5-- ADDRESS: 533'3 Uwi v moo, r-,-e C 1,k.,LLl L K) C `1 DATE EVALUATED'Je- I-5 PROPOSED FACILITY rad ri(k-,A.,.. PROPOSED DESIGN FLOW(1949): fotiO PROPERTY SIZE. e $.� LOCATION OF SITE. 415(cl0 Meow ST- S PROPERTY RECORDED• WATER SUPPLY 4--Privat 0 Public 0 Well 0 Spring 0 Other EVALUATION METHOD. ItKkuger Boring 0 Pit 0 Cut TYPE OF WASTEWATER. Sewage 9 Industrial Process 0 Mixed Q SOIL Mok?ROLQG'i OTh ER ; ... ; -(7941) . .:: 1940 T'ROxIY, 1•... ,25 " ... : LAND. 110Rk ':..td 1942 SCAP,E ZON' 1941 :1941 SOIL: 194: 4e: 4 :: 19,44 .,:: N: POSITION/ DEPTH STRUCTURE/ CONSISTENCE! WETNESS/SOIL: sAPRp _ RESTR:! PROFILE: SLOPE:°! (IN.);:;; :::TEXTURE- .- ===MINERALOGY:::: COLOR DEPTH. CLASS:;:_ HORIZ CLASS`° :. SITAR : O - (v C✓C e p .� 1 Is )� I s, &' S_t7o Lie o I 2 • 3 • • 4 DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(1946): Available Space(1945) • P5 SITE CLASSIFICATION(1948)• P.S System Type(s) ;5,6 (25-50 EVALUATED BY i/ i •OTHER(S)PRESENT Site LTAR -5-5— ,35-- i COMMENTS. • LEGEND use the following standard abbreviations LANDSCAPE POSITION GROUP TEXTURE CONVENTIONAL LPP MINERALOGY/ TURE .1955 LIAR• .1957 LTAR• CONSISTENCE STRUCTURE CC(Concave Slope) I S(Sand) 1.2-0.8 0.6- CV(Comics Slope) LS(Loamy Sand) 0'4 X? (Nan-expansive)gh(Slightly G(Single Grain) D(Drainage Way) SEXP(Slightly Expansive) M(Massive) DS(Debris Slump) B SL(Sandy Loam) .0.8-0.6 0.4-0.3 FJCP(Expansive) CR(Crumb) FP(Flood Plain) L(Loam) OR(Granular) IS(Foot Slope) SBK(Subangular Blocky) (Head Slope) lit SCL(Sandy Cl y.Inam) 0.6-03 ABK(Angu4r Bloc L(Linear Slope) 0.7-0.15 Blocky) SL(Silt Loam) PL(PLVy) N(Nose Slope) CL(Clay Loam) PR(Prismatic) R(Ridge) SiCL(Silty Clay Loam) S(Shoulder Slope) Si(Silt) MOIST ET T(Terrace) IV SC(Sandy C1a VFR(Very Friable) NS(Noe-sticky) y) 0.4-0.1 0.2-R05 FR(Friable) SS(S0 SiC(Silty Clay) Fl(Firm) Sh) Sticky) C(Clay) S((tidy) lift(Organic) None I(Very(Extremely v.Very Sticky) VS(Very Sticky) EFI(Extremely rum) NP(Nnrvplastie) SP Adjust LTAR due to depth,consistence,structure,soil wetness,landscape,position,wastewater flow and quality P(Pls(Slightly Plastic) NOTES q y p(p�K) HORIZON DEPTH In inches below natural soil surface VP(Very Plastic) 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 water or inches from land surface to soil colon with cluoma 2 or less- CLASSIFICATION S(Suitable),PS(Provisionally Suitable),or record MunseB color chip designadon Evaluation of saprolite shall be by pits. ) (Unsuitable) Long-term Acceptance Rate(LTAR):gal/day/122 Show profile locations and other site features(dimensions,reference or benchmark,and North). • • • V✓ J \ • • {�--- ...a .. • V �I11JI ` pi • • • • • • DENR(#####tf) Review(#####) • BA CATAWBA COUNTY IOOA SOUTHWEST BLVD t NEWTON, NORTH CAROLINA 28658 RECEIPT !!!aae��� aa► h PHONE: 828.465.8399 U\v ;�,vj0�4 /"C Monday, June 6, 2016 1842 sM ‘vww.catawbacountync.gov PAYOR: Hanson,James& Kathy PAYMENTS TRANSACTION NUMBER: TRC-686576-06-06-2016 PAYMENT DATE : 06/06/2016 PAYMENT TYPE: Check 5532 INVOICE NUMBER FEE NAME FEE AMOUNT 06-16-329070 Improvement Permit Fee $150.00 TOTAL PAYMENTS : S150.00 EHPR-06-2016-24029 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 4890 MOORE ST, SHERRILLS FORD NC 28673 Owner JAMES & KATHY HANSON, 134 PRESEVE WAY, MOORESVILLE NC 28117 C:7047373303 ** NO PEOPLESOFI'ACCOUNT ASSIGNED ** receipt 06/06/2016 11:44 Page 1 of 1