HomeMy WebLinkAboutRBPR-12-2021-39482.TIF .�$A •o. THIS IS NOT A PERMIT Case# RBPR-I2-2021-39482
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UCATAWBA COUNTY HEALTH DEPARTMENT
• PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES •
/g. sM Residential Building Plan Review- Building New
• IMPROVEMENT- REPLACE WELL - EXSSYSTEM-
71)42)_ R& :si ABANDONMENT
Applicant ."RAYMOND OTTESEN, 111 PALMER MEADOW CT,CARY NC 27513
C:9197534632 RAAYMOND737@YAHOO.COM
Owner JAMES"FRANK"GREENE,563 LAGUNA CANYON WAY,BREA CA
C:714-393-8450 FRANK@GREENEHOUSEGROUP.COM
'NAME TO APPEAR ON PERMIT
*Raymond Ottesen
SITE ADDRESS: 3505 FAMILY CIR,TERRELL NC 28682 PIN# 462705089018
NAME of SUBDIVISION: Lot 4 Section/Block
PROPERTY SIZE: Square Feet Acres 0.44
DIRECTIONS: no directions written
PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank
•GALLO 360 • WATER SUPPLY: Private Well
WORK: 7/20/22 REVISE TO IP TO DESIGNATE REPAIR, EXISTING SYSTEM INSPECTION
1/19/22 revised to Septic Expansion for a 3 bedroom home and a Well Abandonment
Previous description: 12/7/21 WILL START WITH EXISTING SYSTEM INSPECTION ADDITIONAL FEES MAY
APPLY IF EXISTING SYSTEM IS NOT LARGE ENOUGH WELL ABANDONMENT MAY BE REQUIRED. New
3 bedroom Single Family Dwelling
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? Yes
Are there any easements or right-of-ways on this property? No
APPLICATION FOR: New Structure
STRUCTURE TYPE: PRIMARY RESIDENCE
FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: .
DESCRIPTION OF well house
EXISTING STRUCTURES
ON SITE(IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: 40x70
#OF NEW BEDROOMS:: 3
BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?
Desired system types(Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL:
OTHER: INNOVATIVE: ANY: YES
Other described:
APPLICATION FOR WELL CONSTRUCTION
PROPOSED WELL TYPE: Individual Well REPLACE WELL?: YES
APPLICATION FOR WELL ABANDONMENT
ABANDONMENT TYPE:
chapplical ion 07/20/2022 14:11 Page 1 of 7
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NAME ON PERMIT: ( •RAYMOND O 1'FSEN), I I I I'AI,AIIiI( MniA HOW CI',CARY NC 27513
( 'Raymond Onesen)
' Silo Addrou: 3505 I'AAIILY C119,'IICRRIiLL NC 210ns2
Properly Slag: Squire feet' Acres 0.44
Directions: no dircclions ssiinen +�
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aMS0 re,air I..aku Mr CO rtmthr(S t a en).Permits may Ito fowl as If Ina informn:ian on mil nppl.c.nron/uo plan e•.an;tes a 11 Inc inlefCM use 1Ol foe
unposed uuAy ehenan S.Permits matt be revCO•ed II T.le concilann aro aurrea sue.that the,Clem norm l rtmd•l,on•nr rn;..nation:vp;rprrons
I na.e real Ihis app'catfrs one Ceflry rot No Intormal'0n provided her eln Is we.complete and seam Aulno•¢nd county are stale alhc a's aro
pra':N tidy or entry l0 essndua necessary Impactions to determine Cbnckance with Apr1C$nle Iaws.Grid like I unaep•arrt ghat I am We)/
1";) r.'e lcv He pope:Iden:b:a:Ion and Whetlnq Of all['Wert*fines msa corners and making the sae a:GessoOb so that a cmgivelc site evalualon
can:a r•Crtar'ed,
The urs ent:od is she mote:Cl Ine ore:erty 01 IC:al agent Or Una pane:
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Date: r•"71-i? vt Signaiury of Apphel of Agent sr..-- la
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If'nu need further infomrmiun or ussislanee please call%2%-d 155-&-S2'.7d
AREAS
SETBACKS: loom 760'contour line
Existing Tank Check Fee 12/03/2021 soma
wen Permit& Inspection Fee 12/03/2021 - S300.00
Well Abandonment Fee 01/I0/2022 S100.00
Autncriration to Construct Fee(New/Expansion) 01/19/2022 570,1)0
Fee
Imarovemenl Permit Fee 01/19/2022 SI50.00
FEES ARE NON-REFUNDABLE
ONCE A SITE VISIT IS.MAI)E OR
WORK ON A PLAN REVIEW HAS COMMENCED
SYSTEM REDESIGN ANOIOR RETRIP WILL INCUR AN ADDITIONAL CHARGE
• (SEE FEE SCHEDULE)
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