HomeMy WebLinkAboutEHPR-1-10-3518 (2).TIF
p~ THIS IS NOT A PERMIT Case # EHPR-1-10-3518
1.
CATAWBA COUNTY HEALTH DEPARTMENT
Plan Review Application for Environmental Services
1842 sM Environmental Health Plan Review - OSWP
EXS_SYSTEM
APPLICANT OWNER CONTRACTOR
HIGHWAY TIRE JETEN PROPERTIES LLC ED TARANTIN( GOODIN SIGNATURE HOMES, CHAD
8576 E NC 150 H WY 684
Terrell NC 28682 NORMANDY
(828)478-9943 (828)478-9943 MOORESVILLE NC 28117-
704-363-7302
NAME TO APPEAR ON PERMIT HIGHWAY TIRE TIRE HIGHWAY Pin#: 461708896110
SITE ADDRESS: 8576 E NC 150 H WY. Terrell, NC
DIRECTIONS: HWY 150
NAME of SUBDIVISION: Lot # I Section/Block/Phase
PROPERTY SIZE: Square Feet Acres 2.47 Date Platted/Recorded
TYPE OF FACILITY: House Mobile Home Dimension of Structure 60 X 30 X 30 Bedrooms 0
Basement: Water Using Fixtures in Basement: No. in Family
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: 1 i ( Number of Employees 4.00 Is 2nd() 3rd_C_
OTHER: (Specify)
Do you aniticipate any additions to Facility?
If so, describe: ADDITION ON REAR OF BLDG FOR RACKS AND CAR LIFT
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? NA
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.. n re se ation by you of house or structure
location should conf rm to applicable setbacks.
Date: Signature of Applicant or Agent
An Environmental Health Specialist will contact you within orking day f application date.
If you need further information or assistance p ase call 8 -466-7291
AREA 1
(FOR OFFICE USE ONLY)
Zoning Approval: _Yes No Zoning Approval UDO Zoning Form A
Minimum Setbacks
FrontV FEE NAME DATE. AMOUNT
Side Z 5 Existing Tank Check Fee 02/04/2010 $80.00
Rear 3S 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
02/04/10 11:47
THIS IS NOT A PERMIT WLS #
Lao~x 35 I
CATAWBA COUNTY HEALTH DEPARTMENT
Application for Environmental Services
IP AC S. T. Rpr. S. T. Exp. Exist. S. T. Well Prmt. Replacement WV11
1. Name to Appear on Permit
4 _ 3~~~73C> Z
2. Permit Requested By -T P " Business Phone '70
Address Vi4 M 29,11- 1 Home Phone
3. Property Owner 77K-6-tpvi 0V
0, E A -7(1 - Business Phone- gZ~3_ 4qS C1 i43
Address ~(O NC \ 5 lti:v,_ n : Q Q N Z~3 Z. Home Phone
4. Name of Subdivision Lot # Section/Block/Phase
sir ¢ Q ~2
Property Address %c~' 11, E NC X56
Directions to Property:_tk);ji), i n C
5. Property Size: Square Feet Acres Date Platted/Recorded
6. TYPE OF FACILITY: House Mobile Home Dimension of Structure (pAX30 X 30 Bedrooms*0
*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/010 Water Using Fixtures in Basement: yes/ o No. in Family
Whirlpool Tub yes/ 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 1 st 2nd 3rd
OTHER: (Specify)
7. Do you anticipate any additions t{~o `Facility? es / No
If so, describe: (ub X~0 X'SO P AA ;o, faek~, r^l~ r~ oa I •
8. Has any grading, removal, or addition of soil been done to this property? Yes /
If so, describe:
9. Are there easements/right-of-ways recorded on this property? Yes / o
10. Is a public water supply available on or adjacent to the above property? 6Se ~'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.**
11. Well Type Applying For: [ ] Individual well [ ] Community well [ ] Semi-Public well [ ] Irrigation well
[ ] Geothermal well
12. Monitoring Well Request? Yes / No # of wells Name of Site
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.
**IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE IS AN ADDITIONAL CHARGE.**
Date e'0/0 Signature of Owner or Agent CS
CATAWBA COUNTY HEALTH DEPARTMENT '
Telephone (828)'465-8276 TDD• (828) 465-8200 pfwmd N2 %an
IPA AC_Rpt Prmt. Opr Prmt. Sys Type ell Prmt.,><__Replacement Well Well Rpr Prnn,
Owner/Agent y,-/~- Phone I~•_,~~
Address 4J C/ /;-Q X- Subdivision
F-e, L A/ Section/Block/Phase Lot#
Lot Size S' 4/,2 /3-ceCpirections 165:* 14z-n - .9 ~S G 64417 O
Property Address 19 W
Facility- House Mobile Hones- Business-X_ Multi-family Other- Pin Number K12 Q8 8 9 (:;~&Q
Other - 0 Zoning Approval #
# Bedrooms # Seats # Employees 7-07-i9,C. Application Rate 3-5' GPD Flow
Hot Tub or Spa yes/no Special Fixtures - Basement ye no 100% ReVir Area yes/no Z>
Basement Plumbing yet~) Water Supply- rivate Well V-) Public Semi-Public 1`1t5
Type of System. Trench
_A_ Bed Pump Pump/Panel Panel LPP Other
Septic Tank Size -_,~ulvank Size i f u. d; Total Square Feet Depth of Stone
Bed Size Trench Width I
Total Length of All Trenches O &o +34 umber of Trenches
Trench LeMt / /Feet on-Center- Maximum Trench Depth 3(0 Distance of Nearest Well 06
*DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORDaa.,. REQUIRED AT COMPLETION*
****************************************#********************~k***********$*lk llt ik ietfk deiik+l[W W Wa Waaa....................
Topo /Q T % S16pe
~ I
Texture CC~yC-7 I A
Structure ~A6 ► PVI`~~ G y e---
Clay Min; J : / 1 40 V" V
Soil Wetness "
Soil Depth L-fi 1 CN ~f~~s
Restric Hoz. at~f2''J+- ~ SC ~ D E?~'/C
Available space es o j
U~
Overall Class STDU
Comments _
r~~CI
Sr oT 1, -4L
i
w
~ I
'Y9~ K
til~ `s ys ~ a 1
Filter Required if I 1
Riser required when J
tank is more than 6
inches deep.
**NO GUARANTEE OR t
FUNCTION**
Improvement Permit has no expiration date and is transferable, but may-Fe-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 from known possible sources of contamination. No volume of water is
guaranteed at any site by the Health Department.
PermiEHS
OwnSeptic Tank Installed By Dat -0
EHS Installed By Well Grout Approval Date Well Date Sample Collected~~_ '
Date of Results Results EHS
White - Office Blue Building Inspection Operation Permit Yellow - Owner'/Agent Green - Building Inspection Authorization to Construct
14a E)
Catawba County, North Carolina
This map product IVOS prepared from the Colawbo Comity, NC, Geographic h formation S,vvem.
N Catawba Count has made substantial eforls io ensure the accuracy of location and labeling information
contained oa this map. Catawba Comrlr promoles and recommends the independent rerificalion of arm
data contained on this nap product by the user. 77re Comity of Catmrba, ils emplovees• agents and
personnel disclaim, and sholl not be held liable for of v cold all damages, loss of liabilitt, whether direct, indirect
or consequential which arises or mall. m'ise from this map product or lire use Ihere(~f by cmv person or entity. Legend
Selected Parcel Number: 4617-08-39-6110
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CATAWBA COUNTY NC - Parcel Report
Information Regarding Selected Parcel(s)
Parcel ID: 4617-08-89-6110
Name: JETEN PROPERTIES LLC
Name2:
Address: 8576 E NC 150 HWY
Address2:
City: TERRELL
State: NC
Zip: 28682-8710
Account: 154548
Calc Acreage: 2.47
Tax Map: 009 X 01004
LRK: 9024
Deed Book: 2280
Deed Page: 1480
Subdivision Name:
Subdivision Block:
Lots: 1
Plat Book: 52
Plat Page: 79
Building Number: 8576
Street Name: E NC 150 HWY
Site Zip: 28682
Township: MOUNTAIN CREEK
Fire Code: SHERRILLS FORD
City Code: COUNTY
State Road:
Total Bldgs Value: $241,800
Land Value: $57,500
Total Value: $299,300
Year Built: 2001
Year Remodeled:
Last Sale Date: 5/1/1998
Last Sale Amount: $175,000
Neighborhood: 129
Watershed: WS-IV Critical Area
Watershed Split: NO
Voter Precinct: P31
E911 District: COUNTY
Zoning: GI
Zoning2:
Zoning3:
Zoning Split: N
Zoning Overlay: CRC-O,MUC-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: SU-82, R-448
Census Tract 2010: 011502
Census Block 2010: 2027
Small Area Plan: SHERRILLS FORD
Agricultural District:
Printed: Wednesday, February 03, 2010 05:22 PM
Hick
tryPCOffice 828.465-8399 Commercial Plan Review Application Newton PC Fax 8284658962
