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Home My WebLink AboutEHPR-3-11-10026.TIF �g'' C THIS IS NOT A P�RMIT Case # EHPR-3-11-]0026 �" �`' � CATAWBA COUNTY HEALTH DEPARTMENT V :��: `�' ' t Plan Review Application for Environmental Services 1842 5M Environmental Health Plan Review - OSWP IMPROVEMENT NAME TO APPE O PERMIT Matt Campbell SITE ADDRESS: 29g0 GRIER ST Newton, NC Pin#: 372113033438 NAME of SUBDIVISION: SAMUEL A LUTZ PROPERTY Lot # � p- � 7 Section/BIocWPhase PROPERTY SIZE: Square Feet Acres 0.889 DIRECTIONS: Startown Rd to Robin Wood Rd / Turn on Grier Street / 1 st house on right APPLICANT OWNER CONTRACTOR Matt Campbell Matt Campbell 2980 Grier ST 2980 Grier ST Newton NC 286�8-8341 Newton NC 28658-8341 828-261-5743 828-261-5743 PRIMARY CONTACT: Owner APPLICATION FOR: New Construction DIM EXISTING STRUCTURE: 30 x 50 EXISTING FACILITY TYPE: House NUMBER OF EXISTING BEDROOMS: 3 SEWER TYPE: Septic Tank NUMBER OF EXISTING OCCUPANTS: 2 EXISTING WATER SUPPLY IN USE: Private Well CALCULATED DESIGN FLOW: Public water is *"NOT*" available for this property. PUBLIC WATER TYPE AVAILABLE: N/A DESCRIBE WORK: ln-ground pool 18 x 25 x 40 DESCRIPTION OF house and detached buildings EXISTING STRUCTURES ON SITE (IF ANY) PROPERTY EASEMENTS: none PROPOSED CONSTRUCTION ACCESSORY STRUCTURES DESCRIPTION: In-ground pool # OF NEW BEDROOMS: STRUCTURE DIMENSIONS: 18 x 25 x 40 ACC DWELLING? No PLUMBING? No # OF STRUCTURE OCCUPANTS: I understand !hat 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 Heaith Department employees to go on this property for evaluation purposes. I certify the above inforrnation to be correct and understand that an Improvement Permit issued as a result of this information is transferable and may be eligible for a norrexpiring 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 obcain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or structure ]ocation should conform to applicable setbacks. Date:� -�J" �iJ� ` �) 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 8?_8-466-7291 AREA2 �****�******�*****************�*******************************�**********************************************�**�***�* Minimum Setbacks Front: 30 Side: 10 Rear: 10 Side St: Max Height: 03/2�/ l l 1122 ��,A . CATAWBACOUNTY Case# EHPR-3-11-10026 � G Public Health Department ¢ t. � Subdivision SAMUEL A LUTZ PROPER� .-� Environmental Heal[h Division - I lan Review `.�i "�' PO Box 389, IOO Southwest Blvd, Newton, NC 28658 Lot# 10-17 iH42 sw • PIN# 372113033438 Applicant/Owner Matt Campbell, 2980 Grier ST, Newton NC 28658 Site Address: 2980 GRIER ST, Ne�vton, NC Property Size: SF 0.889 ACRES DireCtions: Startown Rd to Robin �Vood Rd / Turn on Grier Street / 1 st house on right FEE NAME DATE AMOUNT BALANCE DUE Improvement Permit Fee 03/25/2011 $150.00 TOTAL FEES $150.00 CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 03/25/11 1122 1 �� , THIS IS NOT A PERMIT � CATAWBA COUNTY HEALTH DEPARTMENT � n �� , �; Application for Environmental Services � l� f f� Page 1 IH4 sM Improvement Permit d Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Euisting Facility ❑ Property Address e2 ��o'�' I��• Subdivision �} .l� Lot # Acres Section/Bloc hase Driving Directions to Property S }� �� '�� m� lM�, �,a oo c� �� . �o �o � �' I � � -'� . �. 6 � , fl o iu S �. ��'l__ y' I � Wc � 4 � W J [L NAME TO APPEAR ON PERMIT? Owner ❑ Applicant ❑ Contractor O Applicant Contact Information U Name m Address �,� r � �'j� . �,; � � Phone ��g_ �, s� . ' 3 � Cell Phone �'j � � . a (p ( � � 'j �} 3 � Owner Contact Information � Name Z Address � Phone Cell Phone �"' Contractor Contact Information W Name � Address � = Phone Cell Phone I -• z WHO WILL BE THE PRIMARY CONTACT? [�Owner ❑ Applicant ❑ Contractor Z Description of E�cisting Structures on Site o S d— e r�e ��1 t � � # of Bedrooms *�' ,�j Structure Dimensions _ j�U )G 5 D # of Occupants a F=� Basement 0'`Yes ❑ No Basement Fixtures ❑ Yes [�To � Planned Future Additions or Improvement�s (Building Permit NOT requested at this time) OG Describe s�% �►'� ►� I �°� � � Proposed Future Structure imensions �$ y,2.