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Home My WebLink AboutEHPR-4-11-10317.TIF From: 04/11/2011 11:40 #438 P.001/001 HYK b��4b LHIHW�H LUUNIi Ui�VI 1�G� 4b7 �G'(b r.� $ THTS �S NOT A P�RMIT Ca3e # EJC�'R-4-11-10317 � � �` � CATAWBA COUNTX HEALTH DEPA,R'TIV�NT Plan Review A,pplica�on for Environmental Services Environmental �ealth Plan Reviewv - OSWP �N �� 5� � EXPANS/ON r rd NA 13�h IT GRACE GARNDER SITE ADDRESS: 4 �80 EURTS RI1, Vale, NC Pir�t: 2697031 ]20Z2 0 NAME of SUBDM510N: Lol# SecqoNBlock/Pbasc PROPERTY SIZE: 3quare Feet Acres 2.3 ] 9 DIREC710N5� l OW/ PRDYST` X RDS / TURN LEFI' APPROX 5 MILES OUT - OFF PLATEAU RD TO BURTS YLD / CL05E TO Gt�.BERT RD AP�L��IT Ow1vE�, GRACE GAFWDER GRACE GARNDER 47_80 BTIRTS RLl 4280 SURTS RU �'ALB NC 28168 v�,E NC �8168 704276�1919 704Z7�1919 PRINI/�IRY CONTACT: pweer APPLICAnON FqR: New Cnnstruction DIM EX(ST1NG STRUCTURE 30 X 56 EXISYING FACIL�TY TYPE: House NUMBER OF EXISTING BEDROOMS: 3 SEWER T1fPE: 5eptic Tank Nl)MBER OF EXISTING OCCUPMiTS: z EXI3TING WqTER SUPPLY IN USE: privaLe We]I CALCULATEO DESIGN FLOW: � Public water is �'�NOT°' available for thfs property. PUBLIC WATER TYPE AvAILABLE- DE5CRIHE waRK: Pv"I' ABOVE GROUND POOL DESCRIPTIDN OF SINGLB FAMILY . ExisnNC s�ucruREs ON SITE (IF AMI� PR OPERTY EASEMEPl7S: NONE PROPOSED C�NSTRUCTION ACC�S30RY STRUCTURES DE3CRIPTION: PVT ABOVE GR�UND POOL # OF NEW BEDROOMS: STRUCTURE DIMEMSIONS: 24 FT ROUND ACC DWELLING� No PLUMB(NG7 No NA , # OF STRUCTURE OGCUPANTS: p I understdnd thdt this is e fotmal appllratfop fof 8 well pertnA, Improv6me�t permit arAuthor{,:qdOf1 to ConsGud a grou�d ebsorption sev�ge dispossl systam to serve the above descnbed tacility o� thls property and autho►ite Catawb8 County Health DepaRment employees to go an this property for evaivation purposes. I cxRiy the abpve infortnation to be �orrect anG understand that an Improvement Permlt issued as a result ofthis Inforrnetion is transTerabie and may be eligible for a non-eXplring date, but may be revoked if lhi� informatlon, slte plans or intended use r,�lenges forthe propased fa�lllry. A Weil Permit and Autha�ization 6o Conatruct iseued by this department is valid for (5) flve yeats from the date issued end is nvt transferabfa Nvte; 1'ou must o6tain Zonin,g Approval prior to locgting a home or sm►ctUre on shis propetty. Any representation by you of house or Structure I cati should confocm to npplicablc sctbac(�5, D�� Sigaature ofAp�licanc or Ageat �C� �j,�� An Environmental Health Speeialist wiil contact you w;rt ' worldng day f ppli�ation date. If you need further info,tmation or assistaace please call 62 7Z91 �art�Ma��r�*�.3:�=•s�t�a*��tr�.*�:.: . 1�.�' �Fi�'I ae � #tfi44�h �A�If�ll� $etl18C1(S: Front: 80 5ide: 10 Rear: 10 Side 5t: Max Height: oan�iu OS:�R � C�� CATAWBA COUNTI�, NC � �, 100-A South West Blvd PLAN RECEIPT F--] Newton, NC 28658- U �� ' (828)465-8399 Monday, April 11, 2011 j$4'L sM www.catawbacountync.gov P�an �ase: EHPR-4-11-10317 �nvoice Number: INV-4-11-273979 Environmental Health Plan Review Invoice Date: 04/11/2011 Site Address: 4280 BURTS RD, Vale, NC APPLICANT OWNER CONTRACTOR GRACE GARNDER GRACE GARNDER 4280 BURTS RD 4280 BURTS RD VALE NC 28168 VALE NC 28 ] 68 704-2 704-276-1919 Fee Name Fee Amount Authorization to Construct Fee Adjustable $150.00 (New/Expansion) Fee 7otal Fees Due: $150.00 PAYMENTS PAYER: GRACE GARDNER Date Pay Type Check Number Amount Paid ChangE 04/11/2011 Credit Card -1 $150.00 $0.00 Total Paid: $150.00 Total Due: $0.00 ��lan receipl 04/I I/201 I 12:14 A �� C p� THIS IS Z?