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HomeMy WebLinkAboutEHPR-01-2023-43242.tif .)BA6 THIS IS NOT A PERMIT Case# EHPR-01-2023-43242 CATAWBA COUNTY HEALTH DEPARTMENT v • PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES AI Ig 'L sM Environmental Health Plan Review-Septic Malfunction AUTH CONST- SEPTIC MALFUNCTION Applicant KYLE COOK,3984 GRANITE ST,TERRELL NC 28682 C:7044081078 KYLEFCOOK r CHARTER.NET NAME TO APPEAR ON PERMIT Kyle Cook SITE ADDRESS: 3984 GRANITE ST,TERRELL NC 28682 PIN# 461704531025 NAME of SUBDIVISION: J P BOST Lot# 21 Section/Block PROPERTY SIZE: Square Feet 30,927.60 Acres 0.71 DIRECTIONS: E NC 150 Right Sherrills Ford Rd,left Granite St property on right PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: Sewage surfacing to top of ground 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 residence,garage EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 47 x 60 residence NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES: SEATING CAPACITY: TOTAL FLOOR SPACE(SQ FT): Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: eliapplicauwai 01/23/2023 10:42 Page 1 of6 +� CATAWBA COUNTY Case# EHPR-O 1-2023-43242 E.., t , Public Health Department Subdivision J P BOST d . 111(�� '4 Environmental Health Division PIN# 461704531025 PO Box 389,100-A Southwest Blvd,Newton,NC 28658 8 w NAME ON PERMIT: (KYLE COOK),3984 GRANITE ST,TERRELL NC 28682 ( Kyle Cook) Site Address: 3984 GRANITE ST,TERRELL NC 28682 Property Size: Square Feet 30,927.60 Acres 0.71 Directions: E NC 150 Right Sherrills Ford Rd,left Granite St property on right 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: Signature of Applicant or Agent If you need further information or assistance please call 828-465-8270 AREAS *****************************************************************s****************************************** FEENAME DATE FEE AMOUNT Authorization to Construct(Repair) Fee 01/23/2023 $150.00 TOTAL FEES $150.00 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) clapplic;itn m 01/23/2023 10:42 Page 2 of 6 CCatawba county public heal Application for En wiraoiscaud tI&b Sonic* nits IS TtOT'A PEPMT1 is fo Nor imprrreeetl rtes.tt LI A.tbort allot to Cenci cWw Sepik ❑Sop&Rrpslrt II*Cllos M Septic tic 0 Sept E tpt ilia 0 1 t System imps kiS Or R1e*fsertios LO Neer a d ❑ .c'Neil Qfir. r..rr.,�tt Q war _ � j9 __Cry+ 5+- " tirial �L tf, - Aims .. _ i Loa Defellog Direttiose to respect,• is _' iCii l Paid eivill0 3 S 14 '�..' . i 11:0:4, ,. M I .0+c ,.._ Describe Trod, CO A c if ` CLIP 11 r 44 4 d 1 r. rill 4.ir_ . .... - N1patttt Name g.bllc• Caa K_ Appikaai Aaktics IN 611 : ,; $ #- Tceectl Apt. 2 jun. Pho°c 7 . 12.E.,., ' Emtil a F- k Ike Jr . Owner Nuke tsivild_ifettc,„ Pborbc lb+{-q o '• !d'7 r i LR. 1 gy Ftrott,,,A Chg.kv.A.Iet Contractor Naas Contactor timed,r Agar.s Par nit? N.Ortsar cl 0 cimihoul ►4n..rtlt bi rlk Prineoly Cootoal ISI Owner 0 Aorlisat 0 C'esesaor • N C .Iaiestlal Primary'traitors ❑ Mew R ecalencr ❑ Addiction b RrsWeers !et New Bedroom't liarOoaop.cw SI:war r Mnemonic*, e6u 1Oer?r daeceesacie ot& ke a Nettled _ (flexile tnsel 0 timarra,+ 0 Cmdel spoor 0 Nab It boom mail.Will Mae k Wier Mai!'avers Samaraa 0 ye', [] t+iei i Seamen,Wei r Z. 0 Yee © No Amoebic) Dercelloi a of Sys tembaomr 't s of Qco.pents Swim Dliermiose ((book Osc) ❑basterece D Oral Spike ❑ Slob tdBaeaseaa.Wilt Thera be Woke Mac Femme In Sammie.