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Home My WebLink AboutEHPR-08-2016-24463.TIF sap •G THIS IS NOT A PERMIT Case # EHPR-08-2016-24463 d F:v:x CATAWBA COUNTY HEALTH DEPARTMENT ❑' P r,o. 11:1v '" PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES . \--1_847,-- sM Environmental Health Plan Review - OSWP = en 1:1c.< - IMPROVEMENT b .: 9o • Owner BRIAN MAJOR, 4183 ANDERSON MOUNTAIN RD, MAIDEN NC 28650 H:828-428-8926 C:828-446-7481 HOME:828-428-8926 NAME TO APPEAR ON PERMIT BRIAN MAJOR SITE ADDRESS: 4201 ANDERSON MOUNTAIN RD, MAIDEN NC 28650 PIN # 367704515065 NAME of SUBDIVISION: Brian and Patricia Major Lot# 1 Section/13Iock PROPERTY SIZE: Square Feet 54,450.00 Acres 1.250 DIRECTIONS: Hwy 16 S, right on Anderson Mtn Rd, approx 1 miles property on right PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP For Property Subdivision 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? No Are there any easements or right-of-ways on this property? Yes Property Easements Description: 15'driveway easement APPLICATION FOR: New Structure STRUCTURE TYPE: ! PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 27.5 x 60 #OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: I9-ehapplicatiun 08/08/2016 12:00 Page I of4 t'' r. CATAWBA COUNTY Case it EHPR-08-2016-24463 Public Health Department Subdivision } Brian and Patricia Major 4 X0, Environmental Health Division PIN? 367704515065 --� PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 /g.2 S, NAME ON PERMIT: ( BRIAN MAJOR), 4183 ANDERSON MOUNTAIN RD, MAIDEN NC 28650 ( BRIAN MAJOR) Site Address: 4201 ANDERSON MOUNTAIN RD, MAIDEN NC 28650 Property Size: Square Feet 54,450.00 Acres 1.250 Directions: Hwy 16 S, right on Anderson Mtn Rd, approx 1 miles property on right 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 acce sible so that a complete site evaluation can be performed. Date: „j — (4— Signature of Applicant or Agent .lrco -� fj�� , 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 711F.!FNA 111,1 n--v 1j1'i'II 1Tj Un I)11118 �1I�` I i�I �tj lI il!ll 1DA E i FIII1B AMOUNTirypi. li. i t ji:J 1�'�.1l11a,ljili�hiHi iii _H.. kiL1l i T81L,.� F Yhf Improvement Permit Fee 08/08/2016 $150.00 111TOTALFEESillIfi !ll I!l11Il�lIIi131IIldl,J1 a Yha!!I"� �1dlF1j1I!d!ij' i t11 I!li11a!'` $15006.�i �, I""I'I'h�! t 4 �4R41� �4� `�� ,; " ''WI WII i a��il J�IwiILIWWIlGIIIIlJ I II lltl to a �I'w o,g,t v�RlillhW'1� +d8!IYJh�lJIWWJ�• 1;111 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) Ii9-ehapplication 08/08/2016 12:00 Page 2 of 4 CATAWBA TE-IIS IS NOT A PERMIT cou Tr - CATAWBA COUNTY HEALTH DEPARTMENT tie„„tea--� Application for Environmental Services >1�Y � Page 1 Improvement Permit Authorization to Construct El Septic Repair Ti Septic Malfunction ❑ Septic Expansion ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment E. Well Repair Ti Existing System Inspection (Pre-Approval Required) ❑ va Application is for New Construction Existing Facility ❑ j Property Address A itAln 0:AJ I"1 � , Subdivision Petz3i.4oA) Ai re , af3 e, ca Lot# / Acres ,I, 2 g Section/Block/Phase Driving Directions to Property TA.Ma N.C.,' £t/ S q fit;I e S ft "dreier C A) Ain; i 4 Rel , U'C7 — t / m, `le « u `) la ht, NAME TO APPEAR ON PERMIT? Ti Owner Ti Applicant Ti Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name 8 r/.4,0 I Ja, ar Address y g, AWA2P ,su Y'1ri A4 , /V/ �, e'4ev jV ,G 2sL .sD Phone 5, 3 R — �/,a gg_ ,2 !„ Cell Phone u JA _ y 5VG —94/4” Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant Ti Contractor Description of Existing Structures on Site \SCOfl ( j- #of Bedrooms 4T 3 Structure Dimensions a 7, $1 k t: a #of Occupants a Basement Ti Yes y No Basement Fixtures Q Yes '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. Yes E7 No Does the site contain any jurisdictional wetlands? ® Yes CI No Does the site contain any existing wastewater systems? C Yes Cl No Is any wastewater going to be generated on the site other than domestic sewage? ® Yes 0 No Is the site subject to approval by any other public agency? / g� e Yes C No Are there any easements or right of ways on this property? Describe% drive a oy F A Sia F" Existing water supply in use [Y( Individual Well ❑ Community Well Ti Semi-Public Well Ti County/City/Township Water Line Is a public water supply available? ** Ti Yes Le 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 0 Alternative 0 Conventional 0 Innovative 0 Other 0 Any CATAWBA THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT ,,„;;;; Application for Environmental Services Page 2 Proposed- Facility Type U Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *t 3 Project Description )Y/b c U /kr Min. in e. Structure Dimensions 7,c 41 4 n #of Occupants Basement ❑ Yes n No Basement Fixtures in Yes DI No ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed H Multi-Family Residence#Units #Bedrooms per Unit*t Total#Bedrooms *t Structure Dimensions ❑ Food Service Specify Type # Seats Floor Space -Entire Food Service Facility (Sq 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 ❑ Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug [ 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. p Signature of Owner or Agent Date j4.e19 p Printed Name of Owner or Agent s\..1BA ' CATAWBA COUNTY 'TM: ( ,, 100A SOUTHWEST BLVD NEWTON, NORTH CAROLINA 28658 RECEIPT ep i►a PHONE: 828.465.8399 CJ 24Ni. Monday, August 8, 2016 1842 sm www.catawbacountync.gov PAYOR: MAJOR, BRIAN PAYMENTS TRANSACTION NUMBER: TRC-771953-08-08-2016 PAYMENT DATE : 08/08/2016 PAYMENT TYPE: Credit Card 169785897 INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-331348 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EHPR-08-2016-24463 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 4201 ANDERSON MOUNTAIN RD, MAIDEN NC 28650 Owner BRIAN MAJOR,4183 ANDERSON MOUNTAIN RD, MAIDEN NC 28650 H:828-428-8926C:828-446-7481 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 08/08/2016 12:00 Page 1 of 1