�� 1 U# of Bedrooms *�' if applicable Z Are there easements or right-of-ways recarded on this properiy ❑ Yes No Describe Is a public water supply available on or adjacent to the above properiy ** ❑ Yes 0"No Check type available ❑ Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line Existing water supply in use Individual Well ❑ Community Well ❑ Semi-Public Well ❑ County/CiTy/Township Water Line ❑ I WOULD LIKE TO SCHEDULE A COMBINED FLAGGING AND SOIL EVALUATION (SEE COMBINED EVALU PROCEDUES) �� G THIS IS NOT A PERMIT � � a CATAWBA COUNTY HEALTH DEPARTMENT J ' '° � Application for Environmental Services Page 2 Ig¢Z �, - Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms * j' Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes ❑ No Accessory Structure(s) Describe 5� �i oc # of New Bedrooms *�' if applicable Structure Dimensions �� (Q i nL�, c;�e,c.K # of Occupants h) � Accessory Dwelling ❑ Yes [�'�To Plumbing []'Yes ❑ No Describe Plumbing Needed unc�.�r`�;�wv:Q no�- 5u-wi �o..�ny ❑ Multi-Family Residence # Units #Bedrooms per Unit*�' Total # Bedrooms *�' Structure Dimensions ❑ Food Service Specify Type # Seats Floor Space -Entire Food Service Facility (Sq Ft) # Employees per Shift # o f Shifts Dining Area (Sq. Ft.) ❑ Business Specific Type of Business Retail Floor Space # of Em ployees per Shift # of Shifts ❑ Other Facility Type Specify If Church # of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ No Describe Calculated Design Flow, Commercial �' Additional information may be required to determine design flow from certain facilities. This value will be determined during consultation with on- site staf *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 confumed 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. j'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. 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. 0 CHANGE WORK ORDER REQUIItING REDESIGN AND/OR RETRIP WILL TNCURE AN � ADDITIONAL CHARGE (SEE FEE SCHEDULE) a I understand that this is a formal application for Environmental Services and authorize Catawba County Environmental � Health employees to go on this property for evaluation purposes. I certify the above information to be correct and understand 0 that an Improvement Permit issued as a result of this information is valid for 5 years or may be non-expiring under certain V specified conditions. Improvement Permits and Well Permits are transferrable, but may be revoked if this information, site W plans or intended use changes for the proposed facility. An Authorization to Construct issued by this department is valid for m (5) five years from the date issued and is not transferable � � Signature of Owner or Agent �,; �``g.t'' C� Q�� Printed Name of Owner or Agent � q,�� rri p b� 11 Date 3°�� - vZmll � � Catawba County, North Carolina N Thrs map product ivas prepared fi�om the Calmsba Coimty, NC, Geographic lnjormntion System. Cutativbn Coirntv has made substantra! efjorts to ensure the nccuracy of (ocntron and lc+6e(ing rnjorn�a[ion contained on thrs map. Cntmvba CounN pranates nnd recommends the rndependent verrfication ojnny data contamed on lhis map product by the t�ser. The County ojCatmvba, its employees, agents and personnel dtsclain:, and shnl! not be held Gable jor any and a(I damages, loss or lia6ilitv, whether d�rect, rndn�ect or consequent�a! wleic{t arrses or moy arise jrom this map product or the use thereo any person or entrry. . Le9Eftd Selected Parcel Number: 3721-13-03-3438 1 inch = 40 feet Prepared for: J _. , r . � -,;; ,--�-- �-.._ , � _----------------� _ _ _ - . , - - - .---" _ -- �,�---- _ --,- - "�---..__� oo oo � � �� - . i ' � .,� ' ' 2Q8 ' 39 4.30 19 �'_ ; �—�_ �,--- , _ _ 18 _� , ;, `� � _ , , , . ___ , � ; ; ,� , � , , ,�� -��;� � , 17 �. ._ 1-�- � �� , , � , , �. 