-0 Ye* p No R asin. w.il,r CI 4'o Q .> Atecesewil Sinctarttl)aerc �t�theimikevia rbmb.s ❑ c ❑ Ko ubrcritte rtusaaas teodari _ (Choose ono ❑ittare■ear D cRl epee 0 Slim trnowWilkie Iiawise min taste ill B..o,rget ❑Ye+c ❑ 14e noioirB wait›t' ❑ Ya 0 N. t MI iId-psiallr-Reakkaat *or Ailorerecook aDvievorne pa Aipartmaet Tc+14 p pompous s it&mire"t lM of Ocameme e Oral D Smetemate ❑Fowl 0 Ste If Bikiblital.W n Tin a.Wier Min Mares bt Sateraate ❑Yes ❑ No Karr WaI}2' 0 Yes ❑ too V. rti�pil+i Wd1vr e CIividdal:will ❑Seem--'Mfrs £JG Wei Type 0 Draw 0 fir ❑ Ow IJ m Weill Polk itegosekvi 0 Yet 0 No Demi* _ _ ' is Wit CaTlied Well Coriblkeor Wail Water Line or Piecdtsal Ube,roar WI Hard to text Tort❑Yes El N. • CaL%wbt Co titp Cc ti r,25 G'° Nnx Ik F Pa389. .fNC VMS Ulan Strienieeti+er hats .;� .c - , ;t7T---7 ,, Dmicttbe 2,40 f i-if. Ihsj i►,e.q. sidceanr ff monsioe , �. Ratesscet 0 Yes ® No Flostmeni Plumbing 0 Yes a No Eakin*atite Sappily_ —,, a1 Tndividur311'cli C3 Simard Wea Nusbar islcrormsxr r., , 0 Catluratirry 311'O ©CconteCityfinsetatsigt Water Lbwe is a pabik water,apply i+•aila bet"" 0 Yes 0 Flo Coutthercial 0 Pra�lod Nan Co ettrnciis ❑Eii.N te1 .f UM 0& i�liir le SC413 Dining Ares r tiq. FL) - r Lifitioyeei.pee Shill •OSUMI Church s or n Unsure 0 4 _. .f .,. . ,. .� _.......-_ +s [,No f of LiirdFea tr(rf per Shift. �t Shifts_._ _.. ... C(iromorial L4iiriac>rr 0 Yes R> entiil Kitchell 0 Ye# 0 Na AMINIIMM/NriaMaiMaNY Dtrytarc 4 c.F004mo..�_ a��,,, 0 of Eopler rnca par Shill trot:Shwas I9srlitesnoOther Specify Type —.._ Smiley Dtmmminui Retail floor*Ire 0 of Eeq►ld?ttt putt Shia 'I DiSl ifb Other Ietantnttoi CadeuLined )u.n lion•,Commercial f ('This Indic will he determined by EH strain tlse App its itrll wally the l x:al h itb&portion*upon submittal of this applicaCioet if say cif the fotie.rlstg y 10 the povertjie tiarstion. If the aesuet w arty caseation is -,applicant mull utin t Wp nlrwg deesSWISIOGIL o Yrs b7 No L .the SAC COMMA an,"art sdis.nonal winds? Ci Yrs 1"1:1 No Nag the situ contain any cutting wasterrakr tritons? o Yea SZ1 NQ rs any u•s•.acwata* going ea be sciriccmai on dog sift Wok's***dasisca&+t ae+wsigcT O Ya S)No Ii Mc site tTuba:a ru ipproYal by wry ocher ruMic X' o Yes q No Are them wn'casements oe right of ways co this property? Ike If applying for so tmprovenw,at Permit or A othorkentiii is Constrict,Plane bolts*Desired Symms Type(st (systems can be ranked in order of you prcrrrceatc1 o Aeverted o Attic-matrix. o Csxoninierroil 0 le toroth a 0• -- II) Any *Any rarer rh.1 will be iatiee4t.4 for ik•,rpinj rt Ow tine otcssnatneresioe cc for(ieta-e corisidermion should be Bowed as•bedroom'w*t ccunied on all arizAirstimto. The melba-of Cacdrraolrsil will be taonftnrtd by rooms identified co floor plies a e bedroom it the tare ofhan'idirg permit issuance. This may prcwnt the twat,tot woe system expansion its the inesc t If l rear,-tune to*irked bus fat no bedrocroo,.caktilinedsieitin rook will be&eeen i lby EN Stitt .r I i No,A well pinion nisei be issued with the A intiosiarittorti toCu%WUtt ,a'ritir tO lid E PROPti;RTIAND 3 tl:Y'Tir;M Plt1 WILL M .s M,4+Car,M7c Mr SCiDDt1L1FI 8fitireamental Hcald,1V *ot el-s.'uae:ed require ding,ameariw,wiiYor robins loo•the wood, Pprrry i+rttertapplitan is revertible AN anao#. Ali liflottgratind widow,*chalks'bat Not t#rndad so- last p ivier„cable.t>tkpbua.ps,wooer Lira;.mad imptkin