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Home My WebLink AboutEHPR-04-2023-44031.tif '.1137A � THIS IS NOT A PERMIT Case# EHPR-04-2023-44031 L`-., CATAWBA COUNTY HEALTH DEPARTMENT v 'e PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 sM Environmental Health Plan Review-OSWP REPLACE WELL Applicant TYLER BLACK,4718 LITTLE MOUNTAIN RD,CATAWBA NC 28609 C:8285147699 BLACK.TYLER514@GMAIL.COM NAME TO APPEAR ON PERMIT Tyler Black SITE ADDRESS: 4718 LITTLE MOUNTAIN RD,CATAWBA NC 28609 PIN# 367802756110 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 53,578.80 Acres 1.23 DIRECTIONS: Hwy 16 S,left Buffalo Shoals Rd,right Little Mountain Rd, 11th house on left PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: WATER SUPPLY: Private Well DESCRIBE WORK: replacement well,existing well water is muddy and not drinkable 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 EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 39 x 69 NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION BASEMENT? Yes 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: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: YES ehappli can on 04/13/2023 08:18 Page 1 of3 41i • CATAWBA COUNTY Case# EHPR-04-2023-44031 (..... Public Health Department h 'fi 2 Subdivision '-'1 Environmental Health Division �' ''C PIN# 367802756110 PO Box 389,100-A Southwest Blvd,Newton,NC 28658 2 sm NAME ON PERMIT: (TYLER BLACK),4718 LITTLE MOUNTAIN RD,CATAWBA NC 28609 (Tyler Black) Site Address: 4718 LITTLE MOUNTAIN RD,CATAWBA NC 28609 Property Size: Square Feet 53,578.80 Acres 1.23 Directions: Hwy 16 S,left Buffalo Shoals Rd,right Little Mountain Rd, 11th 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: Signature of Applicant or Agent If you need further information or assistance please call 828-465-8270 AREA4 FEENAME DATE FEE AMOUNT Well Permit&Inspection Fee 04/13/2023 $300.00 TOTAL FEES • • • S300.00 FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) ehapplicado❑ 04/13/2023 08:18 Page 2 of3 Send aS emer enc �QP, catawba county public health Ex►Sk►n We\t vi4eif is rnuAdi aria ►1 Ck l A it• Application for Environmental Health Services THIS IS NOT A PERMIT • Application is for: ❑New Construction ❑Existing Facility ❑Improvement Permit ❑Authorization to Construct ❑New Septic ❑Septic Repair/Malfunction ❑Septic Relocation ❑Septic Expansion ❑Existing System inspecti n or Reconnection ❑New Well &Replacement Well- ❑Well Abandonment ❑Well Repair Property Address y7l r li 4--k /�OU,rrtotirt joacriea4,ii, AjC 'FpDci Acres f c 3 Subdivision Lot# ''ni �U� 'ado 12 16. �d %ke .'1'r f i al71 o `i>{ Driving DirectionsfoVrolptr—t-y4frilie,c-1- B h�OYYfouvliaio �Z rr 1tp,n th 4-t0u$_ on t k Describe work Applicant Name •7 l Applicant Address G/7J ' Z!.1" re I77Ol Yl la In )aO'' (_7,a 4 A loA Ate 07?6dq Phone 802.57"J.AI -'7699 Email b � iywJ5)L1Q)�p ;I , e6 Wt Owner Name l ► IV E jade_ Owner Address � ,yt oes c;,bew ) Phone Email Contractor Name Contractor Address Phone ] Email Name to Appear on Permit? Owner ❑Applicant ❑Contractor Who will be the Primary Contact? Owner ❑Applicant , ❑Contractor Proposed New Construction-Residential " Primary Residence ❑ New Residence ❑ Addition to Residence #of New Bedrooms*t #of Occupants Project Description Structure Dimensions,also specify dimensions of decks&porches (Choose One) 0 Basement 0 Crawl Space 0 Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes 0 No Retaining Wall>2' ❑ Yes 0 No Accessory Dwelling #of New Bedrooms*t #of Occupants Structure Dimensions (Choose One) ❑Basement 0 Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes 0 No Retaining Wall>2' ❑ Yes 0 No Accessory Structure(s)Describe Structure(s)Dimensions Plumbing ❑Yes ❑No Describe Plumbing Needed (Choose One) 0 Basement ❑Crawl Space El Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes 0 No Retaining Wall>2' ❑.. Yes 0 No Multi-Family Residence #of Apartments #Bedrooms per Apartment*t Total#Bedrooms in Structure*t . #of Occupants Structure Dimensions (Choose One) 0 Basement 0 Crawl Space 0 Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes 0 No Retaining Wall>2' 0 Yes 0 No Well Construction/Abandonment/Repair Proposed Well Type Etc Individual Well ❑,Semi-Public Well 0 Community Well Abandonment Type ❑ Drilled Bored ❑ Dug ❑ Unknown Well Repair Requested ❑Yes [v No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank?"Yes ❑No Environmental Health Catawba County Government Center, 25 Government Drive I PO. Box 389, Newton, NC 28658 Phone: (828)465-8270 I Fax: (828)465-8276 j EHAdmiin@CatawbaCountyNC.gov Existing Structures on Site Describe 460.e �" ..P� � ' Structure Dimensions //IX l ei #of Bedrooms* 3 #of Occupants a Basement ["Yes ❑ No Basement Plumbing 0 Yes g No Existing Water Supply Individual Well 0 Shared Well—Number of Connections ❑Community Well • 0 County/City/Township Water Line Is a public water supply available?