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Home My WebLink AboutEHPR-2-10-4058 (2).TIF i I THIS IS NOT A PERMIT Case # EHPR-2-10-4058 CATAWBA COUNTY HEALTH DEPARTMENT U : Plan Review Application for Environmental Services 1842 SM Environmental Health Plan Review - OSWP NEW WELL APPLICANT OWNER CONTRACTOR TRACIE FORREST TRACIE FORREST 3212 CREEK BEND CT 3212 CREEK BEND CT SHERRILLS FORD NC 28673- SHERRILLS FORD NC 28673- (704)799-5302 (704)799-5302 NAME TO APPEAR ON PERMIT TRACIE FORREST Pin#: 369803206970 SITE ADDRESS: 3212 CREEK BEND CT, Sherrills Ford, NC DIRECTIONS: HWY 16 S, LEFT MT BEULAH, AT STOP SIGN RIGHT ON LITTLE MOUNTAIN RD, LEFT MOUNTAIN CREEK RIDGE, 2ND LEFT ONTO CREEK BEND, HOUSE ON RIGHT IN CUL DE SAC 3212 ON MAILBOX NAME of SUBDIVISION: MOUNTAIN CREEK RIDGE Lot# 22 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.839 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure Bedrooms 3 Basement: Yes Water Using Fixtures in Basement:No No. in Family 3 Whirlpool Tub : Gal. Capacity: MULTIPLE FAMILY RESIDENCE: Units 0.00 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 1st 2nd 3rd OTHER: (Specify) Do you aniticipate any additions to Facility? If so, describe: NO FUTURE ADDITIONS, APPLICATION IS FOR WELL REPAIR TO PLACE LINER IN EXISTING WELL 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 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 obtain Zoning Approval prior to locating a home or stricture on this property. Any representation by you of house or structure location should conform to applicable setbacks. aj~sl►~ Date: 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 828-466-7291 AREA 1 (FOR OFFICE USE ONLY) Zoning Approval: ,Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front FEE NAME DATE _ AMOUNT Side Well Permit & Inspection Fee 02/25/2010 $300.00 Rear TOTAL FEES $300.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 02/25/10 12:39 THIS IS NOT A PERMIT WLS# CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services i+ Repa-ir F- IP I- AC F- S.T. Rpr. 7 S.T. Exp. Exist. S. T. Well Permit F- Replacement Well 1. Name to Appear on Permit: I Tacit Foy-a5 r 2. Permit Requested By:j -maw 1:6Y(--e--5 Business Phone: Address: I Ct Srd~~ it /-C Home Phone: 3. Property Owner: Jca# and Tmc,(t f~rresZ- Business Phl nie:-~~, -70q 7Qq 573D,~-- Address: Creek L~ She Cri I►§ it &73 Home Phone: 1 90q l 14 4. Name of Subdivision:0 4aj n I r~ Lot Section/Block/Phase: -0 Property Address: Directions to Property: '1 ~(fi f PY 4 u 0 / r , q0 iye-d S r on UPY 0? h1,n Cfe~,~ w,d z,-, olad& Cff 2r -rte Gtr oY1 > 7L gee cu ae_ 5. Property Size: Square Feet Acres -o Date Platted/Recorded ' 6. TYPE OF FACILITY: art House Mobile Home Dimension of Structure Bedrooms*1 13 *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: XYes No Water Using Fixtures in Basement: Yes A/ No No. in Family: Whirlpool Tub: Yes /No Gallon Capacity: MULTIPLE FAMILY RESIDENCES: Units Total Number of Bedrooms DAY CARE: Number of Children RESTAURANT: Seats ! Square Feet Dining Area j Square Feet Food Stand/Meat Market Floor Space TYPE OF BUSINESS: No. of Employees 1 st I 2nd 3rd OTHER : (Specify) 7. Do you anticipate any additions to Facility? F Yes XNo If so describe 8. Has any grading, removal, or addition of soil been done to this property? r Yes XNo If so describe j 9. Are there easements/right-of-ways recorded on this property? Yes (/~vo 10. Is a public water supply available on or adjacent to the above property? (-'Yes yNo Check type that is available: f Community Well F_ Semi-public Well F_ County/CityTrownship waterline 11. Well Type Applying For: F- Individual Well i- Community Well F Semi-public Well I- Irrigation Well - Geothermal Well 12. Monitoring Well Request:(- Yes (-No # of Wells: ; 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 (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 set backs. **IF A PERMrT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE