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HomeMy WebLinkAboutEHPR-04-2018-28987.TIF agA' ,C 1'1115 IS NOTA PERMIT Case# EFIPR-04-2018-28987 7 AftH CAFAWBA COUNTY HEALTH DEPARTMENT m � 1ro l. PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES tIii ti' / ° Y j s 4'1 sN Environmental Health Plan Review- OSWP W.:: NEW WELL ❑° + Applicant KEITH ESTES,7717 WINDY PINE CII2.DENVER NC 28037 C:7045303798 NAME TO APPEAR ON PERMIT KEITH ESTES SITE ADDRESS: 4937 ISURRIS RD,DENVER NC 28037 PIN # 369604949531 NAME of SUBDIVISION: Lot# 2 Section/Block PROPERTY SIZE: Square Feet 311,454.00 Acres 7.15 DIRECTIONS: Hwy 16 S, left on Campground Rd,left Catawba Burris Rd,house on left PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 600 WATER SUPPLY: Private Well DESCRIBE WORK: New Well—was sharing with adjacent property but is no longer connected 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? Yes 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? No APPLICATION FOR: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF 91x73 house EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 91x73 NUMBER OF EXISTING BEDROOMS: 5 #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED? Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO ehapplieaiiun 04/252018 09:30 Page 1 of4 4v c FAW BA COUNTY Case# EH PR-04-2018-28987 .T � Public Health Department Subdivision C 0 Y Environmental Health Division PINT 369604949531 BO Box 389, 100-A Southwest Blvd,Newton,NC 28658 I NAME ON PERMIT: (KEITH ESTES),7717 WINDY PINE CIR.DENVER NC 28037 ( KEITH ESTES) Site Address: 4937 BURRIS RD, DENVER NC 28037 Property Size: Square Feet 311,454.00 Acres 7.15 Directions: Hwy 16 S,left on Campground Rd,left Catawba Burns Rd,house on left 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: 4 .,) / D Signature of Appliear l or Agent If you need further information or assistance please call 828-466-7291 AREA1 fR4448**•t??thRf4ta*tttt4488ikitt*kit*t*tt*kk4tet ee888 t 844844t4tt#t?I8*4*84844t4848t Yn 8888848844484*8**µ4Y#8 FI1NA\IE DATE FEE A\IOIINI I Well Permit& Inspection Fee 04/25/2018 5300.00 I'O'I'AI.FEES $3110.00 • FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCE!) SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) chnpplicvtion 04/25/20IS 09:30 Page 2 of4 0Afl A ,t A THIS IS NOT APERMIT COUNTY - CATAWBA COUNTY HEALTH .II.EPARTMEN`I' ��—`��r - Application for Environmental Services hortF Camp Application is for: New Construction Existing Facility 1 I Improvement Permit Authorization to Construct INew Septic I I Septic Repair/Malfunction Septic Relocation [ I Septic Expansion E isting System Inspection or Reconnection MI New Well Replacement ��W��Well ll__ ��rr n Well Abandonment P1 Well Repair Property Address ��q37 �f'�'tr n"/%' ' 157a'Aii 4Subdivisior 2c/%/'E/J_ J2/C ' c2p37 Lot# Acres Driving Dire tons to Prop rty id-) /6 d PO (2,,1, (3✓uwr1 a •cri i-, "xi' ,4ot' /4/ 4r/ Applicant C/onta�t 4 nfor •a m Name 7 .i �< /1 Address/77/7 /✓hJfr ! "��. 1/�in //PC , A/C . (916 'J Phone Cell Phone 7,0- — _±5_7/±(±_. Owner Contact Information Name Address Phone Cell Phone Contractor Contact xnformation Name License # Address Phone Cell Phone Name to Appear on Permit? n Owner ❑ Applicant n Contractor Who will be the Primary Contact? Owner Applicant Contractor Existing Structures on Site? Yes n No If yes describe #of Bedrooms * S #of Occupants Basement ✓ Yes ❑ No Basement Plumbing 9 Yes ❑ No Existing Water Supply? �i Individual Well ❑ Community Well ❑ County/City/Township Water Line Is a public water supply available? ** Yes n No S�,4„/ /.fit// '/:cI v2t /cJ Well Construction/Abandonment/Repair Proposed Well Type k- Individual Well n Semi-Public Well Community Well Abandonment Type Drilled n Bored Dug n Unknown