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Home My WebLink AboutEHPR-04-2023-44028.TIF 11 •C THIS IS NOT A PERMIT Case# EHPR-04-2023-44028 C" CATAWBA COUNTY HEALTH DEPARTMENT v ` PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES I; . 2 ski Environmental Health Plan Review- OSWP NEW WELL Applicant TIM WILLIAMS,4163 CASCADE S'l,TERRELL NC 28682 C:704-798-1714 TIMW.MIDS'I'ATF@GMAIL.C)M NAME TO APPEAR ON PERMIT Tim Williams �,�� ,�� •��•�� SITE ADDRESS: 4163 CASCADE ST,TERRELL NC 28682 PIN# 461703120183 ��W NAME of SUBDIVISION: THAD AND HAROLD GABRIEL Lot# PT 12 Section/Block PROPERTY SIZE: Square Feet 16,117.20 Acres 0.37 DIRECTIONS: E NC 150 right Sherrills Ford Rd,right Hob Ln right Cascade St on left PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: New Well previously sharing with neighbor 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: 32 x 32 NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 2 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: APPLICATION FOR WELL CONSTRUCTION — PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO ehapplication 04112/2023 14:20 Page 1 of �� CATAWBA COUNTY Case# EHPR-04-2023-44028 1..4., Public Health Department Subdivision THAD AND HAROLD GABRIEL d ,,, "1 Environmental Health Division d PIN# 461703120183 PO Box 389,100-A Southwest Blvd,Newton,NC 28658 \ I842 w NAME ON PERMIT: (TIM WILLIAMS),4163 CASCADE ST,TERRELL NC 28682 (Tim Williams) Site Address: 4163 CASCADE ST,TERRELL NC 28682 Property Size: Square Feet 16,117.20 Acres 0.37 Directions: E NC 150 right Sherrills Ford Rd,light Hob Ln right Cascade St 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: r! p2_3 Signature of Applicant or Agent //If you need further information or assistan please call 828-465-8270 AREA5 +s*s*+****s+***s*s*+***+*****++*++*********s**ss********s*****s*ss*********+s++*+****+*+++s+*++*ss****+*++ss FEENAME DATE FEE AMOUNT Well Permit& Inspection Fee (14/12/2023 $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) ehapplication 04/12/2023 I4:20 Page 2 of 3 catawba county public health Application for Environmental Health Services THIS IS NOT A PERMIT ,Appiicatiionis;for: New Construction ❑..:Existing.Facility ❑ Improvement Permit ❑Authorization to Construct ❑New Septic ❑ Septic Repair/Malfunction ❑ Septic Relocation ❑ Septic Expansion ❑Existing System Inspection or Reconnection [ ..New Well ❑Replacement Well ❑Well Abandonment ❑Well Repair Property Address `-t/Ca '3 C ifs c ri-de 5 tree t Terrell /VC. 9,8 G£3 a. Acres 4 /3 7 Subdivision Lot# I d Driving,D' ections to Property_T�rry r 1'' '� . i S U �-/- TP cr el l Post D 1 ice : Ai Ake _1st- Ili 1 h l- ow Hob l m , Turn/ Ai h t Or✓ _is c e 5 ti, it tl' //i e cm/ it' f-f Describe work C"t/ W e-I r u;(Ls S d,ivi Applicant Name .T g w1 L fr✓i I/i in 5 Applicant Address 6 Li/(0 3 C )4 5 c,i-d e sire e t refit-// il/G p�,2 Phone 7�� - 7 �- 7l4/ Email Ti v,w, /' 1f5/-n-te �� 9mi-i / .Cavj'I Owner Name Tim L y�/,'�1, n,S Owner Address £l 6 3 C/1s04 tir> S t--re ef- Terrell V.C. .$6 9 - Phone 76`/— 79 8 /71 Email 7"1 rt IV /Yi r`d5t _ '-fe 3/�/4"' I, Cam Contractor Name Contractor Address Phone Email Name to Appear on Permit? 0 Owner ❑Applicant ❑Contractor Who will be the Primary Contact? 0 Owner ❑Applicant ❑Contractor roposed 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 ❑ No Accessory Dwelling #of New Bedrooms*t #of Occupants Structure Dimensions (Choose One) ❑Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes 0 No Retaining Wall>2' El Yes 0 No Accessory Structure(s)Describe Structure(s)Dimensions Plumbing 0 Yes ❑No Describe Plumbing Needed (Choose One) ❑Basement 0 Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' 0 Yes 0 No Multi-Family Residence #of Apartments #Bedrooms per Apartment*t _Total#Bedrooms in Structure*t #of Occupants Structure Dimensions (Choose One) ❑Basement El 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/Abandon,ne t1Rep#sa> r to.: . . Proposed Well Type Individual Well ❑Serm-Public Well 0 Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑Yes ❑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 I EHAdmin@CatawbaCountyNC.gov Existing Structures on Site hired / / Describe Ail 6�U �'/}G hive Lt 1-b ill Structure Dimensions a LI , 5 Gj #of Bedrooms* #of Occupants A- Basement ❑ Yes [�Q No Basement Plumbing ❑ Yes ❑ No Existing Water Supply t°,: ❑ Individual Well KShared Well—Number of Connections c2. ❑ Community Well ❑ County/City/Township Water Line Is a public water supply available?