IS AN ADDMONAL CHARGL** I < Date: i/ D Signature of Owner or Agent: Print Form Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geographic Information System. N 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 ofanv 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: 3698-03-20-6970 1 inch = 40 feet Prepared for: ,207 040 O ~ 22 c~ co ~t CY) J Cn 69- LO 21 ® 03 - 04C 500- Q w THIS IS NOT A LEGAL DOCUMENT a Thursday, February 25, 2010 12:24 PM .OOW& 1 IL - CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3698-03-20-6970 Name: FORREST ANTHONY SCOTT Name2: FORREST TRACIE M Address: 3212 CREEK BEND CT Address2: City: SHERRILLS FORD State: NC Zip: 28673-6002 Account: 204479 Calc Acreage: 0.84 Tax Map: LRK: 802644 Deed Book: 2739 Deed Page: 0556 Subdivision Name: MOUNTAIN CREEK RIDGE Subdivision Block: Lots: 22 Plat Book: 60 Plat Page: 126 Building Number: 3212 Street Name: CREEK BEND CT Site Zip: 28673 Township: MOUNTAIN CREEK Fire Code: SHERRILLS FORD City Code: COUNTY State Road: Total Bldgs Value: $216,400 Land Value: $36,400 Total Value: $252,800 Year Built: 2006 Year Remodeled: Last Sale Date: 3/29/2006 Last Sale Amount: $33,000 Neighborhood: 128 Watershed: WS-IV Critical Area Watershed Split: NO Voter Precinct: P31 E911 District: COUNTY Zoning: R-40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: WP-O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: BALLS CREEK Middle School: MILL CREEK High School: BANDYS School Split: NO P&Z Case Number: Census Tract 2010: 011501 Census Block 2010: 3017 Small Area Plan: SHERRILLS FORD Agricultural District: Printed: Thursday, February 25, 2010 12:24 PM V-POS -Transaction Receipt Page I of 1 Transaction Receipt Catawba County, NC Catawba County Permit Center 100 A SW Blvd Newton, NC 28658 828-4658404 02/25/2010 12:35PM Catawba022510123442792Eng 28829394 EHPR-2-10-4058 TRACIE FORREST 1 N/A FORREST/TRACIE M null null ************2243 Authorization and Capture Amount: $300.00 Cardmember acknowledges receipt of goods and/or services in the amount of the total shown hereon and agrees to perform the obligations set forth by the cardmember's agreement with the issuer. Signature 77 click here to continue. https://www.velocitypayment.com/admin/catawbacountync/vpos/942/transactions/receipt/?... 2/25/2010 A Cpl CATAWBA COUNTY, NC 100-A South West Blvd PLAN RECEIPT Newton, NC 28658- 0 (828)465-8399 Thursday, February 25, 2010 184 Z sM www.catawbacountync.gov Plan Case: EHPR-2-10-4058 Invoice Number: INV-2-10-259886 Environmental Health Plan Review Invoice Date: 02/25/2010 Site Address: 3212 CREEK BEND CT, Sherrills Ford, NC APPLICANT OWNER TRACIE FORREST TRACIE FORREST 3212 CREEK BEND CT 3212 CREEK BEND CT NC NC Fee Name Fee Amount Well Permit & Inspection Fee Fixed $300.00 Total Fees Due: $300.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 02/25/2010 Credit Card -1 $300.00 $0.00 Total Paid: $300.00 Payer: TRACIE FORREST Total Due: $0.00 plan rcccipi;:10613ef9-554t,-%15 d-Rl19-14321afl)R123; ipt 02/25/2010 12:36 CATAWBA COUNTY / Q\ Public Health Department < Environmental Health Division Subdivision MOUNTAIN CREEK RIDGE 1~ PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 SectBUPh/Lot # 22 ~~...~i (828)465-8270 FAX(828)465-8276 TDD(828)465-8200 PIN# 369803206970 Applicant/Owner. ZJR CUSTOM HOME BUILDERS, LLC Site Address: 3212 CREEK BEND CT SHERRILLS FORD NC Property Size: SF .842 ACRES Directions: 16S/ LEFT MT BEULAH RD/ RT LITTLE MT RD/ 1/2 MILE ON LEFT INTO MOUNTAIN CREEK RIDGE (SEE IP WLS2004-00556) Catawba Coun Health Department Operation Permit , i e4 L CA-' System Code System Type: cription: ctt»r`,1~~ svS. Types V and VI systems expire in 5 years. (In accordance with Table Va) Owner must contact health department 6 months prior to exiration for permit renewal. PERMIT CONDITIONS: 1. Performance: System shall perform in accordance with Rule .1961. II. Monitoring: As required by Rule. 1961. III. Maintenance: As required by