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HomeMy WebLinkAboutEHPR-04-2018-28978.TIF ]•G THIS IS NOTA PERMIT Case# EHPR-04-2018-28978 ¢, -1 CATAWBA COUNTY HEALTH DEPARTMENT ❑�_ " W$ I' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 4't_, \1842 sw Environmental Health Plan Review-OSWP 3' .B;it've IMPROVEMENT 'tr �'ti ❑�1•JAIlYT Applicant JIM CAUDLE,3822 GORDON ST,TERRELI-NC 28682 C:3363999500 Contact Person CHARLES E BEATFY (CHARLES E I3EATPY).3530 DOCKSIDE LN,SHERRILLS FORD NC 28673 B:828-320-0744 NAME TO APPEAR ON PERMIT JIM CAUDLE SITE ADDRESS: 5763 LITTLE PKWY-SFIERI2ILLS FORD NC 28673 PIN # 368702879621 NAME of SUBDIVISION: Lot b 24A and C Section/Block PROPERTY SIZE: Square Feet 588,060.00 Acres 13.5 DIRECTIONS: 16 S,left Mt Beulah Rd, appx 2 miles left on Little Parkway,end of pasture and white fencing.Call Jim Caudle for gate code lot 24 on left as you start up hill PRIMARY CONTACT: Contact Person SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: IP only for purchase and combination of 2 lots. SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is"YES",then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? No Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? No Are there any easements or right-of-ways on this property? Yes Property Easements Description: Little Parkway APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 50 x100 house detached garage 80 x40 II OF NEW BEDROOMS:: 4 BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED?Yes Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: YES INNOVATIVE: ANY: Other described: 25%reduction ehapplication 04/242018 13:47 Page I of 4 N CATAWRAcouNTY casco EHPR-04-2018-28978 .T f.Fa©rt. Public Health Department Subdivision < !Ai. " Environmental Health Division PIN/ 368702879621 2 , PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 84 NAME ON PERMIT: (JIM CAUDLE),3822 GORDON ST.TERRELL NC 28682 (JIM CAUDLE) Site Address: 5763 LITTLE PKWY,SHERRILLS FORD NC 28673 Property Size: Square Feel 588,060.00 Acres 13.5 Directions: 16 S,left Mt Beulah Rd,appx 2 miles left on Little Parkway,end of pasture and white fencing.Call Jim Caudle for gate code lot 24 on left as you start up hill Completed applications are valid for a period of 2 years.Improvement Permits are valid:with complete site plan=60 months(5 years);with complete plat =without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid.An Authorization to Construct issued for septic repair is valid for 60 months(5 years).Permits may be revoked if the information on this application/site plan changes or if the intended use for the proposed facility changes. Permits may be revoked if site conditions are altered such that they effect permit conditions or installation requirements I have read this application and certify that the information provided herein is true,complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. The undersigned is the owner of the property or legal agent of the owner. Date: 1- Z f'—/8 Signature olApplicant or Agent _i / , iia. If you need further information or assistance . ease cal . :-466-7291 A REA1 l4 tt??♦R}}?}f!!lll*4*4 *sfti♦*!♦i<♦*i♦**ti4*4****t♦ttriti*4*44*4YY*******Yttt#%4M4tx************** *4*4*4** I �` ___.INAI�Ii: ______._.—�____ _ __ _DSII',__ .I_I_I_ A MOUNT__ Improvement Permit Fee 04/24/2018 $150.00 • TOTAL FEES S150.00 FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) chapplication 04/24/2018 13:47 Page 2 of4 C ATAwB e THIS IS NOT A PERMIT cousrr , CATAWBA COUNTY HEALTH DEPARTIVTENT "Q+ at' tic.