** ❑ Yes [ No Commercial El 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 El Yes El No Residential Kitchen El 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. If the answer to any question is"yes",applicant must attach supporting documentation. ❑Yes g No Does the site contain any jurisdictional wetlands? 0 Yes lit No Does the site contain any existing wastewater systems? ❑Yes Q9 No Is any wastewater going to be generated on the site other than domestic sewage? ❑Yes piNo Is the site subject to approval by any other public agency? ❑Yes IRNo 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 ❑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 bedroom and 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 SYSTEM REDESIGN WILL INCUR AN ADDITIONAL CHARGE(SEE FEE SCHEDULE) Environmental Health soil/site evaluations require digging,augcring,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 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. Signature of Owner or Legal Agent (i(/h1 i_ (/1(/y�2iL�el}y1!/ Date ! —/` —6)0�_ Printed Name of Owner or Legal Agent TI m L... v V f 11, An15 Catawba County Environmental Health //a 00 1_ .4149 'c'p a `--._, ii I/ \--"---_,;(15. C.') `LN. 0 lbFS '00 t .po ''''''N„._ / qo z . f •4155 / N. ; ••416 `" 3, N. If iO 9 / „ ui F i 1, N. s d� �rf /, / / R \ t r •4169 / N`' f u `; OOOf rf •4175 • •tiR• L -.N�� 'TO Parcel: 461703120183, 4163 CASCADE ST 1 in=5Oft TERRELL, 28682 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 03/31/2023 , CATAWBA COUNTY HEALTH DEPARTMENT PERMIT ...,, - .. • .-- 1 "A $20.00 SEPTIC TANK INSPECTION FEE _ MUST BE PAID EEFCRE THE CQMFLET1COMPLETION PERMIT FOR SEPTIC TANKS iMPROVEMERI PEI1Mii CAN L3E TG•icituind Absorption Sewage Disposal System — G. S. 130-13C) N° 3 3 6 4 l OWNER OR CONTRACTOR Ad G-,-77",5 DATE SI 2 7-77 ADDRESS. .. _. . LOCATION.... ..... /7.1d...Z4.__ ._iltiftt_d- fr -- _1 "7 4 -1-- SUBDIVISION NAME LOT NO :CT 10 N.OR BLOCK NO HOUSE .7- (___ MOBILE HOME (. 'BUSINESS ( . .) e. NO. ;BEDROOMS ( ) NO. BATHROOMS ( _) 4%1 GARBAGE DISPOSAL UNITI Yes (.....) No (.....) SIZE,OF TANK____1&.).0_____Total Gallons fronT NITRIFICATION FIELD 43 a J i . Ft. ' WATER .SUPPLY: IRWATE (i) _., fT113j)C ( ) INSTALLED 'BYUk1t4.. . 0/Aletf.)<,_ - - CERTIFICATE OF COMPLETIONBY DATE INSTALLED. . __. .. __. .. . ...__. .._ _. ._.._.. _ Health Department ND 2-74 • /o3a —//: ob CATAWBA COUNTY HEALTH DEPARTMENT Telephone: (704) 465-8270 TDD: (704) 465-8200 Improve. Permit Authorization to Construct_Repair Permitc,,efer. Permit System Type , . Owner/Agent � C, // Phone Address 63�(� (`/3r6.-G91Dr.S1^ Subdivision TetP Ezc. /1 C O� Section/Block/Phase Lot# Lot Size // �� Di /rections: , ACD- O'?S,S' co/v. mc.. - ,'7-JD -sy ,4-d6r- , ,i `s' COMAJF "7r F Alb Q O if `v Cam(-mac s-7- T /L,z- owe" - / 3___ Facility: House Mobile Homed Business . other: Tax Map # Multi-family Other . Zoning Approval # # Bedrooms # Seats # Employees . Application Rate GPD Flow Hot Tub or Spa yes/no Special Fixtures . 