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HomeMy WebLinkAboutEHPR-10-2023-45701.tif catawba county public health ti-WR-10-)0)3-/670 I Application for Environmental Health Services 3 THIS IS NOT A PERMIT 1 Application is for: ❑New Construction liS1 Existing Facility NI Improvement Permit D 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 ZSc3 J Acres S-2- Subdivision W j Lot#3.6C7O7 ts65-73 Driving Directions to Property 1)24-2) Tr Ea+.-t- of Describe work iG n k £vujuw4-.t.z„, „ Applicant Name5 � 1 S Applicant Address gj 6 (� , , y ,,4 . Sc4„-?- . 3.10 Phone cZZit)• Z77-co79 Email G,42u/y..-GSQc4i Develop Cciabk 1o0 Owner Name ,t4f) lJG fLP c/o JQ. c.o,..ti O ) Owner Address // et FI tvc, 13 e y o j uiA 12 3 d Phone Cf' c'j Zc-K—Sur) Email1Jh 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 roject Description Stru a Dimensions,also specify dimensions of decks&porches (Choose ❑Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basem Yes ❑ No Retaining Wall> ' ❑ Yes 0 No Accessory Dwelling ew Bedrooms*t #of Occupants Structure Dimensions (Choose One) ❑Basement awl Space ❑ Slab If Basement,Will There Be Water g Fixtures In Basement ❑Yes 0 No Retaining Wall>2' ❑ Yes ❑ No Accessory Structure(s)Describe Structure(s)Dimensions Plumbing ❑Yes ❑No Describe Plumbing Needed (Choose One) ❑Basement ❑Crawl Space ❑ Slab asement, • ' ere Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' ❑ Yes ❑ No Multi-Family Residence #of A ents #Bedrooms per Apartment*t Total#Bedrooms in re*t #of Occupants Stn:eture Dimensions (Choose On asement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes R mg Wall>2' ❑ Yes ❑ No Well Construction/Abandonment/Repair Prposed Well Type ❑ Individual Well ❑ Semi-Public Well ❑Community Well Abandonment Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested CIYes Will • ater me or Electrical Line from Well ea es o �� Environmental Health Catawba County Government Center, 25 Government Drive I P0. Box 389, Newton, NC 28658 Phone: (828)465-8270 I Fax: (828)465-8276 I EHAdmin@CatawbaCountyNC.gov • CA%��G THIS IS NOTA PERMIT Case# EHPR-l0-2023-45701 a CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Ig su Environmental Health Plan Review-OSWP IMPROVEMENT Applicant CHILD DEVELOPMENT SCHOOLS,816 CAMARON ST 3.10,SAN ANTONIO TX 78212 B:2242775078 CBARNES@n CHILDDEVELOPMENTSCHOOL.COM Paid By BRYAN MOSTER,50 W 5TH ST,CINCINNATTI OH 45202 NAME TO APPEAR ON PERMIT Child Development Schools SITE ADDRESS: 2853 WATER PLANT RD,MAIDEN NC 28650 PIN# 365702856573 NAME of SUBDIVISION: Lot r4 2 Section/Block PROPERTY SIZE: Square Feet 196,891.20 Acres 4.52 DIRECTIONS: S NC 16 Hwy,right Providence Mill Rd,left Water Plant Rd,on right before Davis Rd PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 945 WATER SUPPLY: Public Water DESCRIBE WORK: IP only to designate repair area building 3 55 children and 8 employees. no applicances in building 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? Yes Property Easements Description: septic and access easement APPLICATION FOR: Existing Structure STRUCTURE TYPE: **NO STRUCTURE SELECTED** FACILITY TYPE: Day Care OTHER DESCRIPTION: DESCRIPTION OF daycare EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 119 x 286 NUMBER OF EXISTING BEDROOMS: I OF OCCUPANTS: PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES: 8 SEATING CAPACITY: TOTAL FLOOR SPACE(SQ FT): Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: ehapplicat, ,, 10/10/2023 10:28 Page I of3 • 1�+. CATAWBA COUNTY Case# EHPR-10-2023-45701 Public Health Department F '�'� 2 Subdivision d Environmental Health Division PIN# 365702856573 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 NAME ON PERMIT: CHILD DEVELOPMENT SCHOOLS ( ),816 CAMARON ST 3.10,SAN ANTONIO TX 78212 Child Development Schools ( ) Site Address: 2853 WATER PLANT RD,MAIDEN NC 28650 Property Size: Square Feet 196,891.20 Acres 4.52 Directions: S NC 16 Hwy,right Providence Mill Rd,left Water Plant Rd,on right before Davis Rd 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 AREA2 FEENAME DATE FEE AMOUNT Improvement Permit Fee 10/10/2023 $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) eltapplicat n 10/102023 10:28 Page 2of3 • catawba county public: health Application for Environmental Health Services r Jl THIS IS NOT A PERMIT IGI Application is for: —O New Construction J Existing Facility - _� ®Improveme— nt Permit ❑ Authorization to Construct New Septic ❑Septic Repair/Malfunction ❑Septic Relocation ❑Septic Expansion ❑Existing System Inspection or Reconnection J1 New Well ❑Replacement Well Well Abandonment 0 Well Repair Property Address Z.