HomeMy WebLinkAboutEHPR-03-2023-43721.TIF �A �G THIS IS NOTA PERMIT Case# EHPR-03-2023-43721
+¢ �I CATAWBA COUNTY HEALTH DEPARTMENT
PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES
J$ 2 su Environmental Health Plan Review- OSWP
IMPROVEMENT
33 4)3 ) ej4 Skid
Contractor *WHITLEY CONSTRUCTION I,I,C (JOHN WHITLEY),PO BOX 3395,MOORESVILLE NC 28117
B:704-658-9251 (OFFICE) C:704-361-9880 JOHN WHITLEY OTIIER:7049286582F:7046581053
JCWHITLEY a ATT.NET
Owner MICHAEL&PATRICIA DIXSON,PO BOX 248,SHERRILLS FORD NC 28673
C:7046502959 MICHAELD64 a AOL.COM
NAME TO APPEAR ON PERMIT
Michael & Patricia Dixson
SITE ADDRESS: 7218 LONG ISLAND RD,CATAWBA NC 28609 PIN # 470003040364
NAME of SUBDIVISION: Lot# 2 Section/Block
PROPERTY SIZE: Square Feet 125,888.40 Acres 2.89
DIRECTIONS: NC 16,left onto Balls Creek Rd,right onto W Bandys Cross Rd,bear left onto Buffalo Shoals Rd,then immediately
bear right onto E Bandys Crossroad,right onto Sherrills Ford Rd,keep left to get onto Long Island Rd, property on the
left
PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank
GALLONS PER DAY: 480 WATER SUPPLY: Private Well
SC E WORK: 3/27/23 APPLICATION REVISED TO 4 BEDROOMS PER PATRICIA DIXSON
PREVIOUS DESCRIPTION:A2 IP only for property subdivision
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? No
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: 8
PROPOSED CONSTRUCTION
5yy STRUCT, RE DIM:: 49x68
#OF NEW BEDROOMS:: �4
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: YES ALTERNATIVE: CONVENTIONAL:
OTHER: INNOVATIVE: ANY:
Other described:
ehapplicamaa 03/272023 15:45 Page I of4
-\ CA'IA%SBACOI;N'hY Gaze fl I.I1PR-03-2023-4372 I
ii: �
t f` Public health Department Subdivision0,.,on r Environmental Health DivisionI'INU 470003040364
• PO Box 389,1(kl-A Sauthssest[)led.Newton,NC 2x!58
NAME ON PERMIT: 1 MICIIAIit.& PATRICIA DIXSON),PO BOX 2d8,SIILRRILLS FORD NC 2x67 i
(Michael&Patricia Oixson)
Site Address: 7218 LONO ISLAND RI),C ATAW IBA NC 28609
Property Size: Square -ccl 125,888.40 Acres 2.89
Directions: NC 16,left onto Balls Creek Rd,right onto W Bandys Cross Rd,bear left onto Buffalo Shoals Rd, then immediately
bear right onto E Bandys Crossroad,right onto Sherrills Ford Rd,keep left to get onto Long Island Rd.property on the
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 a 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.s 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 so;e!y
responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site eva.uatron
can be performed
l !.
_
The undersigned is the owner oft property or legal agent of the owner �'_-_,-' l >
Date: /27 Signature of Applicant or Agent
If you need further information or a istance please call 828-165-8 2 711
AREA4
FFENAMME DATE, FEE A4IOI'%T
Improvement Permit Fee 03;15;202 3 S 15t)p0
TOTAL FEES $150.00
FEES ARE NON-REFUNDABLE
ONCE A SITE VISIT IS MADE OR
WORK ON A PLAN REVIEW HAS COMMENCED
SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
01^7;)u;t I .tt
t'asc 2 ni l
Sheet I of Z
PROPERTY ID#: 0•:?s 0 0 f{'
SOIL/SITE EVALUATION COUNTY: q,.,
for ON-SITE WASTEWATER SYSTEM
(Complete all fields in full)
I OWNER: M , (,k. ( r r,4-.tb‘x`� r
ADDRESS: 17/ 4aku Pi i pr �� —Tr ._�7— __ APPLICATION DATE
s 1^'��►25 y 1 t� DATE EVALUATED; //iv�t/
PROPOSED FACILITY: '1-9 PROPOS D DESIGN FLOW(.1949): 36'l�'Nv 3 PROPERTY SIZE: ^-3.4Q c.
LOCATION OF SITE:_ 'r c 2 t—.,3 t 5, � ' C Je, S�
WATER SUPPLY: IJ Private D Public L9"�II 0 f PROPERTY RECORDED: Jtl�
__�� Span$ ❑Other
EVALUATION METHOD: t�Auter Boring Pit 0 Cut TYPE OF WASTEWATER: w Seage ;Industrial Process L Mixed
P •
R
o SOIL MORPHOLOGY OTHER
LF (.1941) PROFILE FACTORS
.1940
E LANDSCAPE HORIZON
POSITION/ DEPTH
# SLOPE% (IN.) 1942 PROFILE
.1941 .1941 SOIL .1943 .1956 .1944 CLASS
STRUCTURE/ CONSISTENCE/ WETNESS/ SOIL SAPRO RESTR <AR
TEXTURE MINERALOGY COLOR DEPTH CLASS HORIZ
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DESCRIPTION INITIAI.SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946):
Available Space(.194S) -< SITE CLASSIFICATION(.1948): I 4
t L.
System Type(s) qcce EVALUATED BY: 5. S k i 11 6, It
Q r, OTHER(S)PRESENT: (_, (pJl
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Site LTAR G , 3 s
COMMENTS:
Updated February 2014 --
SOIL/SITE EVALUATION
(Continuation Sheet-Complete all field in full) Sheet 1—°f
PROPERTY ID#: tea,.,---e_
DATE OF EVALUATION: �
L n t COUNTY: ,
• • .
P • •
R
o SOIL MORPHOLOGY OTHER
F (.1941) PROFILE FACTORS
1 .1940
1..
E LANDSCAPE HORIZ .1942
POSITION/ ON .1941 .1941 SOIL .1943 .1956 .1944 PROFILE
# SLOPE% DEPTH STRUCTURE/ CONSISTENCE/ WETNESS/ SOIL SAPRO RESTR CLASS
(IN.) TEXTURE MINERALOGY COLOR DEPTH CLASS HORIZ <AR
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COMMENTS:
Updated February 2014