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HomeMy WebLinkAboutEHPR-08-2016-24595.TIF • s1Y A • THIS IS NOT A PERMIT Case # EHPR-08-2016-24595 `� _ r<Q CATAWBA COUNTY HEALTH DEPARTMENT a ' •• . r0 WE v11 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES �� /842 sM Environmental Health Plan Review - OSWP G f.o REPLACE WELL a '° Applicant CHRISTOPHER BRUMLEY, 6636 LONG ISLAND RD, CATAWBA NC 28609 C:8282446506 NAME TO APPEAR ON PERMIT Christopher Brumley SITE ADDRESS: 6478 LONG ISLAND RD, CATAWBA NC 28609 PIN # 379003308122 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 1,146,063.60 Acres 26.31 DIRECTIONS: HWY 16 South, Left onto Buffalo Shoals Rd, Right onto East Bandys, Right onto Sherrills Ford Rd, Left onto Long Island Rd, go about 3/4ths mile& house is on the Left.Across from Commscope sign. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Replacement Well. - Water is running low& no longer sufficient for home. 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, Shed EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: House 59x32, Shed 10x14 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION BASEMENT? Yes BASEMENT FIXTURES? Yes 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 19-ehapplicatan 08/25/2016 12:50 Page 1 of4 4A CATAWBA COUNTY Case if EHPR-08-2016-24595 • Public Health Department Subdivision n�u , ; Environmental Health Division PIN/ 379003308122 'dM' PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 1g42 s+ NAME ON PERMIT: (CHRISTOPHER BRUMLEY), 6636 LONG ISLAND RD,CATAWBA NC 28609 ( Christopher Brumley) Site Address: 6478 LONG ISLAND RD, CATAWBA NC 28609 Property Size: Square Feet 1,146,063.60 Acres 26.31 Directions: HWY 16 South, Left onto Buffalo Shoals Rd, Right onto East Bandys, Right onto Sherrills Ford Rd, Left onto Long Island Rd, go about 3/4ths mile& house is on the Left. Across from Commscope sign. 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 hat a complete site evaluation can be performed. Date: 8-1.S—ZOI( Signature of Applicant orAgenf{ An Environmental Health Specialist will contact you w Iden 5 working days of application d If you need further information or assistance please call 828-466-7291 AREA1 1 6q r;';t,: strip wil if.51111E1l�t" IFEENAME„ gµ(Ea� l V �,l'ii lt�EL�u��liillil�ipATE Iii a�EEE`AMOUNT,L Well Permit & Inspection Fee 08/25/2016 5300.00 E{ '�i �a`°„ TOTAL FEEs y""II��ill I'll�� _ I 'I iTill Ifld 111 Ili till tIIII 46f i III �� ��K� ��I ���� (t, q II I�l 5300 00 I �Ni1191Vh114AW'/' Pr'r,'IWlit iitaateli,a'l !d uiu�a4u19F�iiWIIW�-t�r]I1111111 41.tIIG(Will"'u.L7J�I1 LVi�11.,�!_" 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-chapplicatinn 08/25/2016 12:50 Page 2 of 4 CATAWBA THIS IS NOT A PERMIT coounnt,I�1VsV IIJ^h CATAWBA COUNTY HEALTH DEPARTMENT No„„4 Application for Environmental Services Page 1 Improvement Permit❑ Authorization to Construct r Septic Repair n Septic Malfunction ❑ Septic Expansion E. New Well Permit❑ Replacement Well Tgi Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility Property Address 6978 tom Ts 14”.el gJ . ql Subdivision ('w-�'Atob , 1J1.1C. ZS�O Lot# Acres Section/Block/Phase Driving Directions to/ Property Nw� (L 5 )/L LSA i4.to ,s j+oAIS ,7/L FA s-f /3a.t 11 s , T/( SLety:ils �,� RJ . I /c. L0::, .rs4.--,1 /cNol NAME TO APPEAR ON PERMIT? ❑ OwnerApplicant ❑ Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information 4. Name C%.vt 54.,el..t✓ A. igna-rAlti Address £ 63L-, / nr, TS I.n.el VA ea ba �C Z ebb 1 Phone Cell Phone tin g _ z ef+ - (,„Sat. Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? I I Owner [ pplicant ❑ Contractor Description of Existing Structures on Site 4 #of Bedrooms *j 3 Structure Dimensions # of Occupants JF Basement KYes ❑ No Basement Fixtures a Yes 0 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 ZNo Does the site contain any jurisdictional wetlands? , Yes CI No Does the site contain any existing wastewater systems? 