�, Ll1t- ,r iii7 arct Koo,5 Acres Subdivision Let# Driving Directions to Property Describe work ♦ Applicant Name C ift c-I2 i f P.6 pr jlHvot-� Applicant Address 0/6 cA!haft 4 i . 5-1111 Iv Phone (22c•) 2 77 -Sv 78 Email CN / fwr z.er/ v-,M-t(i tzar • Owner Name /Yl/1e N41 „ t /' G/a 72FF472,3Y bvzer fU� Owiner Address 1/9 q g— lATh t Aid 7L1i/fz S. CA 2/3o Phone 6 SS?,' ) 2 EY - .) Email hiLApc FtI2-ne/ Ak1'/j r' -. /eit, I 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 0 New Residence 0 Addition to Residence #of New Bedrooms•t_ #of Occupants Project Description Structure Dimensions,also specify dimensions of decks&porches ((loose One) ❑Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In B• •. .t ❑Yes ❑ No Retaining Wall>2' 0--Yes....0 No Accessory Dwelling #of New B 'f __ #of Occupants Structure Dimensions (Choose One) ❑Basement Q Crawl Space 'lab If Basement,Will There Be Water Using F ures In Basement ❑Yes ❑ No Retaining Wall>2' 0 Yes 0 No Accessory Structure(s)Describe _ \ Structure(s)Dimensions Plumbing ❑Yes ❑No Describe PIumbing Needed � _ (Choose One) ❑Basement 0 Crawl Space ❑ Slab If Basement, 'i I. Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' ❑ Yes ❑ No Multi-Family Residence #of Apartments #Bedrooms per A. • ent'f- Total#B-Fth,00ms in Structure•fi #of Occupants— Structure Dimensions ` I (Choose One) 0 Basement 0 Crawl Space 0 •• If Basement,Will There Be Water Using Fixtures In Ba ernent ❑Yes ❑ No Retaining Wall>2' ❑ Yes-❑ . • Well Construction/Abandonmeat7Repair Proposed Well Type ElIndividual Well Semi-Public Well _- ❑Com aitv�ell Abandonment Type ❑ Drilled ug ❑ Unknovvn Well Repair Requested ❑Yes 0 No Describe__-----``Z Will Certified Well Contractor Install Water Line or Electrical Line from Well He:aic -issue 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 J Existing Structures on Site Describe c,C_..__Cac,i Structure Dimensions /A #of Bedrooms AO, #of Occupants AOC Basement 0 Yes ® No Basement Plumbing ❑Yes ® No — I Existing Water Supply 0 Individual Well 0 Shared Well—Number of Connections_ __.__,_ . 0 Community Well 0County/City/Township Water Line 1 Is a public water supply available?•• ® Yes ❑No Commercial ❑Proposed New Construction ❑Existing/Change of Use ❑Repair Food Service Specify Type SC(V.C.L'fa_t,~, c.r_ODYA[s4..______ #Seats Dining Area(Sq.Ft.) #Employees per Shift #of Shifts - Church #of Sean _ _ Daycare❑Yes ElNo #of Children__ #of Employees per Shift #of Shifts__ ___ Commercial Kitchen ElYes ❑No Residential Kitchen ElYes ElNo '7 Daycare#of Children. _-`S #of Employees per Shift`_e- #of Shifts_ /______ — Business/Other Specify Type__ Structure Dimensions___-_ _-._-- Retail Floor Space_ #of Employees per Shift ��,f/ #of Shifts _ _ l Other Information- 11!1k c p i f iL1 u c /4 i h. 'IL:S 17'4 it�i -_ - _- -- -- Calculated Design Flow,Commercial t (This value will be determined by EH staff) r, 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. 1 0 Ycs l,$No Does the site contain any jurisdictional wetlands? RI Yes 0 No Does the site contain any existing wastewater systems? D Yes i3 No Is any wastewater going to be generated on the site other than domestic sewage? 