„, Application for Environmental Services Application is for: 0 New Construction, I Existing Facility ge Improvement Permit ❑ Authorization to Construct • gNew Septic Septic Repair/Malfunction n Septic Relocation ❑ Septic Expansion I I Existing System Inspection or Reconnection New Well ❑ Replacement Well ❑ Well Abandonment n Well Repair Property Address 574,3 Lime Pft2Kwn y Subdivision 4'77-L6 nlodAr.f'Pa&srgrn ,Sr/E22,tC5 to/20, ale £84,73 Lot # 2+ Acres /3. S Driving Directions to Property /(0 -5 / LEFT Mt jCULAN 20/APPRo 3( 2 fin e-C3 L 6fl on) tint-6 Alsga3497EN n of AjPsrat2er 4 WNfre EEn1 c/.ra- CAL .. fort aAro Care 23Q- 311- lac/tor 24 or-) GeFr A5 era Sn ar tAP /-//6L / A/1/4/loX /Zoo' 2o1?U F/LortrfYGE Applicant Contact Information Name 9/mt ell cwbE Address ,38 zz- 6.cyzoof3 6 T , re7tRe u- , /l/ C Z214.87— Phone Cell Phone 33‘, -399- 9So0 Owner Contact Information Name Address Phone Cell Phone Contractor Contact Information Name et/mi-le �ER rr1 License # Address Phone Cell Phone $28 - 3 2 o - 074 /— Name 74 ¢Name to Appear on Permit? ❑ Owner ® Applicant ❑ Contractor Who will be the Primary Contact? n Owner ❑ Applicant N Contractor Existing Structures on Site? _ Yes No If yes, describe ti of Bedrooms * #of Occupants Structure Dimensions Basement ❑ Yes ❑ No Basement Plumbing ❑ Yes ❑ No • Existing Water Supply? ❑ Individual Well ❑ Community Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes ® No Well Construction/Abandonment/Repair • Proposed Well Type ❑ Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes n No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank? 0 Yes 0 No cATAw ^ THIS IS NOT A PERMIT COUNTY .........--• ---,,,, CATAWBA COUNTY HEALTH DEPARTMENT „o,„,c,,;;;-. Application for Environmental Services Proposed New Construction - Residential Primary Residence ® New R silence ❑ Addition to Residence # of New Bedrooms *1* 4 Project Description 005 E $ csA}2RGE Structure Dimensions -1-0 b bo',c too ' # of Occupants Z. Basement ®,Yes n No Basement Plumbing ® Yes ❑ No Accessory Structure(s) Describe an-ROWED GA/2Aoe- Structure Dimensions gto X 'rO'->/- Plumbing TI Yes No Describe Plumbing Needed Accessory Dwelling n Yes g No # of New Bedrooms *t # of Occupants Proposed New Construction - Commercial Food Service Specify Type # Seats Floor Space-Entire Food Service Facility(Sq. Ft.) # Employees per Shift # of Shifts Dining Area (Sq. Ft.) Business/Other Specify Type Structure Dimensions Retail Floor Space # of Employees per Shift # of Shifts If Church # of Seats Commercial Kitchen n Yes ❑ No If Daycare, # of Children If Multi-Family Residence, # of Apartments #Bedrooms per Apartment*t Total # Bedrooms *t Other Information Calculated Design Flow, Commercial t (This value will be determined by EH staff) The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in question. If the answer to any question is "yes", applicant must attach supporting documentation. ❑ Yes lil No Does the site contain any jurisdictional wetlands? O Yes R No Does the site contain any existing wastewater systems? 0 Yes Ed No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes NI No Is the site subject to approval by any other public agency'? ® Yes 0 No Are there any easements or right of ways on this property? Describe stria sr 44" If applying for an Improvement Permit or Authorization to Construct, Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) ❑ Accepted 0 Alternative *Conventional 0 Innovative g1 Other 25.