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HomeMy WebLinkAboutEHPR-07-2016-24360.TIF til4 A c�G THIS IS NOTA PERMIT Case # EHPR-07-2016-24360 CATAWBA COUNTY HEALTH DEPARTMENT 11r51:1s z "i 7 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ti _ Ig42 sm Environmental Health Plan Review - OSWP WELL r• Applicant JERRY OLIVER, 3400 LOVE RD, CLAREMONT NC 28610 1-1:828-994-0089 C:828-569-3950 1-IOME:828-994-0089 NAME TO APPEAR ON PERMIT Jerry Oliver SITE ADDRESS: 3400 LOVE RD, CLAREMONT NC 28610 PIN # 376003329240 NAME of SUBDIVISION: Wilson Park Loth 1 Section/Block PROPERTY SIZE: Square Feet 21,344.40 Acres .490 DIRECTIONS: Hwy 10 E, turn right Balls Creek School Rd, right Love Rd, 2nd on right past Ringtail Rd PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: New Well currently sharing with neighbor 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: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF 70 x14 EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO L:9-chapplication 07/25/2016 12:31 Page of • 48A CATAWBA COUNTY Case# EI-IPR-07-2016-24360 '� � ,G\ Public Health Department Subdivision Wilson Park ; f v Environmental Health Division PIN# 376003329240 W PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 !84%x" NAME ON PERMIT: (JERRY OLIVER),3400 LOVE RD, CLAREMONT NC 28610 ( Jerry Oliver) Site Address: 3400 LOVE RD; CLAREMONT NC 28610 Property Size: Square Feet 21,344.40 Acres .490 Directions: Hwy 10 E, turn right Balls Creek School Rd, right Love Rd, 2nd on right past Ringtail 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 rules. I understand that I am solely responsible for the proper identificatio and labeling of all property lines and corners and making the site ac ssible b that a complete si - - .luatiortcan be performed. Date: /-9-.5--- / Signature of Applicant or/Nun 101,t An Environmental Health Specialist will contact you w' m 5 w ing days o application date. If you need further information or assistance p1 call 828-466-7291 AREA1 rSFEENAMEr= ,tj-r1 � "a °DALE FEEAMOUNT4. Well Permit & Inspection Fee 07/25/2016 $300.00 1 OTAL FEES • r- a 3� � 5300 00";°•• . 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) 09-chapel icarion 07/25/2016 12:31 Page 2 of 4 cAT� � THIS IS NOTA PERMIT �` CATAWBA COUNTY HEALTH DEPARTMENT ,,,o„„Oa,—,O Application for Environmental Services Page I improvement Permit n Authorization to Construct n Septic Repair n Septic Malfunction n Septic Expansion n New Well Permit[Ij'Replacement Well I I Well Abandonment n Well Repair n Existing System Inspection (Pre-Approval Require-d)) n Application is for New Construction Existing Facility IX Property Address ,3j*10 /i 'ejezSubdivision toe C4 I 4,7 t IJ, d. G25-t,/O Lot# Acres yZ Section/Block/Phase Driving Directions to Property /() NAME TO APPEAR ON PERMIT? Rt)wner n Applicant Contractor Applicant Contact Information Name jehvy w• (Q[ ivel Address ?Lipp Acue Ac) . lorry-teat Ay,e. 79, -6 /O Phone 99; - 9 i/ -Q O K 7 Cell Phone y a 1 - 56 9' - -d Owner Contact Information Name Address Phone Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE TIHE PRIMARY CONTACT? [- --Owner n Applicant ❑ Contractor Description of Existing Structures on Site /9921 mo A;/a '/ar # of Bedrooms *j 3 Structure Dimensions 70 c /a/ # of Occupants Basement [ Yes 2-No Basement Fixtures 0 Yes i'-j 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. CI Yes SINo Does the site contain any jurisdictional wetlands? ®Yes ® No Does the site contain any existing wastewater systems? C7 Yes ®No Is any wastewater going to be generated on the site other than domestic sewage? Yes El No Is the site subject to approval by any other public