100% Repair Area yes/no Basement yes/no Basement Plumbing yes/no Water Supply: Private Well Public Type of System: Trench Bed Pump Pump/Panel Panel LPP Other Tank Size: Septic Tank Size S7774't0 Pump Tank Size Nitrification Field: Total Square Feet 6046 Depth of Stone //e" Bed Size �d/:).CJ.6 1 Trench Width - Total th of All Trenches Number Individual T ch Len / n ' J Trench Depth Dista of Nearest Well 1 *DO NOT INSTALL EN WET* I _ _ Topo % Sl•.e �i f- jiv eCM L�KL Textu e 1 1 I L ,VJ ES _ ct =� 'c—/ alritleil 1 VT"x i 0 i C ay Min. -'_ ` So 1 Wetnes ,_ 1I +I 37-0A/ Soi' Dep •— Rest ic.,4 l " _� Avai e space yes/no Z Ove -1 Class S PS U MN Comments. I -A-----1 y4 - Nci+ /`c-_t /.t✓Teo¢/ 6-6 NW ----5413iLE2 t Fi2 -, **NO GUARANTEE OR WARRANTY IS IMPLIE R GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility. An Authorization to Construct is valid for (5) fi yearsfro ,41at issued and is not transferable. Permit Date /y(�Jvy� ice_— _.._ • Owner/Agent Sanitarian Installed By mbia t pa.J2Vty Date 6-29 -72 Sanitari n White-Office Yellow-Owner/Agent • 2 : 30-, .3 a' 1-1'11-ff L . 6IITE5 CATAWBA COUNTY HEALTH DEPARTM NW1±cE1vED ------ Application for Repair or'Existing Septic Tank MAY 2 3 1997 CATAW3A COUNTY 1 ENVIRONMENTAL HEALTH 1. Permit Re nested By //8 L &, 'ici 5' Business Phone Address 9/6-3 (,ascac t. s� �i-? .l//Ale, ,2.fil,?z Home Phone .9 7J L?96 2. Original owner or builder hen sewage stem was installed and date of installation /)a j% E. C/e/-2Le.s 3. Property Owner /a.// 6. Lel i J � Business Phone Address �// G.3 r a s c a.c)e S�/ 7 11,4C, iS /'Z Home Phone C./7 SV- - ?9 4. Location/Subdivision Lot Section/Block Road Number/Name OS c e\ e 37- Directions to Proyerty: �� - a •f �(� g c ,s �- a?a,'l5' �,�. 01 , .(fir • )lj fir 1-o ill,p�. e.�,/ p ,-,�..A., --,...1 e.-r c1 r• o .S 1� a;l) �' �i Gt o �.a,-.e 'Li'v ('a_s G ei e. 5.-i-s 7t,t A ce i !ci A I ,-O - n r Pe_-".c_ - I e er L e -t . �/ t e 4c.S J 1-}at'S'a �R i'VC tAla! Aa-1,A -.- 414, o r Al •Z r 1 4, ..., , 5. TYPE OF FACILITY: House Mobile Home c—Dimension of Structure „? S/,,. 6 0 Bedrooms ' Basement: yes/0 Water Using Fixtures in Basement: yes/lio No. in Family 2— Hot Tub or Spa yes/ o� MULTIPLE FAMILY RESIDENCE: Units Total Number of Bedrooms DAY CARE: Number of Children RESTAURANT: Seats Square Feet Dining Area Square Feet Foodstand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees 1st 2nd 3rd OTHER: (Specify) 6. Do you anticipate any additions to Facility? yes/ y -- If-so;describe:--- ---- - ---- �✓ - 7. Has any grading, removal, or addition of soil been done to this property? yes/ 7 If so, describe: P 8. Are there easements/right-of--ways recor ed on this property? yes no 9. Water Supply: Individual Well Community Well Municipal I understand that this is a formal application for a lot evaluation and/or Improvement Permit for a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that any permit or report issued as a result of this information will become invalid if it is found to be incorrect or if any changes are made in the lot or the size and location of the proposed facility. Date `j . .2 I — �f 7 _ Signature of Owner or Agent (FOR OFFICE USE ONLY) Repair ✓ Existing Septic Tank Please Contact 6-A,2 y 5'/min O/✓s between 8 am and 9 am Phone "4-63,S4 S)a -7 3 Zoning Approval: yes/no Zoning Approval #: Tax Map # Repair Permit Fee /VC Date Paid 514 3/9 Receipt#•-.. Initial AP Existing Septic Tank Fee Date Paid Receipt# Initial White-Office Yellow-Owner/Agent .4eA co CATAWBA COUNTY IO0A SOUTHWEST BLVD H�" '1111, NEWTON,NORTH CAROLINA 28658 RECEIPT ` + PHONE:828,465.8399 www.catawbacountync.gov V r Wednesday,April 12, 2023 1 g 4'Z sM PAYOR: Williams,Tim PAYMENTS TRANSACTION NUMBER: TRC-61721213-12-04-2023 PAYMENT DATE: 04/12/2023 PAYMENT TYPE: Credit Card 303671034 INVOICE NUMBER ACCOUNT FEE NAME w-. FEE AMOUNT 04-23-421150 110-580200-663000 Well Permit& Inspection Fee $300.00 TOTAL PAYMENTS: $300.00 EHPR-04-2023-44028 .�.�.��•��-.��.� ._..__ CASE TYPE: Environmental I lealth Plan Review WORK CLASS: OSWP SITE ADDRESS: 4163 CASCADE ST,TERRELL NC 28682 Applicant TIM WILLIAMS,4163 CASCADE ST,TERRELL NC 28682 C:704-798-1714 TIMW.MIDSTATEaGMA1L.COM **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 04/12/2023 14:20 Page 1 of I