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Home My WebLink AboutEHPR-3-10-4160.TIF wA THIS IS NOT A PERMIT Case # EHPR-3-10-4160 CATAWBA COUNTY HEALTH DEPARTMENT v Plan Review Application for Environmental Services 1842 SM Environmental Health Plan Review - Septic Malfunction SEPTIC MALFUNCTION APPLICANT OWNER CONTRACTORS " MATT GIESE MATT GIESE 7295 GABRIEL ST 7295 GABRIEL ST SHERRILLS FORD NC 28673 SHERRILLS FORD NC 28673 704-913-2900 704-913-2900 NAME TO APPEAR ON PERMIT MATT GIESE Pin#: 460703224728 SITE ADDRESS: 7295 S GABRIEL ST, Sherrills Ford, NC DIRECTIONS: HWY 16 S - TURN LEFT ONTO HWY 150 - TURN LEFT ONTO LITTLE MOUNTAIN RD - TURN RIGHT ONTO GABRIEL ST - 3RD HOUSE ON RIGHT NAME of SUBDIVISION: LARRY A KLINGER AND WIFE Lot # I Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.569 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure 48 X 52 Bedrooms 4 Basement: Yes Water Using Fixtures in Basement:Yes No. in Family 2 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 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 X Community Well 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. Date: 3 -y --~e/v Signature of Applicant or Agent An Environmental Health Specialist will contact you witpx 2 working days of application 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 30 FEE NAME DATE AMOUNT Side 15 Authorization to `Construct (Repair) F,03/04/2010 $425.00 Rear 30 TOTAL FEES $425.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 03/04/10 11:25 THIS IS NOTA PERMIT Ef.. ftx-~-/,o _L11~0 CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services IP F- AC X S.T. Rpr. S.T. Exp. F- Exist. S. T. Well Permit F- Replacement Well 1. Name to Appear on Permit: L 7-T ~iL°S~ 2. Permit Requested By:F Business Phone: 7d~/-q/~ aid ° Address: 1-,'Z,%5 4&.i'i~: Home Phone: Toy q-S:'S~ 3. Property Owner: Business Phone: ~Oy,9a~- yv4i Address: Home Phone: 3/7"y~oZ 7-Z~9 4. Name of Subdivision: Lot F Section/Block/Phase: Property Address:° Directions to Property: 5. Property Size: Square Feet I Acres S- Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home Dimension of q ru~ r Bedrooms*I , *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 the house plans as a bedroom at the time of building permit issuance. This may prevent the need for system size increase in the future. Basement: e Yes No Water Using Fixtures in Basement: 6Z Yes No No. in Family: Whirlpool Tub: R Yes (-No Gallon Capacity: MULTIPLE FAMILY RESIDENCES: Units F 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: ~ No. of Employees 1 st F-2nd F 3rd OTHER : (Specify) 7. Do you anticipate any additions to Facility? (-Yes a No If so describe 8. Was any grading, removal, or addition of soil been done to this property? Yes a No If so describe 9. Are there easements/right-of-ways recorded on this property? (-Yes 7-.No 10. Is a public water supply available on or adjacent to the above property? r Yes C,~,No Check type that is available: F Community Well I- Semi-public Well F- County/City/Township waterline 11. Well Type Applying For: F individual Well F- Community Well F Semi-public Well F- Irrigation Well F- 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 (S) 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: -y-d2oio Signature of Owner or Agent: Print Form Catawba County, North Carolina N This map product was prepared from the Catawba County, NC, Geographic Information System. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information 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 from this map product or the use thereof by any person or entity. Legend Selected Parcel Number: 4607-03-22-4728 1 inch = 60 feet Prepared for: O~ 153.62 140.81 (150) ~ 4 107.94 1 8 94 4 7 28' 57-5,8 N 270/.' 