Hickory PC Office 828-465-8399 Hickory PC Fax 828.322-6814 N
Hickory DAC Office 828-323-7556 +0 . _ Hickory DAC Fax 828 324-5931
Effective July 1'r 2004 all submittals/re-submittals of commercial plans must be accompanied by a $10.00 plan processing fee
Name of Project: IcHWA(4 -TIRE IRDD171oa Project Cost: 61, Sop, pe
Address of Project: 85% E. Kwq, 150 - TERRELL KC PIN # 61.x7088 Gm)
*The plan review section is charged with contacting the business owner, designer, contractor and contact person during the review process
in order to keep everyone updated on progress. The contact information below is vital for this function. Please include current information
*Plans may be submitted at the Newton or Hickory Permit Centers. e K t-
`Sid ftx
Owner of Business: EDTaita►,r-tao Ph. Qz$-y?B-9qw3 Fax. 44
Address: _f sWo E NC iso gwq i 2QPLL, Email: -
Designer Name: 5Qlgp)4 CWRPEn_,M2 PE Ph. _2,36 - 449- QSS Fax. 336- Nq -05CA
Address: 2o4 Lo . m,Ar~) er , t&sorJyiLIF , µt~)~es272y9 Email: >3Qo W (Z~s> aG vl
General Contractor:CHaD CocNnlStGu E Ph.~4-3G,3-173oz Fax. 3 -4(d 1-2343
Address: 04 iQ D4 Rib, Moot2L--mot t t 6 &C 2810 Email: Ci X90 0- CH►4bG00bI tJ Cowl
Contact Person: MEAL. Loi..)G Ph. Toy-363 -3Gg3 - Fax/ Email MWL@CttA66o06tJ C
Please Check the Zoning and Planning Jurisdiction that your Project is in:
[ ] OClaremont •4 Full Sets with Site Plans [ ] OLongview •4 Full Sets with Site Plans
[ ] OConover •3 Full Sets with Site Plans OMaiden •4 Full Sets with Site Plans
K; County •5 Full Sets with Site Plans ONewton 93 Full Sets with Site Plans
[ ] Hickory 97 Full Sets with Site Plans [ ] OTown of Catawba 94 Full Sets with Site Plans
;A Zoning Application and Grading application( if City of Hickory) must be submitted with plans.
.Number of sets of complete plans submitted to the Permit Center.
OThese Zoning Departments require plans be submitted to their offices in addition to listed above.
Please Check Fire Bureau that your Project is in:
[ ] Hickory [ ] Conover [ ] Newton M County (includes Claremont, Maiden, Longview, and Town of Catawba)
Does the Project have a Fire Alarm System: [ ] Yes N No
Does the Project have a Sprinkler 1 Standpipe System: [ ]Yes N No
*Sprinkler Plan Submission to the County, Hickory, Conover or Newton Fire Bureaus' is the responsibility of the customer and must
be forwarded to the Permit Center when completed and approved.
Will this Project require Environmental Health Review: [ ] Yes W No
*If yes, submit one set of plans to Environmental Health with appropriate fee (reverse side of this form lists information).
Type of Sewage Disposal: Is Public Sewage available on or adjacent to this project? N Yes [ ] No
*If No, a Septic permit must be applied for prior to project review approval, if not already approved.
Type of Water Service: Is Public Water available on or adjacent to this project? N Yes [ ] No
If No, a Well Permit must be applied for prior to project review approval, if not already approved.
Are you disturbing more than 1 acre of soil: [ ] Yes M No If yes, 5 sets of erosion control plans and one set of
calculations will need to be submitted. A fee of $200 for the first acre and $150 for each additional acre of disturbed soil will be
collected at the time of plan submittal. Additional applications will be required. Forms are at permit centers.
Is this Project being submitted for Phase Construction: [ ] Yes N No
If yes, please check which phase: [ ] Footing I Foundation [ ] Shell I Hull-in [ ] Up-Fit ~
Type of Work: PQ Addition [ ] Alteration [ ] New Construction [ ] Other
Type of Use: [ ] Assembly P9 Business [ ] Educational [ ] Factory [ ] Hazardous [ ] Institutional
[ ] Mercantile [ ] Multi-family [ ] Modular Office [ ] Townhouse [ ] Storage [ ] Tower [ ] Utility
Will Industrial Machinery be operated in this facility: No [ ] Yes *If yes, list owners name and number above*
Will electrical Medical Equipment be operated in this facility: M No [ ] Yes *if yes, list ownersname and number above*
Please list the square foots a his project: Total IS Heated I IbM Unheated
Applicants Name Sign_ M 62t loner Date Cpl 1
Created on 08/26/2005 5:16 PM j{1