1 .. � .. I . _ �` � j 1 f`��...� ` ;� � ^ � I r q � { .. , t '.•,(- 1 r , ' �. � , r � �. , -- i � � , , c �" / � r .� .�_„ t r ,' y L � . � � J ,.�.�... � > 1 .' _ , � 2 , � , �- _ ' , � ' ��-... 1 , o , ' ' ' 11 ,� . , �� __ , , , 32 , ,;. , .. --10 � 3 ' Plat 9 �. e... :_, N � � � ' -- , , ; �, , , , � , o 1 _ , < < < - �� , _ �.,� , , � , ,� , r. � 4 ; 1 ,r , �� ; �. , � ; _-, �� 1� � �� I '� % - � , o � . _ _ � i f `` �, , � - _��' � f' � � �'' 343��8 _ ;� , �, 5 -. � f ' _ '7-\ "�' _ r i �' I I � / � i , ! �/ i � %' r ` O _- ��` �` , % r ` � � _ ! � �� r � � � � � f� �, � � / �", � '/� ?� � / , t� � / �� . � . �� . , , 7 ____ _- � � i� I , � � � _ ` � , I � /, I J' � �, � —�- � � � � _ ��. ��' ; ,� Q ` � -_ � ; _ ,� , �- _. �-_ _ _.___ : � ---- 9 \ � ' 7� �n� _ � ! ^ THfS IS NOT A LEGAL DOCL',1�IENT `� ___. 'fJ Friday, March 25, 20ll 10:48 A:�7 , . �. --''"�� .i � CATAWBA COUNTY NC - Parcel Report . Information Regarding Selected Parcel(s} ParcellD: 3721-13-03-3438 Name: . CAMPBELL MATf D Name2: CAMPB�LL TINA B Address: 2980 GRIER ST Address2: City: NEWTON State: NC Zip: 28658-8341 Account: 136625 Calc Acreage: 0.89 Tax Map: 169H 03005A LRK: 57863 • Deed Book: 2209 Deed Page: 1065 Subdivision Name: SAMUEL A LUTZ PROPERTY Subdivision Block: A Lots: 10-17 , Plat Book: 9 � Plat Page: 32 Building Number: 2980 Street Name: GRIER ST Site Zip: 28658 ' Township: HICKORY Fire Code: HICKORY RURAL � City Code: COUNTY \ State Road: . Total Bidgs Value: $130,000 Land Value: $18,200 l s •�� Total Value: $148,200 � Year Built: 1959 \� Year Remodeled: ��-' � Last Sale Date: �� Last Sale Amount: � Neighborhood: 87 Watershed: Watershed Split: Voter Precinct: P35 E911 District: COUNTY Zoning: R-20 " Zoning2: Zoning3: Zoning Split: N Zoning Overlay: Zoning District: COUNTY Split Zoning Dist: N SplitZoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: BLACKBURN Middle SchooL JACOBS FORK � High School:, FRED T FOARD School Spiit: NO P&Z Case Number. Census Tract 2010: 011102 Census Block 2010: 3009 Small Area Plan: MOUNTAIN VlEW Agricultural District:. Printed: Friday, March 25, 2011 10:48 AM ` � r�� . �,, CATAWBA COUNT� EALTH DEPART ENT •' Telephone: (704) 465-8270 TDD: (704) 465-8200 N' / . Improve. Permit_Authorization to Construct,Repair Permit_Oper. Permit [,' ystem Type �� Owner/Agent Phone �� ,� , Address Subdivision Section/Block/Phase Lot# � Lot Size Directions: �- `��Ez Facility: House Mobile Home Business . Other: Tax Map # Multi-family Other . Zoning pproval # # Bedrooms # Seats ## Employees . Ap cat�n_- GPD Flow Hot Tub or Sp yes/no Special Fixtures 00% Repair Area yes/no Basement yes/no Basem umbing o Water Supply: Private well Public .r« Type of Syatem: Trench Bed�Pump Pump/Panel Panel LPP Other Tank Size: Septic Tank Size f,tJ�� Pump Tank Size � �c �a Nitrification Field: Total Square Feet Q Depth of Stone_� Bed Size Trench Width - T'otal Length of All Trenches Number of Trenches Individual Tr nch gt / / / Feet on er aximum Tren Depth � Distance of earest Well � *DO NOT I ALL WHEN WET* *** � kiM � kii#*r'A'b# � tdrtkiYti**bii**ti*iMt#itt4****t**tt k #**** �ki�M*�r� 4 *#t*t*t#**�}***#***ilrtk*ilr�lr***iYiF**#**b**** Topo �� o Slope � Texture ( � � Structure � n� � � � - - p M � - - ` Clay Min. � - 1 � �f�v Soil wetness �� , ��Y:- Soil Depth �� Restric. Hoz. at " � � �- � � � �-. , Available space /no� ^ � �-- -� -� � Overall Clasa S U � �-��-- --- —'� �' � � Comments: � i, � =-- � i � �� i � i , � i. i i ---� i _ i � `'"'''c ! � i i **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** +r.*r,o-*r.r**,w+.,w*•*,t � .r,t,k,tr*,ir. � r*,t«* * . t .« � *« *.�yr*fr*+r , tr*�r* , k**** , k*.rww***�r,t,w,r***,►,r,rv.,r*d r ,t,t.t,t**,t**, t , t*ir*+r *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 j�ssued and is not transferable. Permit Date ��.. � � -� � �� Owner/Agent San' tarian �..,� � � � Installed By ��_ Dat� -.��{ _ Sanitarian o , White - Office Yellow - Owner/Agent