syrscrus+aprh lks smarm Catawba Cvrsnly.ViibironrTic*al iic.Ith is tee itspansibia te.r darts a tottnsrsrba!untiei- Completed a>p+pIiceirK Ctrs valid rot s rk d of 2 roil. her s norment Perarsita are%alit with eseyattp;ete site plan-hG months(S rears); wids coarpkic fit•witl.7u1 expurir icn.. An Authoriralyon Da Chi* I Mom witrd as keg as tilt hipmycialcut PIMPS oat**IA M, Aue ocindiica s Coosi ucr.Issued for sc me reran-s valid for bD ovoids'(S}ismi).Tennis only be ri otued if Ow isitfooloosi a-ow this itostiosisitc Om rtlalrges or Weise itntded sac Oar the proposal aids'y dingo o Permits away be teed if tree rnadtdbets we sihertd suer witty rues :-� tlts4 p4renit c:=- n:or tnstatLtiors tients.,.:.�,.. .. ..�..I bee mead this application and certify toil the in6cwrtri+ttdao p�rca4idoe l is unite,cotes ii Slid aveeaei Authorized codes and woe I officisli we t right of catty COm duel iece s oryr istspottions CO dctcn t trite with applicable Is*i and rvsket, I I y�Crst ad that I inn solely rersttotteta7blo for doe proper ideeti5 ,tiara and labeling droll arty Wes sod mom laid making the Cite r, sio so&at a convicts site evaluwica an be p�naxd. 'Tbi enders nod is the owner of Iht pr'ope+rty or iqpill��amt.-- primedt :oV the off. # +�Si psaurr a od O wner or Legs/Agng, I ,rCr'11t71Ae !i "�l k Name of{hsseror l�rp„ttl'A Kitt ___., -%: + a awba count a Real r11MMr,strtli.III►iliw �� �� � Estate Search / ' - !. 40 0 ri cil\4 \\,, , \\ .10 lit 'CZ,pai- b.,..,,,,,4,,,, . . *4,4 icf, CZ!' / 0 1 \ \\ \ . wei 47 f L... it-..... ,,,,---3 , ......, 1,,, r_, _...... b, . 1 M w+, i�irt Pfk i Ramat 461704531025.3984 GRAMME ST TERMELL, 28882 Owlets: GOOK KYLE. Owner Adkdresa: 3984 GRANITE ST VMuss-8tIding(s): , Lerxt , Toot $469.700 anphippot maid gm JnI1ored ym fob c rote NC r+�wrow IV Coombe Pop nil rw NOM•. ra.imm bowrocyrlber/srati Cwr4oi h of MA.facetCair,q. ,. a+rifr+�cr•io Ito rrerts r�elird M d f In D 4f Ow�w bus onpinnobnipmeendw +a r dna r iM y r M or + w�r� and� iM t++IlA1 wro�4+:r�rr� oleo kern Inds wi bar Pnra� � pt Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 461704531025 Owner: COOK KYLE Parcel Address: 3984 GRANITE ST Owner2: City: TERRELL, 28682 Address: 3984 GRANITE ST LRK(REID): 14231 Address2: Deed Book/Page: 3503/1983 City: TERRELL Subdivision: J P BOST State/Zip: NC 28682-9733 Lots/Block: 21/ School Information: Last Sale: $420,000 on 2019-05-01 School District: COUNTY Plat Book/Page: 12/71 Elementary School: SHERRILLS FORD Legal: LOT 21 PLAT 12-71 Middle School: MILL CREEK Calculated Acreage: .710 Tax Map: 013AX 02021 High School: BANDYS Township: MOUNTAIN CREEK School Map State Road #: 2764 TaxNalue Information: Tax Rates Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoning1: R-30 Building(s) Value: $228,900 Zoning2: Land Value: $230,800 Zoning3: Assessed Total Value: $459,700 Zoning Overlay: CRC-O,WP-O,FPM-O Year Built/Remodeled: 1972/1999 Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2008-03-18 Building Permit Address Search for this parcel. Firm Panel #: 3710461700K If available, Building Permits for this parcel. Septic 2010 Census Block: 5031 links are not permits. 