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Home My WebLink AboutEHPR-11-09-2601.TIF g'A C THIS IS NOT A PERMIT Case # EHPR-I 1-09-2601 CATAWBA COUNTY HEALTH DEPARTMENT v C Plan Review Application for Environmental Services 1842 sM Environmental Health Plan Review - OSWP EXS_SYSTEM APPLICANT OWNER CONTRACTOR JENNIFER POWELL JENNIFER POWELL 4623 LANCASTER DR 4623 LANCASTER DR CLAREMONT NC 28610 CLAREMONT NC 28610 828-850-6637 828-850-6637 NAME TO APPEAR ON PERMIT JENNIFER POWELL Pin#: 376302590477 SITE ADDRESS: 4623 LANCASTER DR, Claremont, NC DIRECTIONS: HWY 70/ TURN ONTO ROCK BARN RD/ GO TO END OF RD/ TURN RT ON OXFORD SCHL RD/ NEXT RT TURN RT ON BELIEVE/ RT ON LANCASTER / 2ND ON RT NAME of SUBDIVISION: CASTLEBERRY Lot # 15 Section/Block/Phase PROPERTY SIZE: -Square Feet Acres Date Platted/Recorded TYPE OF FACILITY: House Mobile Home X Dimension of Structure Bedrooms 3 Basement: No Water Using Fixtures in Basement: No. in Family 4 Whirlpool Tub : Gal. Capacity: MULTIPLE FAMILY RESIDENCE: Units 1.00 Total 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 1st 2nd 3rd OTHER: (Specify) Do you aniticipate any additions to Facility? If so, describe: Has any grading, removal, or addition of soil been done to this property? If so, describe Are there easements/right-of-ways recorded on this property? NO Type of Water Supply: Individual Well Community Well Municipal X 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. Date: Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 working days of application date. If you need further information or assistance please call 828-466-7291 AREA 2 (FOR OFFICE USE ONLY) Zoning Approval: _Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front 30 FEE NAME DATE AMOUNT Side 15 Existin;Tank Check Fee 11/09/2009 $80.00 Rear 30 TOTAL FEES $80.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 12/11/09 10:00 NOV-0'1-2009 12:44 CATAWBA COUNTY GOVT 1 828 465 8276 P.01i01 THIS IS NOT A PERMIT WLS # f0 CV` -11-0q CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Expansion ❑ Existing Tank Check New Well Permit El Replacement Well ❑ Well Abandonment ❑ I . Name to Appear on Permit EN l'F . /P L 2. Permit Requested By 00)t AlnAtfj- Business Phone $l~L~/~ rrr~LbZ Address 12 5' .t/ 76 o / IV, Home Phone 3. Property Owner ,EN "rf t,J / Business Phone Address T W. C / Home Phoned? - 8SD ~fGi37 4. Name of Subdivision Lot # Section/Block/Phase Property Address T! Directions to Pro erty: W T A9 X;P4 Al 7 lutig -2-0014- 91 -7 Pdh ^k A 7- 5. Property Size: Square Feet Acres Date Platted/Recorded 6. TYPE OF FACILITY House Mobile Home Dimension of Structure Bedrooms" t lm. ~xt ~'j ~~,'~rcy: }(,m r;,~ ,r; 1' C" 'r11't 9;; Par-a,-~..~1 `a zr r^. 7p~,IOQm`;~ % •,~('~~'~rlit~rt~~ r., ta~~ ~i''t1T~Pw1. rlr n }.~y~0 V' C r.`y'r ,p.. Y~+ fir; r1^' 7 jai ~ r ' ,a[ ,'~.':3; ~ ; t~ ,.;`C,,r, .s ~fq I~,~il7~, ,1.1'~` a:; ~ ~4+~$,'~.,•»,"'"?i. 1~ o ~ j1,$, d~ ar ~ k,'„9n,,;>,!, , •ly,_, ~ri'y.~.: I 4 ~ I; 3~, k „ e„ ~ r ~ (1, w r ,k~ •~1}t'lLl. t ~ , r..~ ~ .q~. 'M~1H IM R,~~,. • y ♦ ri 3 , , . rr; ,n ,,5' K .~h r. M, 1 W kN•f w'+~ ml di F+ ~ ~ t{J fu m e ttirid~ fibw ~1t~g;p.~t.m~t<zi, ;,u_ cei;~T~its;maypie' ~bn~:. _ yst ~~s1~_ e~.., nc~~n~, 1pr Basement= yes/ oWater [!sing Fixtures in Basement: yes/ to No. in Family Whirlpool Tub yes/no Gallon Ca acit p Y MULTIPLE FAMILY RESIDENCES: Units Total Number of Bedrooms DAY CARE: Number of Children RESTAURANT: Seats Square Feet Dining Area _Square Feet Food stand/Meat Market Floor Space TYPE OF BUSINESS: _ Number of Employees Ise 2nd 3rd OTHER: (Specify) 7. Do you anticipate any additions to Facility? Yes / No If so, describe: 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? Yes / No 10. Is a public water supply available on or adjacent to the above property? Yes / No Check type that is available: [ ] Community well [ ] Semi-public well [ ] County/City/Township water line **If No, a Well Permit must be issued with the Septic Permit." 1 I . Well Type Applying For: KIndividual well [ ] Community well [ ] Semi-Public well 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 valid for 5 years or may be non-expiring under certain specified conditions. improvement Permits and WCII Permits are transferable, but may be revoked if this information, site plans or intended use changes for the proposed facility. An 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. **IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MAD TO THE PROPERTY, THERE IS AN ADDITIONAL CHARGE." Date l' Signature of Owner or Agent CA6 1 / 1-a- TOTAL P.01 Catawba County, North Carolina This map product iras prepared from the Catnwba Count t NC, Geographic h1foi•inatior System. N Caawba C.ountt• has made substantial efforts to ensin-e the accuracy of location and labeling information contained on this map. Catawba County promotes and recommends the independent verification of amp data contained air this map product by the user. The County of Catawba, its emplo.ees, agents and personnel disclaim, and shall not be held liable for arty and all damages, loss or liabila'v. wheiher direct, indirect or, consequential which arises or, ma1v arise from this map product or the rise thereof by at person ov ennm. Legend Selected Parcel Number: 3763-02-59-0477 1 inch = 60 feet Prepared for: X~, i' c~ ~f 16 29.62 °b 16,/~ 1 .n Cb. 6 Cb 38.7 5 2,x'2 - 33.46 j.. 7 . C s4 A f /.D~ ,.S pig . 