Rule. 1961. Other. Subsurface system operator required? Yes_No~ If yes, see attached sheet for additional operation conditions, maintenance and reporting. IV. Operation: This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and All conditions of the Improvement Permit and Construction Authorization. /t/6 6"- System Installer Installation Date Authorized a e gen Date of Operation Permit Issurance Form F r:IT dem~,HForms1tK$Aoo,rot CATAWBA COUNTY Case # WLS2006-00222 Public Health Department Subdivision MOUNTAIN CREEK RIDGE Environmental Health Division PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Sect/BL/Ph/Lot # 22 (828) 465-8270 FAX (828) 465-8276 TDD (828) 465-8200 PIN# 369803206970 Applicant /Owner: ZJR CUSTOM HOME BUILDERS, LLC Site Address: 3212 CREEK BEND CT SHERRILLS FORD NC Property size: SF .842 ACRES Directions: 16S/ LEFT MT BEULAH RD/ RT LITTLE MT RD/ 1/2 MILE ON LEFT INTO MOUNTAIN CREEK RIDGE (SEE IP WLS2004-00556) WELL PERMIT Proposed Use: Private Public Semi-Public Other 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. STREAMSBROOKS/CREEKS 50 FT. 3. EXISTING & PROPOSED SEPTIC REPAIR AREA - MIN. 50 FT. 7. LAKESIPONDS 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 0 C' Issued By: Permit Issuance Date: Customer Signature: WELL INSPECTION: GROUTED DEPTH: 20' DATE: -5-- /0 - 6,6 INITIALS: G 4~C APPROVED CASING: PVC _,,,,STEEL DATE: C, l0 ,OF INITIALS: CASING HEIGHT 12" ABOVE LAND SURFACE DATE: / . a - 02 INITIALS: rys WELL COMPLETION REPORT RECEIVED DATE: INITIALS: WELL HEAD APPROVED DATE: / - a p INITIALS: C- w S a 1 - 2, - (2 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 days upon completion of a well. Authorized State Agent Final Approval Date Form D r: i Tidemark,FormsJWLVAoo.rm / w - CATAWBA COUNTY HEALTH DEPARTMENT Telephone: (828) 465-8270 TDD: (828) 465-8200 WLS # ol116 " 00,Z;2 Improvement Permit AC)~, Repair Permit., Operation Permit. System Type Well Permit._)~_ Replacement Well Owner/Agent j'le n S4-57 ) rv, ) n,rt ~S 18'a t w F,-LS 4L<:, Phone ?n C~ _ S / - d 9 0 ~,4 Address Subdivision mht~,,; ,G2~I,( -51zf --A ~4z-, S cnpzp C. AAn~ , Z 2 Section/Block/Phase Lott 2 7 Lot Size Arections: t-570 ; - Q - J pt Property Address _a j a~ G2{"c 4C !3e Nth Cc)(a ~T- Facility- House_:)(,_ Mobile Home Business Multi-family Other: Pin Number 9 fT 0 -3 6220 Other . Zoning Approval # # Bedrooms # Seats # Employees . Application Rate GPD Flow_ Hot Tub or Spa CLOD Special Fixtures Basemen es o . 100% Repair Are es no Basement Plumbingco~io Water Supply: Private Well Public Semi-Public Type of System: Trench Bed Pump - Pump/Panel- Panel - LPP Other Septic Tank Size /40 Pump Tank Size Nitrification Field: Total Square Feet 1660 Depth of Stone I)IA Bed Size Trench Width 3 Total Length of All Trenches y-01J Number of Trenches Trench Length/io Aolle IA/Ic eet on ! Maximum Trench Depth -114'15-- Distance of Nearest Well -V 'Y- *DO NOT INSTALL SEPTIC WHEN, W ELL RECORD REQUIRED AT COMPLETION* Topo % Slope I \ b ` Texture Structure Clay Min. Soil Wetness c/ Soil Depth " Restric. Hoz. at Available space yes/no Overall Class S PS U Comments: tr I ~ f I ~ .n t; . I I ~ 1 P C I ~j ~ RI Filter Required # Riser required when tank is more than 6 inches deep. PPE RMANCE OR LENGTH OF TIME THIS SYSTEM **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN A TO THE WILL FUNCTION** An Authorization to Construct is valid for (5) five years fro date iss d and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation, an prot tion must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County H Ith D partment 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. Permit Date L p ;Z AD W, EHS wner/Agent- - Septic Tank Installed By Date fay -06 EHS Well Installed By mkt,, L,,-tiL- Well Grout Approval Date .S -1t7 -ice Well Head Approval Date Date Sample Collected Date of Results Results EHS White - Office Yellow - Owner/Agent Pink - Building Inspection Authorization to Construct