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Home My WebLink AboutEHPR-10-09-2385.TIF .a C THIS IS NOT A PERMIT Case EHPR-10-09-2385 CATAWBA COUNTY HEALTH DEPARTMENT (ry V Y Plan Review Application for Environmental Services 1842 5M Environmental Health Plan Review - OSWP APPLICANT OWNER ( ()NTRAC'I01l STEVEN.STFIDMAN STEVEN STFIDNIAN ~I I I HICKORY STREE PL I I I HICKORY STREE f PL JEFFERSON STATION NY 11776 JEFFERSON STATION NY111776 ` NAME TO APPEAR ON PERMIT STEVEN STEIDMAN Pin#: 369604841607 SITE ADDRESS: 6728 GOOSE POINT DR, Denver, NC DIRECTIONS: HWY 16 S - TURN LEFT ONTO CAMPGROUND RD - TURN LEFT ONTO CATAWBA BURRIS RD - TURN LEFT INTO PEBBLE BAY - LOT ON RIGHT NEAR END NAME of SUBDIVISION: PEBBLE BAY PH 4 Lot # 145 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 1.5 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure Bedrooms 4 Basement: No Water Using Fixtures in Basement:No No. in Family 4 Whirlpool Tub : Gal. Capacity: MULTIPLE FAMILY RESIDENCE: Units 1,00Total Number of Bedrooms DAYCARE: Number of Children RESTAURANT: Seats Square Feet Dining Area square Feet Foodstand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees Ist 2nd 3rd OTHER: (Specify) = Do you aniticipate any additions to Facility? If so, describe: NO Has any grading, removal, or addition of soil been done to this-property?.-' If so, describe NO - Are,there easements/right-of-ways recorded on this property'! NO Type of Water Supply: Individual Well 611i'muhit-v Well ~X Municipal Semi-Public I understand that this is a formal application for a well permit, Improvement permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is transferable and may be eligible for a non-expiring date, but may be revoked if this information, site plans or intended use changes for the proposed facility. A Well Permit and Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or structure location should conform to applicable setbacks. ~;tJ 1LrQ~~j Date: Signature of Applicant or Agent An Environmental Health Specialist will contact you within days of applicat'on date. If you need further information or assistance please call 828-466-7291 AREA1 (FOR OFFICE USE ONLY) Zoning Approval: _Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front FEE NAME DATE AMOUNT Side lu~prw uwut I'cullit Fe,, J0/28,2009 . $t50:00 Rear TOTAL FEES $150.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional S60 charge 10/28/09 11:09 Catawba County, North Carolina This map product was prepared firom the Catawba County, NC, Geographic Information System. N Catmrba County has made substantial efforts to ensure the accuracy of location and labeling information A contained on this map. Catawba County promotes and recommends the independent verification of any data contained on this map 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 fi-orn this map product or the use thereof by any person or entity. Legend Selected Parcel Number: 3696-04-84-1607 1 inch = 60 feet Prepared for: JV/ ~ X91 146 `b 1.38A 145 121 0800 o0.o V • p 144 Plat 63 1.5-OA ~ o0 160-17 o: 0 1.48A CC 2650 to THIS IS NOT A LEGAL DOCUMENT Wed, October 28, 2009 10:44 AM CATAI VBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3696-04-84-1607 Name: BRANCH BANKING & TRUST COMPANY Name2: Address: 200 S COLLEGE ST Address2: City: CHARLOTTE State: NC Zip: 28202-2005 Account: 159752902 Calc Acreage: 1.5 Tax Map: LRK: 802932 Deed Book: 2974 Deed Page: 0270 Subdivision Name: PEBBLE BAY PH 4 Subdivision Block: Lots: 145 Plat Book: 63 Plat Page: 82 Building Number: 6728 Street Name: GOOSE POINT DR Site Zip: 28037 Township: MOUNTAIN CREEK Fire Code: SHERRILLS FORD City Code: COUNTY State Road: Total Bldgs Value: Land Value: $91,900 Total Value: $91,900 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 131 Watershed: WS-IV Critical Area Watershed Split: Voter Precinct: P41 E911 District: COUNTY Zoning: R-30 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: CRC-O,WP-0 Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: SHERRILLS FORD Middle School: MILL CREEK High School: BANDYS School Split: NO P&Z Case Number: Census Tract 2010: 011502 Census Block 2010: 4012 Small Area Plan: Agricultural District: Printed: Wed, October 28, 2009 10:45 AM A CD CATAWBA COUNTY, NC 100-A South West Blvd PLAN RECEIPT Newton, NC 28658- (828)465-8399 Wednesday, October 28, 2009 184 sM www.catawbacountync.gov Plan Case: EHPR-10-09-2385 Invoice Number: INV-10-09-256655 Environmental Health Plan Review Invoice Date: 10/28/2009 Fee Name Fee Amount p it Fee. Fixed 130.00 - Im ~t•oveirient Perm Total Fees Due: $150.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 10/28/2000 Check 3521 $150.00' $0.00'; Total Paid: $150.00 Total Due: $0.00 plan receipt d?tfc(i2a-Ocad atb3-8612 1b3fdcc39??d;,rpt 10/28/2009 11:12 THIS IS NOT A PERMIT WL3# CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services r iP F_ AC r S.T.-Rpr. F_ S.T. Exp. F_ Exist. S. T. Well-Permit r- -Replacement Well 1.