Well Repair Requested 7 Yes H No Describe • Will Certified Well Contractor Install Water Line or Electrical Line from Well head to Pressure Tank? Yes 7 No `'s1 • >� ` THIS IS NOT A PERMIT`` L1'�� - COUNT' ) CATAWBA COUNTY HEALTH DEPARTMENT �' Ne Application for Environmental Services Proposed New Construction - Residential Primary Residence New Residence ❑ Addition to Residence If of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement Li Yes No Basement Plumbing ❑ Yes ❑ No Accessory Structure(s) Describe Structure Dimensions Plumbing _ Yes ❑No Describe Plumbing Needed Accessory Dwelling ❑ Yes ❑No # of New Bedrooms *j # of Occupants Proposed New Construction - Commercial Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq. Ft.) ft Employees per Shift # of Shills 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 ❑ Yes Li No If Daycare,#of Children f Multi-Family Residence, # of Apartments #Bedrooms per Apartment*j 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 LI* Does the site contain any jurisdictional wetlands? Ones No Does the site contain any existing wastewater systems? ❑ Yes p'q_p Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes li I- ro Is the site subject to approval by any other public agency? ❑ Yes Oo Are there any easements or right of ways on this property? Describe 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 ❑ Alternative ❑ Conventional El Innovative El Otter ❑ 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 confined by moms 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. j If structure is plumbed but has no bedrooms,calculated design flow will be determined by EH Staff. ** No, a well permit must be issued with the Authorization to Construct. RETRII'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 be perfoirned. The undersigned is the owner of the proper �or leg age ( lli mer. Signature of Owner or Legal Agent - a Date r Printed Name of Owner or Legal Agent / lj k5 Catawba County Environmental Health G fa n p? -- - P — 1141111%Ilk Co 64.92 10.7, E 1 tk, .,. R > Ilh p i (a,5) oi%pme- - 3), o O Sillhi( -... 2 titaq . _ _ It - 11%ippi riNir.s _ (1: I 0 1\ rr) s ".1 I IOily 7s • \1/41/41/4• 875 I 411114 411‘. ... NZ:\\\N) , 4- 1 h' 7 N,/,, /`i ea, Parcel: 369604949531, 4937 BURRIS RD lin=150ft DENVER, 28037 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 04/25/2018 Parcel Report Page 1 of 1 • Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 369604949531 Owner: METROPOLITAN LIFE INSURANCE Parcel Address: 4937 BURRIS RD COMPANY City: DENVER, 28037 Owner2: LRK(REID): 70976 Address: 4425 PONCE DE LEON BLVD Deed Book/Page: 3399/0687 Address2: Subdivision: City: CORAL GABLES Lots/Block: 2/ State/Zip: FL 33146-1837 Last Sale: $310,000 on 2005-12-14 Plat Book/Page: 63/48 School Information: School District: COUNTY Legal: LOT 2 PL 63-48 Calculated Acreage: 7.150 Elementary School: SHERRILLS FORD Middle School: MILL CREEK Tax Map: 017 X 02008G Township: MOUNTAIN CREEK High School: BANDYS State Road It 1852 School Map TaxNalue 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: $636,500 Zoning2: Land Value: $51,900 Zoning3: Assessed Total Value: $688,400 Zoning Overlay: DWMH-O,WP-O Year Built/Remodeled: 2006/ 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 #: Building Details 2010 Census Block: 4012 WaterShed: WS-IV Critical Area 2010 Census Tract: 011504 Voter Precinct: P41 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. ©2017, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=369604949531&typ=P 4/25/2018 CATAWBA COUNTY Case# WLS2006-00735 ,,,----->.,3. \ Public Health Department (V aSubdivision ANITA PISANI . ...x ) Environmental Health Division . \\XL" :V./ PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 Seet/BIJPh/Lot \,.,yes (828)465.8270 FAX(828)465-8276 TDD(828)465-8200 PI1N# 369604949531 Applicant/Owner: ANITA PISANI Site Address: 4937 BURRIS RD DENVER NC Property Size: SF 6.77 ACRES Directions: 165/LF ON CAMPGROUND/LF CATAWBA BURRIS/ PROPERTY ON LEFT Catawba County Health Department Operation Permit A I �" t,;-1/ If 4\ I P '`x° .14 LA d L( ---)\-i i coa±, kY ' i' ° GJ'M-t yr :11201 (ti L I-:\ eikedviliij5 System Code — System Type: 3c\ Description: )LU(k-- t-? ( h0 fMJ ., �-tTypes V and VI systems expire in 5 years. (In accordance with Tab 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 V 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 Aconditions of the IQmIprovement Permit and Construction Authorization. ItlrK. stP allehnt System i 1)- Installation Date - 11 - Ul Au r¢ed 40 e •6770.--C----- Date of Operation Permit lssurance Fomi F .:mn..mmro-a.m,lnhsAnn rot MC./ _ / /—\ cATAwBA COUNTY / vat ,.�^-��r•v Case 4 WLS2006-00735 .<5, e r• `t\ P.M.:.Health Department I Environmental Health Division Subdivisioin ANITA PISANI �.` \'\`=J?fi? �,l PO Bo: 389,100-A Southwest 61vd,Newton,NC 28658 ,..-4C----- Sect/B UI'f✓Lot N \\__i -,,,uiet CO 465-8270 FAX PIN4 369604949531 Applicant/Owner ANITA PISANI Site Address: 4937 BURRIS RD DENVER NC Property Size: 6.77 Directions: 16S/ LF ON CAMPGROUND/LF CATAWBA BURRIS/PROPERTY ON LEFT Improvement Permit Permit Valid For: Five years No Expiration Facility(Residential): House House X Mobile Home Multi-Family Bedrooms 5 New? _ Addition? Projected Daily Flow g.p.d Water Supply Private Well? Public? Semi-Public? Basement: y Basement Plumbing: Y HotTub/Spa: Y Special Fixtures(explain): Proposed Wastewater System: Type: Proposed Repair: Permit Conditions: Owner or Legal Representative Signature: Date: Authorized State Agent: Date: The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the applicant/property owner to insure that ail Catawba County Planning/Zoning and Building Inspections requirements are 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 riot affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina 'Laws and Rules for Sewage Treatment and Disposal Systems' (15A 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 of time. • Authorization to Construct Wastewater System (Required for Building Permit) * See site plat and additional attachments ( ) Proposed Wastewater System: j. Type: ry Wastewater Flow boo g.p.d ( ,- New Repair xpansion ' Soil LTAR: , 35 _ 9P•d./ft2 Type of Facility: _Chi- Basement: y Basement Plumbing: y HotTub/Spa: y Special Fixtures (explain): Wastewater System Requirements Tank Size: Septic Tank COO gal Pump Tank gal Grease Trap — gal Drainfield: Total Area: X200 sq ft Total Length: 406 ft Maximum Trench Depth x27-,30 wrin / ' Trench Width 3 ft Minimum Soil Cover 4 Minimum Trench Seperation ft Distribution: Distribution Box K Serii--ihDistribulion Pressure Manifold LPP Other Additional Specifications: £'pJac'-z -Q_!/SF: •F&A_k Authorized State Agent: f p�,e /JY I/ - Date: fj P (��/� Permit Expiration Date: I) - i43 • I D "�-�C-/� I have read and accept the specifications and all conditions of this permit as indicated. Owner or Legal Representative Signature:- / ,(- �A(/�--.-. Date: 5/V06 n\Tidona.k'o,,,V tZ Savo.rm —` CATA%VISA COUN'T'Y %: �e\ Case# WLS2006-00735 /44. ;\ Pvhlic Health Depnunent ��+ C \t�. Subdivisioin ANITA PISANI I: ,r(� Envnrnuoentnl Health Division \' {W./; PO Btx 389, 100-A Southwest Blvd,Newton,NC 25658 Sect/BL/Ph/Lot# wu (818)465-8270 PAX(S28)465-8276 TDD(828)465-8200 PIN# 369604949531 ElImprovement Permit © Construction Authorization El Well Permit PIN# 369604949531 SITE PLAN WLS#WLS2006-00735 ANITA PISANI ANITA PISANI Applicant/Owner Name Subdivision/Section/Lot �Ai thorizAgent Date System components represent approximate contours only. The contractor must flag the system prior to beginning the installation to insure 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. re r •)f-gt.