2010 Census Tract: 011504 Septic Final Permits prior to 08/2018, contact Agricultural District: Environmental Health. Building Details WaterShed: WS-IV Critical Area Voter Precinct: P41/Voting Map 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. ©2023, Catawba County Government, North Carolina.All rights reserved. :__ N° 3961 CATAWBA COUNTY + HE.AI TH DEPART ENT (704) 465-8270 Lot Eval. Improve. Permit Repair Permit ✓Cert. of Comp. Permit Oper. Permit Omer/Agent L4iO0DK01,/ L/f-40 TF-/Z. Phone Address g'/Q /V027-N '-. b-, Subdivision X,NG-S i 1 ,,nir3ii1J, n/, (2., r?rORC Section/Block Lot# Lot Size Directions: / C PIG-t�� I Al Te-it pC/.. Ow° ,5'1i (I'll 25), f 9 - C//I Jro s7Ay. ST/AJe247- P4ue--1)1 Th DIA- )9-67— ' 7— 4 / le Facility: House t tiobile Home Business . Other: Zoning Approval yes/no # Multi-family_ Other . 100% Repair Area yes/no Bedrooms Seats Employees . GPD Flow Application Rate Hot Tub or Spa yes/no Special Fixtures . REPAIR NOTICE: REPAIRS MUST BE WITHIN Basement yes/no Basement Plumbing yes/no . 30 DAYS OR DAYS FROM DATE OF Water Supply: Privates /Public . PERMIT. , Type of System: Trench !/fled Pump Pump/Panel Panel LPP Other Tank Size: Septic Tank Jcv,p , Pump Tank Nitrification Field: Total Square Feet 40 Depth of Stone te " Bed Size Trench Width 6 Total L gth f All Trenches Number of Trenches Individual Trench Length j/ .%/ / Feet on Center ? ' Maximum Trench Dept V'1 Distance of Nearest Well 5D'-- Lot Evaluation: Approved yes/no (Void After 24 months) Topo % Slope Sketch of lot Eval ion Site - System Design - Final 1 C pkSlf y`. Tex ure SZ »� . F�c.� pt D —. Struc , Tr4N -' A,Ir ''�ttin �— �f$GpnN oil wetn: So1Dep Res r Ho, . a Avai able su. e yes/no . +t"pt1L I \ Overall C .ss S PS U PDus-E ,s Comment : \ \ Ravi a � \� \ A O 3 i 2,Favc:Nt_5 Gar 3f 'ci‘ I , i\kt . **NO GUARANTEEi1I OR WARRANTY IS IMPLIED OR GIVEN THROUGH THE ISSUANCE OF THIS PERT** Permit Date // ." 12 a /t79c L (Improvement Permit void after 60 months) ,Owner/Agent Sanitarian ,-_ _ Installed ByTh,e ✓ntotjZp(A./ Date q-7.-?6, Sanitarian (57. /E.S- I\ i(Nnte any changes/inform . in red or by sketch nn hark) White-Office Blue-Bldg. Insp. Comp. Yellow-Owner/Agent Green-Bldg. Insp.I.P. 4,,,-;4. CATAWBA COUNTY Case# IMPV-02-202 1-144599 Public Health Department Subdivision J P BOST �,-,,�tin Environmental Health Division PIN# 461704531025 ii J " PO Box 389,25 Government Drive,Newton,NC 28658 21 // , (828)465-8270 FAX(828)465-8276 TDD(828)465-8200 LOT# Site Address: 3984 GRANITE ST,TERRELL NC 28682 Name on Permit: KYLE COOK Property Size: Acres 0.71 Directions: Turn South off 150 onto Sherrills Ford Rd drive approx.7 Miles and take left on Granite Street Improvement Permit AN AUTHORIZATION TO CONSTRUCT MUST BE ISSUED PRIOR TO BUILDING PERMITS THIS PERMIT IS NOT FOR SEPTIC INSTALLATION Permit Category: Other Wastewater Flow 240 g.p.d Type of Facility: Primary Residence Basement? No Basement Plumbing? No Bedrooms: 2 Water Supply: Private Well Maximum Occupants: 4 INITIAL SYSTEM SPECIFICATIONS Existing Wastewater System: CONVENTIONAL System Classification: IIA-CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) REPAIR SYSTEM SPECIFICATIONS Repair System Required? Required Proposed Wastewater System: 50%REDUCTION VERTICAL System Classification: IVA-ANY SYSTEM WITH LPP DISTRIBUTION Pump Required ***** Operator Required Permit Conditions: Landscaping or other site alterations that potentially divert groundwater or surface water toward the septic system, or prevent proper drainage away from the septic system, including the direction of gutter flows or foundation drains,is not approved,and may result in failure to approve the initial system installation,or the suspension/revocation of existing permits. 