-roe tet 0 Any *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 floor plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system expansion in the future. t If structure is plumbed but has no bedrooms,calculated design flow will be determined by EH Staff. ** If No,a well permit must be issued with the Authorization to Construct. RETRIP TO THE PROPERTY AND/OR SYSTEM REDESIGN WILL INCUR AN ADDITIONAL CHARGE(SEE FEE SCHEDULE) Completed applications are valid for a period of 2 years. Improvement Permits are valid: with complete site plan=60 months(5 years); with complete plat=without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid. An Authorization to Construct, issued for septic repair is valid for 60 months(5 years). Permits may be revoked if the information on this application/site plan changes or if the intended use for the proposed facility changes. Permits may be revoked if site conditions are altered such that they effect permit conditions or installation requirements. I have read this application and certify that the information provided herein is true,complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can perform-d. The undersigned is the owner of the p• pcef tty or -gat agent o the owner. y Signature of Owner or Legal Agen �_ Date 1 ' 2ie, '/� Printed Name of Owner or Legal Agent 7— /lit. AVDLE 4(2`//8 – d-v- A7LcvanY (to ,ii-6( 90n b. Ar .Q3. \ \ 43 Pen. ar N"--, 9. 7S C o 6 C \ / L'?"–c° G \ \ 7 Z \ co / �, • / Oyu i 33. • ���VVv v \'icln __ 0VYY if‘41 fr if �� �aa.4\ 1 I Pill o�' h /[�lyyuAv° Qqy r / t, �/o /� / - � 7,!; -- / 3. DJJ �a�rtners�i��property/ -11(C\,il 1 � r-`-" G/ / Tract r v ` / :I \\:,27 7 (----- — — , • it ' -'•7--,,,,_ \ m =. ' / \ • yNOTE. Tract C N L{_ E, c o ::-:-.7-7---:.,,,, 'mss cote Little ',vent^en;e, Ci_C L. ;711 CE. 2989. Pc, Q crO ::; 12'n;`.41,-.. acne `` Y� L2;1 U p CIl;;^ _ . I'le Pa a seii : f L'� ;>"' o1v- __ C ivc...,e/ / C fir. ' 1 Y o Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 368702879621 Owner: ROBERTS NADINE L Parcel Address: 5763 LITTLE PKWY Owner2: City: SHERRILLS FORD, 28673 Address: 3561 RIDGETOP RD LRK(REID): 10203 Address2: Deed Book/Page: 2816/0745 City: SHERRILLS FORD Subdivision: State/Zip: NC 28673-9805 Lots/Block: 24N School Information: Last Sale: Plat Book/Page: 74/126 School District: COUNTY Legal: LOT 24A PLT 74-126 Elementary School: BALLS CREEK Middle School: MILL CREEK Calculated Acreage: 8.560 Tax Map: 010 X 01046 High School: BANDYS Township: MOUNTAIN CREEK School Map State Road #: 1846 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoningl: R-40 Building(s) Value: $0 Zoning2: Land Value: $67,900 Zoning3: Assessed Total Value: $67,900 Zoning Overlay: WP-O Year Built/Remodeled: / Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710368700J Building Details 2010 Census Block: 2035 WaterShed: WS-IV Protected Area 2010 Census Tract: 011501 Voter Precinct: P31 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NC Geospatial Information Services,Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report 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/report product or the use thereof by any person or entity. ©2018, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=368702879621&typ=P 4/24/2018 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 368702884051 Owner: ROBERTS NADINE L Parcel Address: Owner2: City: SHERRILLS FORD, 28673 Address: 3561 RIDGETOP RD LRK(REID): 803930 Address2: Deed BooWPage: 3349/1029 City: SHERRILLS FORD Subdivision: State/Zip: NC 28673-9805 Lots/Block: C/ School