�OT A'PERMIT Case # EHPR-4-11-10317 � ��° �' CATAWBA COUNTY HEALTH DEPARTMENT � c.� ,• :;: '`C Plan Review Application for Environmental Services I842 sM Environmental Health Plan Review - OSWP IMPROVEMENT NAME TO APPEAR ON PERMIT GRACE GARNDER SITE ADDRESS: 4280 BURTS RD, Vale, NC Pin#: 269703112022 NAME of SUBDIVISION: Lot # Section/B(ock/Phase PROPERTY SIZE: Square Feet Acres 2.319 DIRECTIONS: ] OW/ PROPST X RDS / TURN LEFT APPROX 5 MILES OUT - OFF PLATEAU RD TO BURTS RD / CLOSE TO GILBERT RD APPLICANT OWNER CONTRACTOR GRACE GARNDER GRACE GARNDER 4280 BURTS RD 4280 BURTS RD VALE NC 28168 VALE NC 28168 704-276-1919 704-276-1919 PRIMARY CONTACT: Owner APPLICATION FOR: New Construction DIM EXISTING STRUCTURE: 30 X 56 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: DESCRIBE WORK: PVT ABOVE GROUND POOL DESCRIPTION OF SINGLE FAMILY EXISTING STRUCTURES ON S17E (IF ANY) PROPERTY EASEMENTS: NONE PROPOSED CONSTRUCTION ACCESSORY STRUCTURES DESCRIPTION: PVT ABOVE GROUND POOL # OF NEW BEDROOMS: STRUCTURE DIMENSIONS: 24 FT ROUND ACC DWELLING? No PLUMBING? No NA # OF STRUCTURE OCCUPANTS: 0 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 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 vafid 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 structi re location should conform to applicable setbacks. � Date: �� Signature of Applicant or Agent '�' � '_�� / An Environmental Health Specialist will contact you within 2�rking days of ppli ata n date. If you need further information or assistance please call 828-466-�221� AREA2 ********************************�*****************�*�**�**************************************�*********************** Minimum Setbaeks Front: 80 Side: 10 Rear: 10 Side St: Max Height: 04/08/ I I 12:38 ��,� , CATAWBA COUNTY , Case # EHPR-4-11-]0317 � �� G Public Health Department , - �` � Subdivision a Environmental Health Division - Plan Review Lot# v �i`� `�' PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 rg42 s� PIN# 269703112022 Applicant/Owner GRACE GARNDER, 4280 BURTS RD, VALE NC 28168 Site Address: 4280 BURTS RD, Vale, NC Property Size: SF 2.319 ACRES Directions: l OW/ PROPST X RDS / TURN LEPT APPROX 5 MIL�S OUT - OPP PLATEAU RD TO BURTS RD / CLOSE TO GILBERT RD FEE NAME DATE AMOUNT BALANCE DUE Improvement Permit Fee 04/08/2011 $150.00 $0.00 TOTAL FEES �150.00 $0.00 CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 04/08/11 12:38 ��,A THIS IS NOT A PERMIT ti �" �� ; � CATAWBA COUNT�i�� I��ALTH DEPARTMENT �� '� Application for Environmental Services Page 1 1 84 2 ,� Improvement Permit �, 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 ❑ Existing Facility ❑ ' ,,l� ,� II ProperTy Address �� l�NL ��C Subdivision �� f? � � 2 � �� Lot # Acres > 3 �j 1 � � � � S� tion�l�k,/Phase Driving Directions to Property � �� '� - � I4��.�.. /� S� u.�..�5 �. 0 � W a NAME TO APPEAR ON PERMIT? ��-CSwner ❑ Applicant ❑ Contractor O Applicant Contact Information V Name ��„(,� �j— W Address Z� � ' S '' �� L 2� Fj m � Phone d yf (Lr - f Cj (' Cell Phone Z� -� ��; ��J � Owner Contact Information � Name z Address � Phone Cell Phone � Contractor Contact Information W Name � Address � Z Phone Cell Phone F� Z WHO WILL BE THE PRIMARY CONTACT? Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site � � �'/ Q # of Bedrooms *�' �j Structure Dimensions Z�C � �, # of Occupants �_ f Basement ❑ Yes No Basement Fixtures ❑ Yes �No C Planned Future Additions or Improvements (Building Permit NOT requested at this time) �C Describe �;�,(,� � Proposed Future Structure Dimensions # of Bedrooms *�' if applicable ? Are there easements or right-of-ways recorded on this property ❑ Yes No Describe Is a public water supply available on or adjacent to the above property ** ❑ Yes o 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 EVALUATION PROCEDUES) ��A G THIS IS NOT A PERMIT 4 � ��'` , � CATAWBA COUNTY HEALTH llEPARTMENT �� Application for Environmental Services Page 2 IS4`L su Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *�' Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes ❑ No ❑ Accessory Structure(s) Describe # of New Bedrooms *�' if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ 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 # of Shifts Dining Area ( Sq. F t.) ❑ Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts Other Facility Type Specify D ' UY� lf 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 staff. *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 septic system size increase in the future. tIf 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 REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN � ADDITIONAL CHARGE (SEE FEE SCHEDULE) W � I understand that this is a formal application for Environmental Services and authorize Catawba County Environmenta] a � Health 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 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 ��-�� Printed Name of Ow r or gent � Date � � r=-=, Catawba County, North Carolina N ' Thls map product was prepnred from the Catmaba Counry�, NC, Geographic lnformation Sys[em. Camwba Cotrnty has mnde strbstanliul ejjorts to ens��re the accuracy oJlocn�ion and lubelrng informatima contained on this map. Carawba County pramotes and recon:mends Ihe rndependent verrfication of any data contarned on �his map product by the user. 77�e County of Ca(awba, its employees, agents and personnel drsdann, and sha!l not be held linble fa• nny nnd a!l damages, loss or liahlNty, whether direct, Indirect or consequenlia! which arises or may arrse jrom this map prodtect nr the use thereo any person or en�iry. L2g@tld Selected Parcel Number: 2697-03-11-2022 1 inch = 100 feet Prepared for: ,�, �� ,� �, -., �,._,.. �,yf ': ✓" _�.. f ,, . ,.. ; ,- ' '" °' frf '.'� �� ,, r , _ _- , ._..'..�^,,, „'`` , `''� ,,"' � -, !, r " .,,- / , ` �,, , f a ,, r • . , , . .-~ � � � . � .% �, , , , ..., , � ,� . : , ...,.. f ,-^ , .� � ,. . ...�.... r' � , � � .,. _ , ,, , � , . ,. . , � r ..._. ,. `.. ,. . . r r' ,�-` , ._,..�.._.,,,.. _. ..._. ., - .,. .' < ; ;' �` f .r' ,, ,.� •,,�, ':a �;� � � ; � �� , �.� r �� ,, " � „_.-_ �"''�, "` T £ `F� � ! � �.�;r, �`' F : .f' � �`'�,� �"'w, � �rJ � f q� F� , '+�,. � s �\ , , o« _ . �}� � � S f f° �`',,, �'-. � �� "�.. � � � � �' � 1 � � �t � ��`- � °`. '\� � � !�, � � �� w. ^"*.<�^>.,,—^._ f .� �, t i f ,,,, »., � Y . � ...� `� � U � �1 �„ �`'� � '� � �+ `--,..,�_ ��.,� r ��l�'C�7 � '"� � � � f ; �-_.. 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'`•., , .. �,� � ! i_� �� L...-.�. . \,4 +7, J � �v THIS IS NOT A LEGAL DOCUMENT ��W nj � ST Friday, April O8, 2011 12:24 PM � '\, ..� � �� .� �• .•y._ �' A , � � - , . 