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 all 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 arc 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'taws and Rules for Sewg-ee Treatment and Disposal Systems' (15A NCAC 18A.1900). 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. Any permit issued for a conventional system may be used for an accepted system without Environmental Health authorization or permit modification.Please notify Environmental Health of this change prior to system installation. 02/01/2021 Authorized State Agent Permit Issuance Date 02/1/2026 Permit Expiration Date No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department. • clgtcnmi 02/11/2021 16:45 . R6PP:-.01- ao;o...... Catawba County Environmental Health 35 .2,9 1 :, ,.:, `:., . * *3950 ,�r y' f ;f .67 <_.. ii 4 5C { `?;$:.4V • • , "moo -44 * 499.t::7 67.49 � ,, • P o •3974 ..'Y;.;`• _:Inc,^ �` / . ! •g -:ter . �.�:t�a le ` tit_':V ... _ ' ` _, ...v.iir ,4\,--74, ..44.,,.. "..,„„v.,:i ,....c ..____,_ __ , _ 330.80 . ...t.w.t.J.,.D.11:::-;•.....-- • N . ' 143.60 ° :. .,.c..r.''?,.:: ,t- ., .,vt.' /� �4000 :ire e• till:iti. •Y.k: ,.....7.4.1 ..T.:.•';`1: ,}r q.•{'.:::•••f' Parcel: 461704531025, 3984 GRANITE ST 1In=60ft TERRELL, 28682 This map/report product was prepared from the Catawba County,NC Geospatlal Information SeMces. 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. P....J. iM A".e....J...P.......,..►IA DEPARTMENT OF HEALTH AND HUMAN 3fiRViCES Sikes 1 el DIVISION OF PUBLIC HEALTH.ENVIRONMENTAL HEALTH SECTION PROPERTY ID 0: ON-STIE WATER PROTECTION BRANCH 151 ttf COUNTY: C�aw4a SOIL/SITE EVALUATION -for ON-SITE WASTEWATER SYSTEM (Compiele all tiekb in WO OWNER: K it l C0k _ APPLICATION DATE ADDRESS: DATE EVALUATED: �� m PROPOSED FACILITY: y}sL3,- zd►- PROPOSED DESIGN FLOW(.1949): 2* PROPERTY SIZE: LOCATION OF SITE: 4 Cam- ST- (-I. 44 ,3 Krt� PROPERTY RECORDED: WATER SUPPLY: ❑Private 0 Public i 4eli 0 Spring 0 Other EVALUATION METHOD: ❑Au er Boring [f�Pit 0 Cut TYPE OF WASTEWATER: 0 Sewage 0lnd> l Process ❑Mixed r o SOIL MORPHOLOGY O.R • F (1941) PROFILE FACICORS I. 1!A L _ PO TION/ -MIPROFILE ✓ SLOPS% (014 .1941 .11141 son. .1943 .ii .1944 CI ASS STRVCTURFJ COMMENCE/ writ lssi SOIL SAPEO RISSTR &LTAR TEXTURE PIDEUtALOGY COLOR Darn' CLAN now LS O 4 & de . c� fl IN4 sz, WA- /v-4 PS 6-ZZ e6V C FA Se- 1 /4 22,—Sb 1r z ec/tic• ne sl r` `.'1 A- 3 ,. j- h-, ,..,,...4. .R r i jt e � 4-44 Ye" 4 a-r0 fa s.21A1 Cir << OA 38 yv4 ,�q es L 5 /d" '3 Gr S L. r,e to 2 lob ts- zits« c r� tc 0 O. 3 V 4 Yg-to 3?- Sc 'l Fe 3e Eta J.� s. ,4, 3 4 DESCALPIION nor1AL SYSTEM REPAIR SYSTMM ORDER FACTORS(.I946): SITE CLASSIFICATION(.1948): l'Y Available Space(1945) g",tz ky " � Sytkm+Iypa(s) EVALUATED BY: � ( "� OTHER(S)PRESENT She LTAR 9-v3 col MEN TS: fi 11.3' �t 35' Tsv ' Q& a P� �e1 STATE oNo ROY COOPER • Governor : _ y NC DEPARTMENT OF HEALTH AND MANDY COHEN,MD,MPH • Secretary * i,nr HUMAN SERVICES MARK T. BENTON •Assistant Secretary for Public Health •''+a,«,,..' Division of Public Health Onsite Water Protection Branch January 2X, 2021 Kyle Cook 3984 Granite St. Terrell, NC 28682 Re: Approval No. JMB2213 Private Well Locatcd Less than 25' from Building Perimeter [Rule 15A NCAC 2C .0107(a)(2)(P)] Property location: 3984 Granite St. Terrell, NC 28682 Dear