Information: Last Sale: School District: COUNTY Plat BooWPage: 74/126 Legal: LOT C PLAT 74-126 Elementary School: BALLS CREEK Middle School: MILL CREEK Calculated Acreage: 1.300 High School: BANDYS Tax Map: Township: MOUNTAIN CREEK State Road #: TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoning1: R-40 Building(s) Value: $0 Zoning2: Land Value: $8,800 Zoning3: Assessed Total Value: $8,800 Zoning Overlay: WP-O Year Built/Remodeled: / Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: Building Permits for this parcel. Firm Panel #: Building Details 2010 Census Block: 1050 WaterShed: WS-IV Protected Area 2010 Census Tract: 011501 Voter Precinct: P31 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report 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/report product or the use thereof by any person or entity. ©2018, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=368702884051&typ=P 4/24/2018 Catawba County Environmental Health —‘-k-k ss-----t-N- .......4.%%.-N4' I/ .1- If 0 i4MAM, li . s 1\N\ . ..J. . . .. La.uu�...q ' 1.1 ...141111614.14P .I.'4•4 -' .. r cat Arrdi 12),,,.00.1° Ist,1 ..".''''r.”. ' -4.4"9"a_ Hirri Er., • • ""�� ... pIt 4 • 6C A. lb a Ahh. 11 *II i/ hi �1"4 dao ,,,,.: 11k o lig zin* g0Q 1 f +rt • '. 0 ° t A . ... 1 . .. , t ... % .• d • a d , o y. 157c• 12qz 4.4 i�j�/. !''P?'r 1 ..1 2 . ss04 , r� O ` • V Y ��`2�� 1 441Sili jl 0 4 tI•11111 fi s .TQ Al 2 Selected Parcels 1 in=600ft This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report 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/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 04/24/2018 $1J :i a 9 3e ,I . 3 ' 4 ° \4:4 rL19:a^a. •on®oo P 5 i --6• i `y a IN r., k ! a j d5• Lrii Y 3i 3 • ja"� O ,' fgy.° 9 al ' -� L93 �me -V 1 i g :la a 7 "I4}a - ' d r, / el Elf,a k :ir'i i4 al 1 1 y9 t • aP ; a / / . mF 3 8Y :.{`v It3 li :qe 11 (�[3,- a a ^y :h�,':�r :' o4Y (mK / 1 ;;n22 te. i4 Mme-- I1 Ih s gA. 9. '"/ /�.. - P . ,,,ver..��m,.�„S � 9 @?,B 's .ga y s g r, I I a2. Pa eI” ri =E / fY Y t 9 .t.� ill sr .: it) ` . a¢: F" ;p ��pp It p ! 0:- b ( LSi���k G GG 4.-i.77,1! „isei ,A. • as1�} i llag a �1111111111 111 1 'g1°gs :'.... p13 YSa33 g Xm jP a f ep .9c`e aF ° =.zt.lii s A .i �glllll-1111111 111111 193' 1'SYI o . a Ya? a. o } a a /m 3i :e " Ei?c a y "v ---- z v^' af �' a gn•a.i - - 3 :aria s 1 1. ?,a? ,� 44 8N 9z?s i8 I I N cl\ !hi air I I \ ` a q zI 447 `;,etia7 -i I/ / // m, baa�� €s�; x�• a / wD i §C7 ti tia-R� z:ll I i a o� �� �Ll II � � ` / mb 0 /9ThIII / ?; I ii ilk- 1 ac I155.5]. w, AAA 13 r ' / 9c O bd'850ay.0:1 0 311,0 y _Cii (111% _ _ s..m SWytl i4N�tl 1N�W "� Kathy C. Orah ii ti I a S I I 09. 1950. P om m j $� �` I 9. 0321 i 9e InA RavAA.. .. o nro I on E k a' Y $a 9 t9 -6 / n n S 2R Ag g a axaific _ " - _ n-c, r c ice§ ^_ "a a; 3s m - �', 55 4~p}'('�°.yi '' . '�' � r1 %3cn v g8 : _ Van g3i3'; o p g m n—n d' "& c• 'K •z'n mon o :e;- 50 Ig za g` ° `4O$ m mg m3 FBe 'a2 L �' ¢a .° " o;o c us -....it Vey m Fp, 11 isg Sa a. .L1h mil `f) i 4.2 r,9p ti ae o IF; '° re,-,;r0-7:mm . * h� v• ea S CATA)VBA COUNT' Case;r AVLS2006-01708 ' .,.A Public Health Depanmcnt '� Subdivision Envies mental Health Division \"\7Wb; • PO Box 389.100-A Southwest Blvd.Newton.NC 28658 Sect/BUPh/Lot it 1:,-V“628: i52si465-5270 FAX S2S.465-8276 TDD;S28)455-5200 PIN# - 368702879621 Applicant/OwnerCHARLES LITTLE posed 5C Site Address: 3839 MT BEULAH RD SHERRILLS FORD NC Property Size: SF 7.23 ACRES Directions: 16S/ LEFT MT BEULAH RD/ APPROX 2 MILES LEFT AT LITTLE PARKWAY/ END OF PASTURE