2 r- J 1 149.02 L? 45 146.44 02.02 L C) lat 38-22 I- FALLEN F 2 N CO N 45 • 193.15 8 c~ 3 (01 < 7 2-&3 ~ ~J 3682 - o N,A 7 F. L Thu, March 04, 2010 11:01 AM THIS IS NOT A LEGAL DOCUMENT 2 8 - 1__O CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 4607-03-22-4728 Name: CRITES ADRIAN Name2: GIESE MATT Address: 7295 GABRIEL ST Address2: City: SHERRILLS FORD State: NC Zip: 28673-7727 Account: 159752107 Calc Acreage: 0.57 Tax Map: 012EX 02001 LRK: 70845 Deed Book: 2948 Deed Page: 0995 Subdivision Name: LARRY A KLINGER AND WIFE Subdivision Block: Lots: 1 Plat Book: 28 Plat Page: 107 Building Number: 7295 Street Name: GABRIEL ST Site Zip: 28673 Township: MOUNTAIN CREEK Fire Code: SHERRILLS FORD City Code: COUNTY State Road: 1971 Total Bldgs Value: $201,800 Land Value: $11,900 Total Value: $213,700 Year Built: 2008 Year Remodeled: Last Sale Date: 1/5/2009 Last Sale Amount: $252,000 Neighborhood: 129 Watershed: WS-IV Critical Area Watershed Split: NO Voter Precinct: P31 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: R-402 Census Tract 2010: 011502 Census Block 2010: 3042 Small Area Plan: SHERRILLS FORD Agricultural District: Printed: Thu, March 04, 2010 11:01 AM A CATAWBA COUNTY, NC 100-A South West Blvd PLAN RECEIPT Newton, NC 28658- 0 (828)465-8399 Thursday, March 4, 2010 4 sM www.catawbacountync.gov Plan Case: EHPR-3-10-4160 Invoice Number: INV-3-10-260064 Environmental Health Plan Review Invoice Date: 03/04/2010 Site Address: 7295 S GABRIEL ST, Sherrills Ford, NC APPLICANT OWNER MATT GIESE MATT GIESE 7295 GABRIEL ST 7295 GABRIEL ST SHERRILLS FORD NC 28673 SHERRILLS FORD NC 28673 704-913-2900 704-913-2900 Fee Name Fee Amount Authorization to Construct (Repair) Fee Adjustable $425.00 Total Fees Due: $425.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 03/04/2010 Credit Card -1 $425.00 $0.00 Total Paid: $425.00 Payer: MATTHEW GIESE Total Due: $0.00 pl:mieccipt;11h3drat?-676-,--lc7'_-b(,17-8852]3cli5c~7: ipt 03/04/2010 11:23 ' CATAWBA COUNTY Case # WLS2007-00471 Public Health Department Environmental Health Division Subdivision LARRY KLINGER AND WIFE PO B. 389. 100-A Southwest Blvd, Newton, NC 28658 Sect/BL/Ph/L.ot # I (828) 465-$270 FAX (828) 465-8276 TDD (828) 465-8200 PIN# 460703224728 Applicant/Owner: GEMINI HOMES Site Address: 7295 GABRIEL ST SHERRILLS FOR D NC Property Size: SF .57 ACRES Directions: HWY 16S TO HWY 150/TURN LF ON LITTLE MTN RD/TURN LF ON GABRIEL/ TURN FIT ON FALLEN PINE/ FIT BOTTOM OF HILL Catawba County Health Department Operation Permit Pro r Lira, y o' S~eO_~, -Fan K- 0 h,15, day - ST3 i006 - 5S 3 ~Z o ~ B~SID~ e ' 210 System Code System Type: IR ON Description: 3SyO N. ~1~ Tr~15Q1( Types V and VI systems expire in 5 years. (In accordance with Te le Va) Owner must contact health department 6 months prior to exiration for permit renewal. PERMIT CONDITIONS: 1. Performance: System shall perform in accordance with Rule. 1961. II. Monitoring: As required by Rule. 1961. III. Maintenance: As required by Rule. 1961. Other: Subsurface system operator required? Yes No ✓ If yes, see attached sheet for additional operation conditions, maintenance and reporting. IV. Operation: This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and All conditions ~of the Improvement Permit and Construction Authorization. '71146K S taInlle4r ns a io i a e u on Date of O ratio Permit Issurance Form F rATide?wrk\Fonns\ nLCnuo.ror CATAWBA COUNTY Public Health Department Case # WLS2007-00471 ~ V Subdivision Divirownental Health Division LARRY KLII\iGER AND WIFE PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Sec[/I3IJPh/Lo[ # 1 (828) 465-e270 FAX (828) 465-8276 TDD (828) 465-8200 PIN# 460703224728 Applicant/Owner GEMINI HOMES Oa y 619 /"v Site Address: 7295 GABRIEL ST SHERRILLS FOR D NC Property Size: • SF .57 ACRES - - Directions: HWY 16S TO HWY 150/TURN LF ON LITTLE MTN RD/TURN LF ON GABRIEL/ TURN FIT ON FALLEN PINE/ RT BOTTOM OF HILL Improvement Permit Permit Valid For: Five years No Expiration Facility (Residential): House House X Mobile Home Multi-Family Bedrooms 3 New? _ Addition? Projected Daily Flow g.p.d Water Supply Private Well? Public?I Semi-Public? - Basement: y Basement Plumbing: Y HotTub/Spa: Y Special Fixtures (explain): Proposed Wastewater System: Type: Proposed Repair: Permit Conditions: a 01) ig -n.to 9-'3 Owner or Legal Representative Signature: Date: Authorized State Agent: - Date: pert-_ g-, a QO The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the applicant/property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are met. This Improvement Permit is subject to revocation if the site plan, plat or the intended use changes, or if site conditions are altered. The Improvement Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina 'Laws and Rules for Sewage Treabnent and Disposal Systems' (15A NCAC 18A.1900). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for any given period of time. Authorization to Construct Wastewater System (Required for Building Permit) * See site plan and additional auachmenis ( ) Proposed Wastewater System: V,5'96, Qr.,, 5W Type: 3G.. Wastewater Flow 34Q g.p.d New_,~L Repair Expansion Soil LTAR: , g.p.d./112 Type of Facility: 3 84?-n awar-n, lJ-omJrj Basement: Y Basement Plumbing: Y HotTub/Spa: Y Special Fixtures (explain): Wastewater System Requirements Tank Size: Septic Tank /000 gal Pump Tank AJIA, gal Grease Trap NlA gal Drainfield: Total Area: 900 sq ft Total Length: 3 0 O ft Maximum Trench Depth 3 in Trench Width 3 ft Minimum Soil Cover G Minimum Trench Seperation _ 9 ft Distribution: Distribution Box SeriinDistribution Pressure Manifold LPP Other Additional Specifications: Authorized State Agent: Date: -MARCH Q7,202 Permit Expiration Date: Dt~r=• r~ a an I f I have read and accept the specif'icati.ons and all conditions of his permit as indicated. Owner or Legal Representative Signatur Date: Form B r:\Tidnnork\FonuVR7Snuu.rut CATAW BA COUNTY Case # WLS2007-00471 Public Health Department ; ,Envirottmental Health Division Subdivision LARRY KLINGER AND WIFE PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Sect/BL/Ph/Lot # 1 (828)465-9'270 FAX(828)465-8276 TDD (828) 465-8200 PIN## 460703224728 Applicant /Owner: GEMINI HOMES Site Address: 7295 GABRIEL ST SI ERRILLS FOR D NC Property size: SF .57 ACRES Directions: HWY 16S TO HWY 150/TURN LF ON LITTLE MTN RD/TURN LF ON GABRIEL/ TURN RT ON FALLEN PINE/ RT BOTTOM OF HILL WELL PERMIT Proposed Use: Private Public Semi-Public Other GROUTING DEPTH: MINIMUM 20 FEET SETBACKS: 1. BUILDNG FOUNDATIONS 25 Fr. 5. UNDERGROUND STORAGE TANKS 100 Fr. 2. EXISTING & PROPOSED SEPTIC SYSTEMS - MIN. 50 FL 6. STREAMS/BROOKS/CREEKS 50 Fr. 3. EXISTING & PROPOSED SEPTIC REPAIR AREA - MIN. 50 Fr. 7. LAKES/PONDS RESERVOIRS 50 Fr. 4. SEWAGE PUMP SUPPLY LINE 50 Fr. ALL OTHER POSSIBLE SOURCES OF GROUND WATER CONTAMINATION 100 FT. The well driller must verify all sepearations are adhered to before drilling the well. If the well driller is unable to tnaintaut any of dte above separations, contact the Health Department at (828) 465-8270 before drilling the well. SEE SITE PLAN FOR PERMITTED WELL LOCATION -l+~ MtIZU4 R9, a0Q2 Issued y: Permit Issuance Date: Customer Signature: WELL INSPECTION: GROUTED DEPTH: 20' 'a/ DATE: 11 164 INITIALS: 1LA APPROVED CASING: PVC _ STEEL DATE: 1 q U INITIALS: CASING HEIGHT 12" ABOVE LAND SURFACE ✓ DATE: INITIALS: l WELL COMPLETION REPORT RECrD DATE: INITIALS: WELL HEAD APPROVED 1/ DATE: 2 l o INITIALS: Water We& Dn-/I;~ 11./1{l >3 Well Driller Date Drilled Well permits are valid for 5 years from the date of issuance and are subject to suspension and/or revocation fro non-compliance with appropriate state and local rules and regulations, or if false information was given in order to obtain a permit. Wells shall be constructed in accordance with all state and local regulations and rules. The Well Completion Report must be submitted to the Health Department within 30 , ys upon completion of a well. 2 Author' d State Agent Final App oval Date Form D r:\TidernartlFonnj\ VUaaa.ra1 CATAWBA COUNTY Case # WLS2007-00471 Riblic Health Depatvnent 4 ' ,Environmental Health Division Subdivision LARRY KLINGER AND WIFE PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Sect1BLLPh/Lot # I (828) 4654270 FAX (828) 465-8276 TDD (828) 465-8200 vRJl~ PIN# 460703224728 Applicant/Owner GEMINI HOMES Site Address: 7295 GABRIEL ST SHERRILLS FOR D NC Property S SF .57 ACRES Directions: HWY 16S TO HWY 150/TURN LF ON LITTLE MTN RD/TURN LF ON GABRIEL/ TURN RT ON FALLEN PINE/ RT BOTTOM OF HILL ® Improvement Permit ® Authorization To Construct Well Permit SITE PLAN 4ZA0-s-e)6-U sT-. 99, ~OkS= i ~ ~AA-~h S~ i► I l a' I~ yS 1 60 Scale System components represent approximate contours only. The contractor must flag the system prior to beginning the installation to ensure that proper grade is maintained. Do not install system under wet conditions. This permit is subject of revocation if the site plan or site conditions are altered. Authorized State Agent Date Form C ,ATide,nark\Fo-sVWL.5 u-rvi