agency? C7 Yes No Are there any easements or right of ways on this property? Describe Existing water supply in use Individual Well n Community Well In Semi-Public Well n County/City/Township Water Line Is a public water supply available? ** Yes ILl'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 LI Alternative ❑ Conventional ❑ Innovative ❑ Other 0 Any ���� `1iIS IS NOTA PERMIT . counrr , -- —�—a,- - � ThusCATAWBA COUNTY HEALTH DEPARTMENT „o; - Application for Environmental Services Page 2 Proposed Facility Type H'Erimary Residence n New Residence ❑ Addition to Residence # of New Bedrooms *j Project Description Structure Dimensions 'ccupants Basement n Yes Ir-"'No Basement Fixtures 0 Yes 4 No ❑ Accessory Structure(s) Describe # of New Bedrooms *j if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes n No Plumbing n Yes No Describe Plumbing Needed k Multi-Family Residence#Units #Bedrooms per Unit*j Total# Bedrooms *j 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 ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type FR-Individual Well n Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled in Bored ;; ❑ Dug IT 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. *My 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 lie 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 Ag nt / `!//. (L%�� Date a i— c2 0/ Printed Name of Owner or Agen J t v v y/ UJ. D 1.; 0 e{^ Catawba County Environmental Health -----------L_____., L..... / ?3G.1 p Ilri mo li 3 i . . iiii r A o� 233.66fry. 4) N176 s0 717.66 9 (- 0 20 00.0 Si4.5 ill / . . . ' ./ > L(l---1 Hi • a 90.00 66.60 • 9-0Q��. ,7.47 33.00 90.83 Pr LOVE RD SL5°/St J E I, of • • 11 N:\\\\\ • 201.69 a Parcel: 376003329240, 3400 LOVE RD lin=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 07/25/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 376003329240 Owner: OLIVER JERRY WAYNE Parcel Address: 3400 LOVE RD Owner2: null City: CLAREMONT, 28610 Address: 3400 LOVE RD LRK(REID): 24121 Address2: null Deed Book/Page: 4270/0575 City: CLAREMONT Subdivision: WILSON PARK State/Zip: NC 28610-9587 Lots/Block: 1/ null Last Sale: $3,500 on 1983-10-01 School Information: Hat Book/Page: 17/199 School District: COUNTY Legal: LOT 1 1 PL17-199 WILSON PK PL 17-199 Elementary School: BALLS CREEK Middle School: MILL CREEK Calculated Acreage: .490 Tax Map: 025 Y 03036G High School: BANDYS Township: CATAWBA School Map State Road #: 1807 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: BANDYS Zoningl: R-30 Building(s) Value: $1,000 Zoning2: null Land Value: $9,500 Zoning3: null Assessed Total Value: $10,500 Zoning Overlay: DWMH-O,WP-O Year Built/Remodeled: null/null Small Area: BALLS CREEK Current Tax Bill Split Zoning Districts: null/null Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710376000J Building Details 2010 Census Block: 3002 WaterShed: WS-IV Protected Area 2010 Census Tract: 011402 Voter Precinct: P5 Agricultural District: Proximity 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=376003329240&typ=P 7/25/2016 CATAWBA C,O&&NTY':HEALTH DEPARTMENT NEWTON;, NORTH' .,CAROLINA ' • COMPLETION PERMIT FOR SEPTIC TANKS : . PERMIT N° _ 105.9 : DATE:, 4— -J _ h[f OWNER. ®� . - ' I 2,- ADDRESS ' . • BUILD,INc . CONTRACTORpp 7 SUBDIVISION // � LOCATIONSep ., . i 1, IAT :if- LOT SIZE ' ' BLOCK. OR •SECTION _ . HOUSE ( ) MOBIIE HOME USINESS ( ) OTHER, ( ) FHA-VA L"OAN (.;) SEPTIC 'TANK: (SIZE WATER. SUPPLY ' ' � NO FIXTURES NO. BEDROOMS • INDIVIDUAL PUBLIC 1 . GARBAGE DISPOSAL UNIT:YES ()NO ( ) IF WELL, TYPE.: BORED _ DRILLED ':DUG, AUTO WASHING MACHINE.: YES '( ) NO ( DISTANCE FROM ;SEPTIC TANK OR NEAREST- NITRIFICATION FIELD :- D o SQ,.FT . POLLUTION: • '? -( • FT.; 1) NUMBER OF LINES - SEPTIC TANK _INA- LLED: BY ; ' 2) LENGTH AND/WIDTH. • IV • _ ' S -.