LAND&WHITE _ PVC FENCING —*call for gate code""" 704-490-3469 " LOT 24 IS ON LEFT AS YOU BEGIN CLIMBING HILL Improvement Permit Permit Valid For: Five years X No Expiration r� Facility(Residential): House blouse X Mobile Home Multi-Family Bedrooms 4 New? -Y Addition? Projected Daily Flow 4€o g.p.d Water SupplyPrivate Well? k Public? Semi-Public? Basement: N Basement Plumbing: N HotTub/Spa: N Special Fixtures (explain): p� Proposed Wastewater Sys tem- �D ate)°e /� Type: r ly Proposed Repair: ._ .J Permit Conditions: Al Owner or Legal Representativ- Signaturtrt m00 late - Date: t 0 . Authorized State Agent: ; 1. -- Date: /j-M(, -free •The issuance of this permit by the Health Departrne t does not guarantee the issuance of other permits. It is the responsibility of the applicant/property owner to insure that all Catawba County Plannine/Zoning and Building Inspections requirements arc 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 'haws and Rules for Sewage Treatment and Disposal Systems' (ISA NCAC ISA .19110). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for any given period or time. Authorization to Construct Wastewater System (Required for Building Permit) * See site plan and additional attachments ( Proposed Wastewater System: Type: Wastewater Flow g.p.d New Repair Expansion Soil LIAR: g.p.d./f12 Type of Facility: Basement: N Basement Plumbing: N Hot fob/Spa: N Special Fixtures (explain): Wastewater System Requirements Tank Size: Septic Tank gal Pump Tank gal Grease Trap gal Drainfield: Total Area: sq ft Total Length: ft Maximum Trench Depth in Trench Width . ft Minimum Soil Cover Minimum Trench Seperation ft Distribution: Distribution Box SerithDistribution Pressure Manifold LPP Other Additional Specifications: Authorized State Agent: Date: Permit Expiration Date: I have read and accept the specifications and all conditions of this permit as indicated. Owner or Legal Representative Signature: Date: Form 13 r:Vlde.nart\Fnm`M11tsavv.mi ,/ C1TAWBA COUNTY a� '0 \ Public Health Dmoment epCase# 8'[_52006-01703 ' : ,-.i Environmental Health Division Subdivision • ,} \'�'\g�Y / PO Box 389,100-A Southwest Blvd,Newton,NC 2865/1SeclipVPh/Lol 4 24 ' \�,,,:- / (828)365-8270 FAX(828)465-8276 TDD(328)165-8200 1 INa 368702879621 ApplicanUOwner CHARLES LITTLE • Site Address: 3839 MT BEULAH RD SHERRILLS FORD NC Property S SF 723 ACRES Directions: 16S/ LEFT MT BEULAH RD/APPROX 2 MILES LEFT AT LITTLE PARKWAY/END OF PASTURE LAND& WHITE PVC FENCING ""call for gate code*" 704-490-3469 * LOT 24 IS ON LEFT AS YOU BEGIN CLIMBING HILL © Improvement Permit 0 Authorization To Construct 0 Well Permit SITE PLAN At Se-Pf'i C vt.t LV$- k_e_ CL Vk•&n o 4 . • —/oo ' Atrti vt(in ✓c± �� c1 from We—PP * ho /wi- eiriVCtarso- ,�C�' J_ $ IAVL (a-�.r o-Vl c r 1," "- r 145Zo' i 49 ae-e 5 .eA-seyrLe&J- - (' rn[L F�1 is. Rad V / 1c.) IniiioJ2 et 4b- ti o p A.tote P� lI . 7p2 20 • I'I=ibD' Scale System components represent approximate contours only. The contractor must flag the system prior to beginning the installation to ensure 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. .40 ii- llo-0t . - �- ' - Auth,rized Sta • Agen fl Date Form C .:.ridemnrk.FnmulilmSA,,,,r„, , DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES Sheet(of/ DIVISION OF ENVIRONMENTAL HEALTH PROPERTY ID#: ON-SITE WASTEWATER SECTION COUNTY: SOIL/SITE EVALUATION / )1 or ON-SITE WASTEWATER SYSTEM 2�� - C j-7 OS OWNER: a.rles ( .