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Home My WebLink AboutEHPR-3-10-4358.TIF ~~A C THIS IS NOT A PERMIT Case # EHPR-3-10-4358 y CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services 1842 ski Environmental Health Plan Review - OSWP EXS_SYSTEM APPLICANT OWNER CONTRACTOR JOANNE KENNEBECK JOANNE KENNEBECK 8663 SHERRILLS CREEK DR 8663 SHERRILLS CREEK DR TERRELL NC 28682 TERRELL NC 28682 828-465-8380 828-465-8380 NAME TO APPEAR ON PERMIT JOANNE KENNEBECK Pin#: 461704635878 SITE ADDRESS: 8663 SHERRILLS CREEK DR, Terrell, NC DIRECTIONS: 150E/ KISER ISLAND RD/ RT SHERRILLS CREEK DR/ 1 ST HOUSE ON LEFT NAME of SUBDIVISION: SHERRILLS CREEK Lot # 16 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.639 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure 57 X 54 Bedrooms Basement: No Water Using Fixtures in Basement:No 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: PVT ACCESSORY BUILDING 12 X 20 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? NONE 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: Signature of Applicant or Agent Qo&~~ 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 1 (FOR OFFICE USE ONLY) Zoning Approval: _Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front 30 FEE NAME DATE AMOUNT Side 10 Existing Tank Check Fee 03/12/2010 $80.00 Rear 5 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 03/12/10 16:05 THIS IS NOT A PERMIT WLS # CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Expansion ❑ Existing Tank Check Y New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ 1. Name to Appear on Permit JCL-nvnp- 2. Permit Requested By n n e n Business Phone Q1 _~JL Address ou (a-3 ~(ll~~~ t l is C ~p~,V2_ t2 Home Phone +-72-Q93-7 3. Property Owner Business Phone Address Home Phone 4. Name of Subdivision h~~,~t CIS C~2Q - Lot # ~ lp Section/Block/Phase Property Address 25 (-Q, ('g 3 5 LtiQ;U_Q~ C' ; - Directions to Property: (a~p S! -10 ~i i ~C' Y L S ( C2mc~ ~ ' 'y- l ~l K-t 7L 0 S l2k n 5. Property Size: Square Feet ytoo Acres CO- 5 Date Platted/Recorded 6. TYPE OF FACILITY: House ✓ Mobile Home Dimension of Structure 5 7X6.6- Bedrooms* 3 *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 system size increase in the future. Basement: yes/& Water Using Fixtures in Basement: yes/6o No. in Family ~ Whirlpool Tub yes/Co) Gallon Capacity 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 1st 2nd 3rd OTHER: (Specify) 7. Do you anticipate any additions to Facility? Yes /dg If so, describe: 8. Has any grading, removal, or addition of soil been done to this property? Yes /yc If so, describe: 9. Are there easements/right-of-ways recorded on this property? (e / No 10. Is a public water supply available on or adjacent to the above property? Yes /(S;) 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.** 11. Well Type Applying For: [ ] Individual well [ ] Community well [ ] Semi-Public well I understand that this is a fonnal 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 Well 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 MADE TO THE PROPERTY, THERE IS AN ADDITIONAL CHARGE." Date l l C7 Signature of Owner or Agent 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 airy 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: 4617-04-63-5878 1 inch = 40 feet Prepared for: 5 • 1 .00 0 ti. 0 0 0 8 1 • M o N L6 O 5 7 ci 0 co N 111~r 24 .99 ~r- 0 5 a cn% 1 THIS IS NOT A LEGAL DOCUMENT Thursday, March 11, 2010 02:42 PM LAMM CATA.WBA COUNTY Case # WLS~006-01376 Public Health Department Ct) PV < Environmental HcalUi Division Subdivision SHERRILLS CREEK PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Sect/BL/Ph/Lot # 16 (828) 465-8270 FAX (828) 465-8276 TDD (828) 465-8200 need PIN# 461704635878 Applicant/Owner: TOM & JOANNE KENNEBECK ~C Site Address: 8663 SHERRILLS CREEK DR TERRELL NC J Property Size: SF .65 ACRES Directions: 16S/ 150E / RT KISER ISLAND RD/ LOT ON CORNER OF KISER ISLAND RD & SHERRILLS CREEK DR (SEE IP WLS2006-00334) Catawba County Health Department Operation Permit 1.2 -D-1 STS 1 LC 0 PAP P`Lry'l-P CY 3 12-0" ~ LJ System Code System Type: '3 Description: D IA (r C Types V and VI systems expire in 5 years. (In accordance with Table 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 condi ns of the Improvement Permit and Construction Authorization. Moen -/Z-Q j System Installer installation Date 3. 