-/-e O•c_ Y 3 C PERMIT FEE $ L G. :. a) :BED SYSTEM (":'1 ) CERTI TE 0^ 'COETION Y B) 'TRENCHSYSTE (�) _" nom 3) DEPTH. OF STONE IN LINES / REMARK . ,i. _ . . ADEQUATE FALL (GRADE), QN:: _ - . 1) BUILDING (HOUSE) SEWER LINE : .. . YES. ( ) NO ( ) 2) NITRIFICATION LINES :: ' • . DATE INS:TALLEDs: �- YES ( :) •NO ,( .)- �' SEPTIC' TANK LAYOUT . , , . - rim . k . . 124 E-4 a 0 _________i_;l__4 •,/ , . n NEALd 'DEPART/v1ENT COP( �s'� �n CATA478P COIJ*ITY 'HEALTH DFP/iRTMENT -.1.5.101-G�` . .l((l • • I.a'ROVE4TFNTJPERMIT ;POR SEPTIC TANKS •:--:Petmit:No , '2, OF 0 . ',� /AL./ l 1J1 • ✓L A .� DATE: / O ADDRESS OF O_.� PHONE . N'AI—TE OF CONT. TOR . ./ LOCATION / /iCe�•t tQ'jc _ i • '-e- n• . (,'�ZF• A,Z /gel - ls�i e SUBDIVIS,,ION/.I?/'pj . .-. -t'G• ,. LOT . `, • SECTION OR BCoGK- LOT .SIZE FHA, V. �N ' • Septic Tank, Contractor must follow. all HOUSE' ( ) MOBILE 'HOME` ( USINESS ( ) .OTHER ( ) Y ) Details, of this perthit •(la out NO... ,BEDROOMS ( ) NO,. FIXTURES ( ) • SEPTIC -TMTK LAYOUT GARBAGE DISPOSAL UNIT: YES ( ) ,NO ( ) • • P PLUMBING UNDER BAS/F�T._E,NT �F,LOOR': 'YES - NO CO ' 1 SIZE OF TANK;__-i L LIQUID GALLONS ��, NITRIFICATION FI !?ILD; �` ' tit - 1,: Number. of lines - 1 `�?- b (,�• 2.. .. Length and width of li s // (-- 3. Total.'Depth of stone. . /Z; ies ,- • ( � - GROUNDWATER INTERCEPTOR •DRAIN; : 4 • • (IF REQUIRED) 3 _ �. � ) M-- :-------ax { C �/ WATER:*SUPPLY." PRIVATES UBLIC ( ' � (� { OWNER:NOTIFIED TO CHECK ZONING YES'y-( ) NO ( ) • !7 ' I ( ° OWNER AGREES.'WITH LAYOUT YES ) NO'( )'/ � / (, OWNER, AGREES(WITH SPECIAL• INST n ONS YE6�(rrO :(r ) �- OWNER OP. CONTRACTOR SIGNATU',+� ��/ — PERP[IT FEE S PERMIT VOID: AFTER 36- MONTHS:" � _FINAL APPROVAL OfTNlS SEPTK;:7ANK SYSTEM B I ROVEMENT, IT I ED BY THE HEAILH DEPARTMENT SHALL INDICATE T13AT THE SANITARIAN l// SYSTEM AAS BEEN CONSTRUCTED ACCORDING TO - T}1E STANDARDS SETIFORTH,IN THE:CATAWBA COUNTY "' " . . . .SEWAGE DISPOSAL-REGULATIONS, BUT-IN NO WAY:- ' .. HEAtTw DEPT..'`COPY'. ;SHALL;BE'.TAKEN.ASA GUA RANTEE:THAT:THE�SYSTEM ' " - -, ' - - 'WILL-.-FUNCTION"SATISFACTORILY FOR.rANY GIVEN ., _ ..L QF TIME. SOIL CLASS'.IFICATION: SUITABLE ('. ) PROVISIONALUY. SUSTABLE. ,('..) 'UNSUITABLE', (. )':. SITE:FACTORS::. _ _, .a-.. 1.' SLOPE (7.-)., ? 'S .--'PS' =�If . 7. SOIL PERMEABILITY S` :- PS--. 0 2. SOIL TEXT,URE,'(1,-2=48; IN..) • . :' S PS ' U ` UNDER 60',( fIN. -`'OVER 66"M-IN.. - SANDY, LOAMY;, CLAYEY' 8: OTHER .'S' 3- SO,IL 'STRUCTURE '(�12 48',Inc.): "S PS U : (SPECIFY) . .. 5:' - PS. -:U- 9 iSOIT ,:SERIES 4..,.1EOIL,DEPTFI (IV'.'): - 1 5. 'RESTRICTIVE HORIZONS (IN,.;) ,S :-' PS U, A:' CECIL. ( ) ' 3. '.HIA.LSSFE O- (IMP,ER,VIOUS STRATA, ROCK): s; ; ' - , C:• MADISON ( ) 'D.: APPLIN'G` ( ) ' ' 6,.: SOIL DRAINAGE GROUNDWATER S'-':P U`. :'E., PACOLET .(• ): F. , FLOOD' PLAIN;;( ), , . '(EXTERNNAL - 'INTERN L' ••`. . -' ' Gi 2=:1 CLAY 'SOIL H. OTH&R-SPECIFY . - ''._Jt.1 CATAWBA COUNTY Z" O le Or2. I 00A SOUTHWEST BLVD NEWTON, NORTH CAROLINA 28658 RECEIPT Q muamam liit,:�, H C3 "1eaPHONE: 828.465.8399 0119.< Monday, July 25, 2016 /842 SM www.catawbacountync.gov PAYOR: Oliver, Jerry PAYMENTS TRANSACTION NUMBER: TRC-750287-25-07-2016 PAYMENT DATE : 07/25/2016 PAYMENT TYPE: Credit Card 168744750 INVOICE NUMBER FEE NAME FEE AMOUNT 07-16-330856 Well Permit & Inspection Fee 5300.00 TOTAL PAYMENTS : 5300.00 EHPR-07-2016-24360 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 3400 LOVE RD, CLAREMONT NC 28610 Applicant JERRY OLIVER, 3400 LOVE RD, CLAREMONT NC 28610 H:828-994-0089C:828-569-3950 ** NO PEOPLESOFPACCOUNT ASSIGNED ** receipt 07/25/2016 12:30 Page 1 of 1