( 1/ APPLICATION DATE ii• 2 (.q -O ADDRESS:38?f7 'i4# A'1tjaJi ✓1QJ/- / DATE EVALUATED: /U-(y(a PROPOSED FACILITY: •C1 bi- PROPOSED DESIGN FLOW(A 949): PROPERTY SIZE: LOCATION OF SIT,ryE: ,, PROPERTY RECORDED: WATER SUPPLY: - Private—Private 0 Public 0 Well 0 Spring 0 Other EVALUATION METHOD: 0 Auger Boring .1g—Pit 0 Cut TYPE OF WASTEWATER: frSewage 0 Industrial Process 0 Mixed P: a. SOIL:MORPHOLOGY • OTHER .... F (1941) PROFILE FACTORS Li 1940 . .:: . ::: E: .EIOR1^ .._... ::. .1942 E. LAND; '.'.t: SCAPE :LON 1941 -".. 1941SOIL .1943 1956 _..1944 ii POSITION/,: DPT EH- --STRUCTURE/ W CONSISTENCFI ETNESS/ ;::;;SOIL SAPRO "RESTR PROFIT E: .:SLOPE:/ .:(IN.)'' TEXTURE::. .. M1IINERALOGY.. i:i coLoR - [:::DEPTH!i ....CLASS:'.- :.:HORIZ - CLASS--: D-iv 51._ GC. 1 hri-is Cc.. SAL �v LPA. pJ 5 D-CS S - 13t g-uis c,i . � �� iy 2 • 3c a LO St- eg-- 3 to-Lig Cc. 564grW P57 -3'17 •4 DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): / SITE CLASSIFICATION(.1948): /2S Available Space(.1945) P7 n�/� IS �D /l/�� / EVALUATED BY: System Typc(s) �� `�J� 4- OTHER(S)PRESENT: Site LTAR ..35 . 35" COMMENTS: • LEGEND use the following standard abbreviations SOIL CONVENTIONAL LPP MINERALOGY/ LANDSCAPE POSITION GROUP TEXTURE .1955 LTAR* .1957 LTAR* CONSISTENCE STRUCTURE CC(Concave Slope) I S(Sand) 1.2-0.8 0.6-0.4 NEXP(Non-expansive) O(Single Grain) CV(Convex Slope) LS(Loamy Sand) SEXP(Slightly Expansive) M(Massive) D(Drainage Way) EXP(Expansive) CR(Crumb) DS(Debris Slump) II SL(Sandy Loam) 0.8-0.6 0.4-0.3 GR(Granular) FP(Flood Plain) L(Loam) SBK(Subangular Blocky) FS(Foot Slope) ABK(Angular Blocky) H(Head Slope) III _ SCL(Sandy Clay Loam) 0.6-0.3 0.3-0.15 PL(Platy) L(Linear Slope) Sit.(Silt Loam) PR(Prismatic) N(Nose Slope) CL(Clay Loam) R(Ridge) SiCL(Silty Clay Loam) MOIST WET S(Shoulder Slope) Si(Silt) T(Terrace) VFR(Very Friable) NS(Nm-sticky) IV SC(Sandy Clay) 0.4-0.1 0.2-0.05 FR(Friable) SS(Slightly Sticky) SiC(Silty Clay) Fl(Finn) S(Sticky) C(Clay) VII(Very Fran v.Very Sticky) VS(Very Sticky) 0(Organic) None EFI(Extremely Firm) NP(Non-pleaic) SP(Slightly Plastic) *Adjust LTAR due to depth,consistence,structure,soil wetness,landscape,position,wastewater flow and quality. P(Plastic) NOTES VP(Very Plastic) HORIZON DEPTH In inches below natural soil surface DEPTH OF FHL In inches from land surface RESTRICTIVE HORIZON Thickness and depth from land surface SAFROLITE S(suitable)or U(unsuitable) SOIL WETNESS Inches frorn land surface to free water or inches from land surface to soil colors with chrome 2 or less-record Munsell color chip designation CLASSIFICATION S(Suitable),PS(Provisionally Suitable),orU(Unsuitable) Evaluation of saprolite shall be by pits. Long-tam Acceptance Rate(LTAR):galday/f Show profile locations and other site features(dimensions,reference or benchmark,and North). • • • DENR(#####M) Review(444410 v�H;ACATAWBA COUNTY G� IOOA SOUTHWEST BLVD +� NEWTON. NORTI-1 CAROLINA 28658 RECEIPT sV• y I'IIONE:828.465.8399 re)" `I Tuesday,April 24,2018 \842 o rw.catmvbacoungtagov PAYOR: CAUDLE.JIM PAYMENTS TRANSACTION NUMBER: TRC-3475148-24-04-20I8 PAYMENT DATE: 04/24/2018 PAYMENT TYPE: Check 7011 NCDL 2805078 dob 2/28/19 exp 2/29/56 INVOICE NUMBER FEE NAME FEE AMOUNT 04-18-352153 Improvement Permit Fee $150.00 TOTAL PAYMENTS: $150.00 EH PR-04-2018-28978 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 5763 LITTLE PKWY.SI IERRILLS FORD NC 28673 Applicant JIM CAUDLE.3822 CORDON ST,TERRELI.NC 28682 C:3363999500 ** NOPEOPLESOFT ACCOUNT ASSIGNED** Contact Person CHARLES E BEAI'I'Y.3530 DOCKSIDE LN,SHERRILLS FORD NC 28673 13:828-320-0744 receipt 04/24/2018 13:46 Page I of 1 I