12.0 u owe State 17 n Date of Operation Permit Issurance Form F r. 1TldemnrklFnrmtV1VJ.CAnn. rnt QATAWBA COUNTY PuNic,Health Department Cto) Case # WLS2006-01376 'Lrn'.rormtental Health Division Subdivisioin SHERRILLS CREEK / PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 SectBL/Ph/LAt # 16 (828) 465-8270 FAX (828) 465-8276 TDD (828) 465-8200 PIN# 461704635878 Applicant/OwnerTOM & JOANNE KENNEBECK Site Address: 8663 SHERRILLS CREEK DR TERRELL NC pos*d~ Property Size: .65 Directions: 16S/ 150E / RT KISER ISLAND RD/ LOT ON CORNER OF KISER ISLAND RD & SHERRILLS CREEK DR 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? Semi-Public? Basement: N Basement Plumbing: N HotT ub/Spa: N Special Fixtures (explain): Proposed Wastewater System: Type: Proposed Repair: Permit Conditions: Owner or Legal Representative Signature: Date: Authorized State Agent: Date: 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 Treatment 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 attachments ( ) Proposed Wastewater System: ~~~u/l /tl 5 m Rt-WP Type: 3B I& Wastewater Flow 366 _g.p.d New Repair Expa Sion Soil LTAR: S g.p.d./ft2 Type of Facility: I*7(s`e 3 1_3e- Basement: N Basement Plumbing: N HotTub/Spa: N Special Fixtures (explain): Wastewater System Requirements Tank Size: Septic Tank IGICiYJ gal Pump Tank /4000 gal Grease Trap gal Drainfield: Total Area: 7/73 sq ft Total Length: n260 ft Maximum Trench Depth in Trench Width .3 ft Minimum Soil Cover Minimum Trench Seperation ft Distribution: Distribution Box SerialhDistribution Pressure Manifold __K_ LPP Other Additional Specifications: Authorized State Agent: Date: j Z Permit Expiration Date: 9. /Z- 1 have read and accept the specifications and all conditions of this pennit as indicated. Owner or Legal Representative Signature: v Date: f~ r.\Tidana rk\PonnsV"Unvv.mt CATAWBA COUNTY Public,Health Department Case # WLS2006-01376 •Envimrunental Health Division Subdivisioin SHERRILLS CREEK PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Sect/BL/Ph/Lot # 16 (828) 465-8270 FAX (828) 465-8276 TDD (828) 465-8200 PIN# 461704635878 WELL PERMIT Well permits are valid for 5 years from the date of issuance an 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 days upon completion of a well. Proposed Use: Private Public Semi-Public Other Lot Size Applicant Owner SF SAME AS CONTRACTOR TOM & JOANNE KENNEBECK .65ACRES 8663 SHERRILLS CREEK DR TERRELL NC Directions: 16S/ 150E / RT KISER ISLAND RD/ LOT ON CORNER OF KISER ISLAND RD & SHERRILLS CREEK DR GROUTING DEPTH: MINIMUM 20 FEET SETBACKS: 1. BUILDNG FOUNDATIONS 25 FT. 5. UNDERGROUND STORAGE TANKS 100 FT. 2. EXISTING & PROPOSED SEPTIC SYSTEMS - MIN. 50 FT. 6. STREAMS/BROOKS/CREEKS 50 FT. 3. EXISTING & PROPOSED SEPTIC REPAIR AREA - MIN. 50 FT. 7. LAKES/PONDS RESERVOIRS 50 FT. 4. SEWAGE PUMP SUPPLY LINE 50 FT. 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 maintain any of the above separations, contact the Health Department at (828) 465-8270 before drilling the well. SEE SITE PLAN FOR PERMITTED WELL LOCATION Issued By: ~nmz ?g-tj C!n Signature: lezz '17 .10 A9 Date: Expires After: WELL INSPECTION: GROUTED DEPTH: 20' DATE: i- 16; 01 INITIALS: I APPROVED CASING: PVC J STEEL DATE: T INITIALS: CASING HEIGHT 12" ABOVE LAND SURFACE ✓ DATE: INITIALS: WELL COMPLETION REPORT RECEIVED 7- DATE: 3' i Z• Cr I INITIALS: WELL HEAD APPROVED ✓ DATE: INITIALS: DRILLED BY: OrI 9- ~h S ISSUED BY: L L/~ DATE: b'1 DATE: 3 2 D SIGNATURE rATidemark\FonnsVWLCaon. rut inn \ C;ATAWBA COUNTY Public,Health Depaltnent Case # WLS2006-01376 Envirottuiental Health Division Subdivisioin SHERRIL.LS CREEK PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Sect/BL/Ph/Lot # 16 (828) 465-8270 FAX (828) 465-8276 TDD (828) 465-8200 PIN# 461704635878 Improvement Permit ® Construction Authorization Well Permit PIN # 461704635878 SITE PLAN WLS # WLS2006-01376 TOM & JOANNE KENNEBECK SHERRR S CREEK 16 Applicant/Owner Name Subdivision/Section/Lot v R &9~ /Z~ q- /,7- Aut rued State A t Date System components represent approximate contours only. The contractor must Flag the system prior to beginning the installation to insure 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. N S k4 l K AV-C~' N ~d 2Z~ I 12 Zs - 4S , L40 Caa s y N S~~t-,ifs C~ Scale rATidema rAFonnsVWLSa an.roi ~~A Cp CATAWBA COUNTY, NC 100-A South West Blvd PLAN INVOICE Q+ Newton, NC 28658- 0 (828)465-8399 Friday, March 12, 2010 184 sm www.catawbacountync.gov Plan Case: EHPR-3-10-4358 Invoice Number: INV-3-10-260423 Environmental Health Plan Review Invoice Date: 03/12/2010 Fee Name Fee Amount Existing Tank Check Fee Fixed $80.00 Total Fees Due: $80.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 03/12/2010 Check 484 $80.00 $0.00 Total Paid: $80.00 Total Due: $0.00 plan im(lice ; 5Q052825-70dc-4740-881 1- 3a65ca722ci6,`.ipt 03/12/2010 16:04