2"� � � _ .,^ /,,2 CATA .�,�I%YY�I ��UJ WBA COUNTY HEALTH.DEPARTMENT " � � NEWTON, NORTH CAROLINA � COMPLETION �ERMIT FOR SEPTIC TANKS PExr�zT �� C- 2 5 3 2 ° DATE:_� �/g�_ OWNER � ' � � ��-+, q�,, ADDRE S S �.. BUILDING CONTRACTOR , e� �o ,,✓ --. ?6-- BDIV�S7I� � � � LO CAT I ON . A--�� °j� !�.�.�.:( "�' �OT �� LOT SIZE - BLOCK OR SECTION HOUSE (� MOBILE HOME ( ) BUSINESS ( ) OTHER ( ) FHA-VA LOAN ( ) SEPTIC TANK: (SIZE /S pp• GALS) WATER SUPPLY: � N0. BEDROOMS__�N0 URES INDIVIDIIAL �UBLIC GARBAGE DISPOSAL UNIT:YES (�p:(,,� IF WELL, TYPE: BORED DRILLED DUG AUTO WASHING MACHINE: YES (�Np O DISTANCE FROM SEPTIC TANK OR NEARES� _ NITRIFICATION FIELD:• � SQ.FT. POLLUTION: r00 r�... FT. 1) NUMBER OF LINES SEPTIC TANK INSTALLED BY: 2) LENGTH AND WIDTH OF LINES � ` S ' - ERMIT FE ` _, a BED SYSTEM CERTIFICATE OF COMPLETION BY: b) TRENCH SYSTEM ( ) • '�-- 3) DEPTH OF -STONE IN� LINES 1— �!� ��S : ��"'""'"'"�� i—' ADEQUATE FALL (GRADE) O�i: 1) BUILDING (HOUSE) SEWER LINE: ' 2) NITRIF� N �ON LINES: DATE INSTALLED: S� j YES � ( Np ( ) � TIC TANK LAYOUT ° � . . ,��a a `-�-- I , ----- � � z �P � �,, ` � � o . x � .. . I � w �o� . � H H 0 O a dti. � �..�. � a . �a'�C/�i ___ _ NEALTH DEPARTMENT COPY �$A �' CATAWBA COUNTY PERMIT �, �,,^ �.� ZONING rr�l�TH�RIZATION (R) � F-� �, <, �Q; Swimming Pool � _ .�ar� '� C� ;��p� � P. 0. I3ox 389 Phone: 828-465-8380 P�RMIT NO: ZONR-4-11-16803 100A Southwest Blvd PAX: 828-465-8484 APPLIED: 04/0&/201 1 Newton, North Carolina 28658 ISSUED: 04/08/2011 1 g 4 2 5M www.catawbacountync.gov EXPIRES: 10/05/201 1 Catawba County Internet Citizen Access Portal: energov.catawbacountync.gov/cap/ APPLICANT OWNER CONTRACTOR GRACE GARNDER GRAC� GARNDER 4280 I3URTS RD 4280 BURTS Rl� VAL� NC 28168 . VALE NC 28168 '_> '; -- ****** NO CON7'RACTORS ASSIGNGD ****** PROPERTY IDIl: Z697O3112�ZZ STIZEET ADDRf�SS: 4280 BURTS RD, Vale, NC LOT#� PROJECT DESCRIPTION: Pv1' AI30vG GROUND POOL CONIM�NTS: PV1' ABOVE GROUND POOL FLOOD ZONE? OWNER TYPE: Residential (Private) 100 YEAR FLOOD "LONE PLAIN? No LAND OWNER: FLOOD PLAiN, STRUCTURE? No R�QUIRED SGTBACKS FRONT: 80.00 REAR: 10.00 CORNER: SIDE: 10.00 MAX HEIGHT: 45 FEE DESCRIPTION DATE FEE AMOUNT Residentia Zoning Pee 04/08/2011 $25.00 TOTAL FEES $25.00 The a�plicant herebvi certifies that all information and attachments to this Certificate of 7oning Compiliance are true and correct and acknowledaes that this permit was issued on the basis of the information required herein The applicant further ackno�vledges that any construction, alteration or addition ��hich differs from this application shall be subject to removal or alteration so as to bring said structurc into conformance with the spccifications and standards of the Cata�vba County Zoning Ordinance. Such corrective action shall be at the expensc of the applicant. It is thc responsibility of Applicant to comply �vith all existing deed restrictions pertaining to the property. Issuai�ce of this permit is not certification of such compliance and does not relieve Applicant of lhe dury to comply. **This Zoning Authorization (R) Permit shall expire six months from the date of issuance unless a building�rmit�is secured and remains activ ,. � Z. � ' L� '`'t- � ��C��, \_/ �'.�,-1 �—�„�-� %�C�%<%,-� � AP L]C N"f Nti�I� (•�PR i�TG ) AI'PLICANT SIGNATURi: ZO�V`ING MPROVI;ll 13Y t 1 ***** ZONiNG FEES ARE NON-REFUNDABLE x**** COMPANY NAMG permit 04/08/2011 1232 Page I of I