-Name-to Appear on-Permit: Steven Seidman C:.a _ l- 90f'q _ J)_3 Y 2. Permit Requested By: Steven Seidman Business Phone: 631-988-3234 Address: 111 Hickory Street Pt. Jefferson Station, N.Y.11776 Home Phone: 631-828-8813 3. Property Owner: (Branch Banking and Trust Company Business Phone: 704-954-1000 [200 S. College Street - Charlotte, N.C. 28202 Address: Home Phone: - Pebble Bay 145 4 4. Name of Subdivision: Lot Section/Block/Phase: Property Address: 6728 Goose Point Drive Hwy 165- Left on Campground Rd- Left on Catawba Burris - Left into 1 st S/D entrance[ lot on right neI& Directions to Property: 5. Property Size: Square Feet Acres ' 1.5 Date Platted/Recorded 3/23/06 6. TYPE OF FACILITY: (e House Mobile Home Dimension of Structure e" Bedrooms*' - - - i*Any room that will be intended for sleeping at th'e time of construction or-for future;consideration should be noted as a bedroom and counted on,all applications. The number of bedroom"s will be confirmed by rooms identified on the house plans as a bedroom at the time of building permitissuance , This may preventthe need for'system size increase,in the future Basement: (e Yes No Water Using Fixtures in Basement: ~CO Yes C' No No. in Family: 7 Whirlpool Tub: (o Yes C No Gallon Capacity: MULTIPLE FAMILY RESIDENCES: Units I Total Number of Bedrooms DAY CARE: Number of Children RESTAURANT: Seats F Square Feet Dining Area I Square Feet Food Stand/Meat Market Floor Space TYPE OF BUSINESS: No. of Employees 1st. F 2nd F- 3rd OTHER: (Specify) 7. Do you anticipate any additions to Facility? C Yes No if so describe EI IVE OCT 2 7 2009 CATAWBA COUNTY ENMRONMENTAL HEALTH 8..Has any grading, removal, or addition of soil been done to this property? Yes No If so describe 9. Are there easements/right-of-ways recorded on this property? t^ Yes (o No 10. Is a public water supply available on or adjacent to the above property? (*-Yes (-No Check type that is available: FX_ Community Well F_ Semi-public Well F_ County/City/Township water line 11. Well Type Applying For: 1- Individual Well rX Community Well F- Semi-public Well F Irrigation Well 1- Geothermal Well 12. Monitoring Well Request:(' Yes No # of Wells: F- Name of Site: I understand that this a formal application for a well permit, Improvement Permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes: I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is transferable and may be eligible for non-expiring date, but may be revoked if this information, site plans or intended use changes for the proposed facility. A Well permit and Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property: Any representation by you of house or structure location should conform to applicable set backs. **IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE IS AN ADDITIONAL. CHARGE " Date: p /a, y 0 9 Signature of Owner or Agent: xkw- ^;f /7LfSl /i / y 70 y- G - X880 Print Form :~eaW-ITe-te ,ol+lnq Pleas vim- n ab 0-c\ o r , ip-, 4- W'-s zoos-~ t ass l" . Foc c~ V12_toJ ~ rn p rove" ~ 10A- A S LOV) Ulf le co.~,~ uj\& ~ ~ 3l q~~ -3z3~-1 P ~eu~ use loca'~~ of s~c~~es~ THE AMERICAN LEGION www.legion.org ° - 4 try) S~~ 2. c~ lv Cr1Q z ~y (,t fps CATAWBA COUNTY HEALTH DEPARTMENT poc,4<i Telephone (828) 465-8270 TDD (828) 465-8200 WLS #.'i~4~ Improvement Permit AC R it rmi it. Operation Permit. System Type Well Permit. Replacement Well Owner/Agent Phone ~76 y-~3 -61-74- Address ' Subdivision Sectio Bloc hale / Lot Size. / 3 irections. Property Address Facility- House Mobile Home Business Multi-family Other Pin Number!FL/-34QCO`~7~f 1~BOd--/~s Other Zoning Approval # t7 # Bedrooms # Seats # Employees Application Rate 3S GPD Flow Hot Tub or Spa es o Special Fixtures Basemen(5j3/no 100 % Repair Arees o Basement Plumbin yes Water Supply Private Well Public Semi-Public ###s#ss*#####s*ss*****s##*»##*s»s##s*###*:ssss###*»ssss:#»**ssss*ss###sss##***~»*s###»ss#s#**##s#s#**#*#s#sss#s####ssss# Type of System: Trench Bed Pump Pump/Panel Panel LPP Other Septic Tank Size Pump Tank Size Nitrification Field. Total Square Feet 7,1 Depth of Stone Bed Size Trench Width 3 Total Length of All Trenches 4t.S3' Number of Trenches Trench Length l~/~I l Feet on Center Maximum Trench Depth 2 y~ Distance of Nearest Well ?/0 *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* opo % Slo ' T tun: ~ S Soil We Cry Soil Dep Restric oz. Ava. le space s/no O Class S P U { ti s JW mments I ~s~ 1St ~f~e',•~-. ale Filter Required { 1~Cari~"h~"~ Riser required when tank is more than 6 { inches deep. { **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** s*s#*#**#»#*s#s###s#s###s##»######ss####s##s#s*#*ss#ssss*sss*sss##*##**#s#s####**#*##**####»#s*###ssss###**s##*#s#s**#»# 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 known possible sources of contamination. No volume of water is guaranteed at any site by the Health Department. Permit Date 6 A EHS. Owner/Agent Septic Tank Installed 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/Agem Pink Building Inspection Authorization to Construct F n 39 "s 'x3( . ~agw =b ~o z a~ a'~3ig_EaS .fie I\y aV N .b E a ,y ~ ~ (jrll - ~:~sa9e°ef ! 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