23:2 039C0" 1 O 7 -2 c THIS IS NOT A LEGAL DOCUMENT ! ' Monday, November 09, 2009 02:07 PM ` 1 i. Catawba County, North Carolina 7his nap product was prepared from the Catawba Coumtn•, AVC, Geographic Inforntotiam System. N Catawba Count' has made substantial efforts to ensure the acctiracv of Iocalion and labeling it formation contained on this map. Calawbo Caun/)' promotes and recammtends the independent ver fcaliom of anv data contained ar7 this map product by the user. The Count), of Ccmawba, its emrplorees, agents and personnel disclaim, and shall ml be held liable for mn and all damages, loss or liabilir' 1'. whether direct, indirect at- consequential which arises or mm• arise from this map produce at, the use thereof hi amv person or enhrm legend Selected Parcel Number: 3763-02-59-0477 1 inch = 60 feet Prepared for: ACC 29.62 16 CD ob 160"T _ -9 cb i OV 4W 38.7 21~' 2 > 33-6 6.74 , ,y s4 1 7 2. 3 ,2 Or") 0391 0 N LO 14 THIS IS NOT A LEGAL DOCUMENT Monday, November 09, 2009 02:07 PNI CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3763-02-59-0477 Name: POWELL JENNIFER ANNE Name2: Ad: ress: 4623 LANCASTER DR Address2: City: CLAREMONT State: NC Zip: 28610-9502 Account: 146476 Calc Acreage: 0.49 Tax Map: LRK: 402751 Deed Book: 2243 Deed Page: 1244 Subdivision Name: CASTLEBERRY Subdivision Block: Lots: 15 Plat Book: 50 Plat Page: 153 Building Number: 4623 Street Name: LANCASTER DR Site Zip: 28610 Township: CLINES Fire Code: OXFORD City Code: COUNTY State Road: Total Bldgs Value: $76,800 Land Value: $10,400 Total Value: $87,200 Year Built: 1998 Year Remodeled: Last Sale Date: 1/3/2001 Last Sale Amount: $20,000 Neighborhood: 67 Watershed: WS-IV Protected Area Watershed Split: NO Voter Precinct: P27 E911 District: COUNTY Zoning: R-30 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: WP-O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: OXFORD Middle School: RIVER BEND High School: BUNKER HILL School Split: NO P&Z Case Number: Census Tract 2010: 010101 Census Block 2010: 2013 Small Area Plan: ST STEPHENS/OXFORD Agricultural District: Printed: Monday, November 09, 2009 02:07 PM CATAWBA COUNTY HEALTH DEPARTMENe "-"D r a3y Telephone (828) 465.8 0 DD !-(828) 465-8200 IP~_AC_~kpr Print. )pr P .~Sy . T pe_ Well Prmt. Replacement Well Well Rpr Ptmt. Owner/Agent ; Phone Address Subdivision Sectio Bloc /P se ULotk t6 Lo ize t ct ns. Property Address GZ LC-~ Facility House . Mobile Home Business Multi-family Other Pin Number 30 Z,5 F647 -7 _3 7h Other Zoning Approval #I Z.p /'J ZD0e5 °,0 0 Zff U # Bedrooms k Seats Employees Application Rate GPD Flow 3 Hot Tub or Spa ye n Special Fixtures Basement ye o 100% Repair Area&no ~ -tv ce-irt.,Cu.~, u - Basement Plumbing yes/no Water Supply Private W~11 Public Semi-Public Type of System: Trench Bed Pump Pump/Panel Panel LPP Other z' Septic Wank Size )or Pump Tank Size Nitrification Field. Total Square Feet Depth of Stone 1Z/R Bed Size Trench Width 3 `t' ~ • Total Length of All Trenches 1542- Number of Trenches Trench Len, Distance of Nearest Well /r gthJr ! 1,5'11.511,5 / 7 Feet on Center Maximum Trench Depth 36 *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* Topo Z- % Slope I Z v Texture I Structure Clay Min. it ; ( Soil Wetness Soil Depth_~~-1 0 I \ Restric Hoz. ati I ~Q r Available space yes/no I ~jl Overall Class S PS-U Comments. ~x!51 drs: r s ~ I o Q I _ Filter Required I - Riser required when I LR-nc4?-s-le2 tank is more than 6 I inches deep. .**NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVE HE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility 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 fro kn n ossible ources of ontamination. No volume of water is guaran eed at y site by the Health Department. Permit Date ' Z E y - /a Dated/'J 'O/ Owner/Agent # Q~ Septic Tank Installe:7-16 EHS Well Installed By Well Gr' t Approval Date Well Head App al Date Date Sample Collected Date of Results Results EHS White . Office Blue - Building Inspection Operation Permit Yellow - Owner/Agent Green - Building Inspection Authorization to Construct