�Sknn vLluStr GL levtit _ —rice --�'t-oyn v D-Ptep i- wc-Q-Q 0 - to' fvo-,n 9r0pe+1-1 1.,t-vi- ,-( 51 -PrciT l > kt basuvuird- \ , X IA/LC-jan 014- CCM-41514 Wept .p 5 D I , q,\ V • 3gipI n I 21 ,4-Yis luA cis}i✓lq . Zco' OP dra-Lt e I" : Ito Nva Lyl loot' x 3' L(n.e S ( Co-rUO. Scale r.\ride nmkv'onnNUT anuu.rvi • .1 2-27t1 CATAWBA COUNTY HEALTH DEPARTMENT re:5i/� // • Telephone: (828)465-8270 TDD: (828)465-8200 WL$ #;oo 5-0i356 Improve en[PP rinir l'� AC, ` Repa jPern it. Operation Permit. System Type_Well Permit._Replacement Well Owner/ gent �}A./�n rcc—..-,' Phone Address • //orCZ (/? l415 7)" Subdivision . A. • /L O1//f C Section/Block/Phase Lott/‘,/917 • Lot Size Directions: /65 t.i , nvi,-0,1 0 QA'r7z.-WCe a (114,-a • . ./44-v("t - /9/0/1,The / stir - . Property Address 4/9.3/) KirrrS E.C/ Facility: House /j( Mobile Home Business_Multi-family • Other: Pin Number 365‘.,-0 z/-941- c3 '3 1 Other . Zoning Approval # 3--��c #Bedrooms '7 . #Seats # Employees . Application Rate ,., GPD Flow 8-1,6 Hot Tub or Spa yes/no Special Fixtures Basemen&r. /) yo. 100% Repair Are /no Basement Plumbingtye9no • Water.Supply: Private Well ,, . Public Semi-Public **************** *******r*****************ttt*******t**tit*******t***************************************************** Type of System: Trench K Bed Pump Pump/Panel Panel LPP Others Septic Tank Sizef;5�%jA( Pump Tank Size Nitrification Field: Total Square Feeto2 cD O Depth of Stone I C. 'Bed Size Trench Width 34, Total Length of All Trenches TOO Number of Trenches Trench Length / / / / / Feet on Center I- Maximum Trench Depth at['3c) Distance of Nearest Well/oij *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* ***********************************ran*************i******************************t**************t*********************** Topo % Slope \-- Texture • \ �I Structure p l Clay Min. t)0 �\ ¢ • Soil Wetness " �� Soil Depth " AAP? Restric. Hoz. at " S • 1 ,i,15 tWi �\ Available space yes/no • /(� (5 ` Overall Class S PS U �f hoc) 1tet� 'Comments: `��, r�",/l L " °61546:lre'S° Se-- [1.6.1A.1/41.- . \A b's , • ai • 11 . `� lob . Filter Required ' Riser required when ) )LJ • tank is more than 6 1 J inches deep. **NO GUARANTEE OR WARRANTY IS IMPLII� GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** *************************************************************************************************************tit******** 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 kn n possible sources of contamination. No volume of water is guaranteed at any site by the Health Department. Permit Date ✓ tj'—s EHS //( n I {� . Owner/Agent1 „,/,2/,---- Septic Tank Installed By Date EHS Well Installed By Well Grout Approval Date Well Head Approval Date Date Sample Collected Date of Results Results EHS White-Office Yellow-Owner/Agent Pink-Building Inspection Authorization to Construct "A' . CATAWBA COUNTY i ��� 100A SOUTHWEST BLVD NEWTON,NOIYIIi CAROLINA 28658 RECEIPT < p��angs/►e PHONE: 828.465.8399 U 1)T!' ds Wednesday,April 25,2018 8!} !� 5M %rrvw.calawbacount vnc.gov PAVUIt: ESTES,KEITH . PAYMENTS TRANSACTION NUMBER: TRC-3480066-25-04-2018 PAYMENT DATE: 04/25/2018 PAYMENT TYPE: Check 14096 NCDL-8280078 DOB- 10/4/58 EXP- 10/4/24 INVOICE NUMBER FEE NAME FEE AMOUNT 04-18-352194 Well Permit& Inspection Fee $300.00 TOTAL PAYMENTS: S300.00 E H P R-04-2018-28987 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 4937 13URRIS RD.DENVER NC 28037 Applicant KEITH ESTES.7717 WINDY PINE CIR, DENVER NC 28037 C:7045303798 ** NO I'EOPLESOFT ACCOUNT ASSIGNED** receipt 01252018 09:29 Page 1 of 1