Mr, Cook; On January 26,2021 the On-site Water Protection Branch received your request for a variance from the Well Construction standards,Title 15A North Carolina Administrative Code Subchapter 2C .0100. The request for the variance concerns a water supply well on the referenced property that is serving one dwelling. A structure is proposed for the property that will-be within twenty-five feet of the well. Specifically, the variance request grants you permission to use a water supply well at a distance closer than the twenty five foot setback to a building perimeter. Achieving the twenty-five foot setback would be difficult given the challenges of the property. Based upon information provided by you,the Catawba County Health Department, it is my finding that based upon current conditions as the site exist today(as well as the current proposal for use of the structure) you meet the conditions necessary for approval of a variance as specified by 15A NCAC .0118 (a)(1)and (2). On that basis and if the following conditions arc met,the requested variance is approved: NC DEPARTMENT OF HEALTH AND HUMAN SERVICES•DIVISION OF PUBLIC HEALTH LOCATION:5605 SIX FORKS RD,RALEIGH NC 27609 MAILING ADDRESS: 1632 MAIL SERVICE CENTER, RALEIGH NC 27699-1632 www.ncdhhs.gov•TEL.919-707-5854•FAX 919-845-3972 AN EQUAL OPPORTUNITY!AFFIRMATIVE ACTION EMPLOYER 1) The well/wellhead shall meet all current 2C. 0100 standards, including but not limited to being properly grouted, terminated at least 12" above land surface, properly scaled, and having a thread-less sample tap etc. 2) The well shall be sampled for the same parameters required of a newly constructed well. If samples indicate contamination, further repairs or treatment will be necessary. 3) No potential sources of groundwater contamination shall be stored near the well-head. 4) No termite treatment shall be applied to the structure within twenty five feet of the well unless alternative methods are approved by the Catawba County Health Department. The granting of this variance is for the well location only. It in no way relieves the owner or agent from other requirements of the North Carolina Well Construction Standards including, but not limited to the requirements in 15A NCAC 2C .01 i 3(b)to repair or to abandon any well which acts as a source or channel for the migration of contamination. This approval does not imply sufficient water quality. Further,the approval does not relieve your responsibility to comply with any other applicable Federal, State,or local laws or regulations. If you have any questions regarding this variance, please contact me at (828) 713-3335. Sincerely, John M. Brooks R.E.I-l.S, MS 2 CATAWBA COUNTY G' I00A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT C) O 7,�r PHONE: Monday,January 23,2023 18 4 2 sM www.catawbacountync.gov PAYOR: Cook,Kyle PAYMENTS TRANSACTION NUMBER: TRC-56072852-23-01-2023 PAYMENT DATE: 01/23/2023 PAYMENT TYPE: Credit Card 300172867 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 01-23-417156 110-580200-663000 Authorization to Construct(Repair) $150.00 Fee TOTAL PAYMENTS: $150.00 EHPR-01-2023-43242 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 3984 GRANITE ST,TERRELL NC 28682 Applicant KYLE COOK,3984 GRANITE ST,TERREI,I,NC 28682 C:7044081078 KYLEFCOOK@CHARTER.NE'I' **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 01/23/2023 10:41 Page 1 of 1