0 Yes ,8(No Is any wastewater going to be generated on the site other than domestic sewage? RI Yes %No Is the site subject to approval by any other public agency? 0 Yes %No Are there any easements or right of ways on this property? Describe Existing water supply in use IN Individual Well ❑ Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ 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) �...-7 0 Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other 0 Any CATAwl A THIS IS NOT A PERMIT COUUNNTTYYL1V VIJL� CATAWBA COUNTY HEALTH DEPARTMENT ,,onTZ:,,. Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures in Yes DI No ❑ Accessory Structure(s) Describe # of New Bedrooms *7 if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence# Units #Bedrooms per Unit*t Total #Bedrooms *It Structure Dimensions El 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 fl No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ''Individual Well 7 Semi-Public Well Community Well Abandonment Type El Drilled ❑ Bored ❑ Dug n 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 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. f 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 comers and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent 7K Date Printed Name of Owner or Agent C4.vCs-kbe tAdC it A. Catawba County Environmental Health i Cii CY/ritiO) ?, •. • • • • • • -44411111111N \ „\i, . • IPP y. 6 7 �4 1.4 - v, C ,a CCOW CO / t OMSc o + 411Th o " °PF RD k S • K • Parcel: 379003308122, 6478 LONG ISLAND RD lin=100ft CATAWBA, 28609 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 08/25/2016 Catawba County Environmental Health . \ \ ‘.. f _ � w 1. aQ' �O r, 34 , sifr i Oil IN- 4 4k I �� Q 0tc0) I clillfr ii. l \*.lifit:S5 7Z-Aill 10 1 \". ` p 2'5.04 4c w. 4 ' C 1. 4 g f--e-----------„, ., Ali,rik. \ v' 57£i.58 ` Q� ` ' =v \('. � � 4..;57,4,11‘-4 ,:ilifri 99p �� O 3 CpM�y •�Op� l,l 96s o \ 75\\\>1-s-NN----.....".„:-.-.\N.\--. ,,T.'-',.. s NN\ \\ , . / Parcel: 379003308122, 6478 LONG ISLAND RD 1 in=300ft CATAWBA, 28609 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/repod product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 08/25/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 379003308122 Owner: BRUMLEY CHRISTOPHER A Parcel Address: 6478 LONG ISLAND RD Owner2: City: CATAWBA, 28609 Address: 6636 LONG ISLAND RD LRK(REID): 20060 Address2: Deed Book/Page: 3345/1340 City: CATAWBA Subdivision: State/Zip: NC 28609-8235 Lots/Block: / School Information: Last Sale: School District: COUNTY Plat Book/Page: Elementary School: CATAWBA Legal: Middle School: MILL CREEK Calculated Acreage: 26.310 Tax Map: 019 Y 02033 High School: BANDYS Township: CATAWBA School Map State Road #: 1833 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: BANDYS Zoningl: R-40 Building(s) Value: $89,700 Zoning2: Land Value: $139,400 Zoning3: Assessed Total Value: $229,100 Zoning Overlay: WP-O Year Built/Remodeled: 1970/ Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: Building Details 2010 Census Block: 2013 WaterShed: WS-IV Protected Area 2010 Census Tract: 011501 Voter Precinct: P21 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. c 00 et ft Q eroct http://gis.catawbacountync.gov/nomap/parcel_report.php?key=379003308122&typ=P 8/25/2016 �4'A cp CATAWBA COUNTY !�! IOOA SOUTHWEST BLVD '� p��� NEWTON, NORTH CAROLINA 28658 RECEIPT U�"t .�► PHONE: 828.465.8399 Thursday, August 25, 2016 /842 sm www.catawbacountync.gov PAYOR: Brumley, Christopher PAYMENTS TRANSACTION NUMBER: TRC-800045-25-08-2016 PAYMENT DATE : 08/25/2016 PAYMENT TYPE: Check 1027 INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-332023 Well Permit & Inspection Fee S300.00 TOTAL PAYMENTS : $300.00 EHPR-08-2016-24595 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 6478 LONG ISLAND RD, CATAWBA NC 28609 Applicant CHRISTOPHER BRUMLEY, 6636 LONG ISLAND RD, CATAWBA NC 28609 C:8282446506 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 08/25/2016 12.50 Page 1 or 1