** ❑ Yes tNo Commercial ❑ Proposed New Construction ❑Existing/Change of Use ❑Repair Food Service Specify Type #Seats Dining Area(Sq.Ft.) #Employees per Shift #of Shifts Church #of Seats Daycare❑Yes ❑No #of Children #of Employees per Shift #of Shifts Commercial Kitchen 0 Yes ~❑No Residential Kitchen 0 Yes ❑No Daycare#of Children #of Employees per Shift #of Shifts - Business/Other Specify Type Structure Dimensions Retail Floor Space #of Employees per Shift #of Shifts 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. I the answer to any question is"yes",applicant must attach supporting documentation. 0 Yes IlidNo Does the site contain any jurisdictional wetlands? ❑Yes ®No Does the site contain any existing wastewater systems? ❑ Yes lBrNo Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes 6eti) o Is the site subject to approval by any other public agency? ❑ Yes N No 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 0 Alternative 0 Conventional 0 Innovative 0 Other 0 Any *Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as a bedroomand 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 SYSTgM REDESIGN WILL INCUR AN ADDITIONAL CHARGE(SEE FEE SCHEDULE) Environmental Health soil/site evaluations require digging,angering,and/or probing into the ground.Property owner/applicant is responsible for marking all underground utilities,including but not limited to:underground power,cable,telephone,gas,water lines,and irrigation systems/sprinkler systems.Catawba County Environmental Health is not responsible for damage to unmarked utilities. 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 maybe 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 coirect. 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. Signature of Owner or Legal Agent / Date 0 l )o?Od 3 Printed Name of Owner or Legal Agent /eY" )kri L0 r , 6 _, A . Now t t, coxfo tf fellaceMei ieUl Gar t • • *It r • • Catawba County Environmental Health 2r6' .sue 07 F f N I , l N. / N., i �1 "'e4 P t O i i4\„ P Y'1 6 }{ j/ rj' 0 # i i 00' 0 •4690 / r, 3S 0 / e � ; (2,8) * J 41/iiir ir/ 9 (155) i fi 1g99 88 4100, -wv No 30 (288, Parcel: 367802756110, 4718 LITTLE MOUNTAIN 1 in=80ft RD CATAWBA, 28609 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 2023 Catawba County NC 04/12/2023 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 367802756110 Owner: BLACK TYLER LEE Parcel Address: 4718 LITTLE MOUNTAIN RD Owner2: BLACK MEGAN MARTIN City: CATAWBA, 28609 Address: 4718 LITTLE MOUNTAIN RD LRK(REID): 2719 Address2: Deed Book/Page: 3777/1194 City: CATAWBA Subdivision: State/Zip: NC 28609-8212 Lots/Block: / School Information: Last Valid Sale: School District: COUNTY Plat Book/Page: Elementary School: BALLS CREEK Legal: Middle School: MILL CREEK Calculated Acreage: 1.230 High School: BANDYS Tax Map: 003 K 03014 Township: CALDWELL School Map State Road #: 1815 TaxNalue Information: Tax Rates Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: BANDYS Zoning1: R-40 Building(s) Value: $188,600 Zoning2: Land Value: $21,500 Zoning3: Assessed Total Value: $210,100 Zoning Overlay: WP-O Year Built/Remodeled: 1966/ Small Area: SHERRILLS FORD Tax Revaluation 2023: Info, COMPER Split Zoning Districts: / Online Appeals Zoning Agency Phone Numbers Valid Sales (COMPER) for this parcel Contact Tax Dept. at 828-282-2009 Current Tax Bill Miscellaneous: Firm Panel Date: 2007-09-05 Building Permit Address Search for this parcel. Firm Panel #: 3710367800J If available, Building Permits for this parcel. Septic 2010 Census Block: 2018 links are not permits. 2010 Census Tract: 011501 Septic Final Permits prior to 08/2018, contact Agricultural District: Environmental Health. Building Details WaterShed: WS-IV Protected Area Voter Precinct: P1/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 #,-PO CATAWBA COUNTY tip � 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT PHONE:828.465.8399 Thursday,April 13,2023 18 42 sm www.catawbacountync.gov PAYOR: Black,Tyler PAYMENTS TRANSACTION NUMBER: TRC-61760450-13-04-2023 PAYMENT DATE: 04/13/2023 PAYMENT TYPE: Cash INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 04-23-421164 110-580200-663000 Well Permit&Inspection Fee $300.00 TOTAL PAYMENTS: $300.00 EHPR-04-2023-44031 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 4718 LITTLE MOUNTAIN RD,CATAWBA NC 28609 Applicant TYLER BLACK,4718 LITTLE MOUNTAIN RD,CATAWBA NC 28609 C:8285147699 BLACK.TYLER514@GMAIL.COM **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 04/13/2023 08:18 Page 1 of 1