1 ❑Yes fig-No Is the site subject to approval by any other public agency? Vd Yes 0 No Are there any easements or right of ways on this property? Describe S.via L d- AG if FA-M.p-.6 -( 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 Vtonventional 0 Innovative 0 Other__ ___ ❑ 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,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 may be revoked if the information on this application/site plan changes or if the intended use for the proposed facility changes. Permits may bo 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 arc 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 a e f tfre-t7wRE . Signature of Owner or Legal Aged# ��_ —� _ Date ld /2 7 i Printed Name of Owner or Legal A C ieA, f J Catawba County Environmental Health 'srL.`6) \ to* s28533 \P' V.A\ ..---''' % is2845 -."'—\\..---11\ ,... . r 7: ------'-'-'----'-- L., \ _,,a • W 13 J p co 'C'----..-2:311 c*--\ \,,- c---'-'"--'—'11% 1.--"----\ ----'rf co 0 11 Piir hpkr, dd; 1 I ` 39t 20 ; li I ,r: ' 0tl Tr i Ili 1 i',1IC4 Nqi I�3 ,:r II .I �II , 3 i :i1t it 'lii,'f �I '1.0 t ,, ,„ ' ill' I lhl ;, 4,1011I i,;ll 1+ i' .ly wil l; I, 41 i6 1 11 1 i U ,`IlrIli III it I Ilr,.., i i lI I l',;'1 I I I� tI:IF' Parcel: 365702856573, 2853 WATER PLANT RD 1 in=100ft MAIDEN, 28650 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 10/10/2023 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 365702856573 Owner: MDC NC1 LP Parcel Address: 2853 WATER PLANT RD Owner2: City: MAIDEN, 28650 Address: 11995 EL CAMINO REAL LRK(REID): 7124 Address2: Deed Book/Page: 3805/1145 City: SAN DIEGO Subdivision: State/Zip: CA 92130-2539 Lots/Block: 2/ Last Valid Sale: $1,315,000 on 2023-04-21 School Information: School District: COUNTY Plat Book/Page: 83/102 Elementary School: TUTTLE Legal: Middle School: MAIDEN Calculated Acreage: 4.520 Tax Map: 007 K 06005A High School: MAIDEN Township: CALDWELL School Map State Road #: 1874 TaxNalue Information: Tax Rates Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: MAIDEN RURAL Zoning1: R-40 Building(s) Value: $510,300 Zoning2: Land Value: $32,400 Zoning3: Assessed Total Value: $542,700 Zoning Overlay: Year Built/Remodeled: 1984/ Small Area: BALLS CREEK Tax Revaluation 2023: Info, COMPER Split Zoning Districts: / Online Appeals Zoning Agency Phone Numbers Valid Sales (COMPER) for this parcel Contact Tax Dept. at 828-465-8436 Current Tax Bill Miscellaneous: Firm Panel Date: 2007-09-05 Building Permit Address Search for this parcel. Firm Panel #: 3710365700J If available, Building Permits for this parcel. Septic 2010 Census Block: 5000 links are not permits. 2010 Census Tract: 011602 Septic Final Permits prior to 08/2018, contact Agricultural District: PROXIMITY Environmental Health. Building Details WaterShed: Voter Precinct: P9/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. AIQ '' 2100 f CATAWBA COUNTY HEALTH -DEPARTMENT PERMIT # COMPLETIQN PERMIT OWNER OR CONTRACTOR: � /7Q_, DATE: 6-1/47 ADDRESS: f lgf ouer _f ' C PHONE: LOCATION: 7..� ate+ Xd `y..' s'-- - - 11---te4‘.. ,......42_,g..- .._-01(t/-:(-27:-7,(--649_..Zi,r- 5 f SUBDIVISION: LOT : SECTION BLOCK: LOT SIZE: House ( ) Mobile Home ( ) Business ( Other ( ) Flow Rate: gpd Bedrooms: Bathrooms : Special Fixtures : Other: Basement - Yes ( ) No ( ) Fixture in basement-Yes ( ) No ( ) Garbage Di p sal Unit: Yes ( ) No ( Water Supply: Private ( Public ( ) TANK SIZE:12_) ?�Q gallons Distance from septic tan or nearest source of NITRIFICAT ON F ELD: , / pollution: Number of lines: G� FINAL APPROVAL OF THIS SEPTIC TANk SYSTEM SHALL IN Length and width of lines NO WAY BE TAKEN AS A QUARANTEE THAT THE SYSTEM WILL (a) Bed System FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF (b) Trench System 36" x /L 7' TIME. or Trench Sys. 30" x DATE INSTALLED: 2j— _ , Total Sq. Ft. / Dept o Stone)" INSTALLED BY: " q C7 REMARKS: SANITARIAN: C ‘04 „-x-afli,a_, SITE AND SEPTIC TANK LAYOV` • _ . . i 1,1k\ `j pfl 5--Ti 1'� i Nue N --- 1 � 1 day P6)�k� � t 1 \ 'fr" 1 r j ] ou HEALTH DEPARTMENT COPY 1 ji T� RI PERMIT NO. '�4 4` J //,',2e,,,,.- -PERMIT FEE: G _PERMIT' VOID AFTER 36 MONThS CATA UNTY HEALTH DE TMENT IMPROVEMENT PERMIT S OWNER OR •/ Y' t/ 74 �: C'O t • DATE: ,5 `-- 7 o ADDRESS: • e D .QS P�yr 5'.•'r24,-t PHONE: LOCAT ON: �. , ado 0 - 2-A"_' SUBDIVISION: LOT 1E SE ION OR BLOCK: LUIS SIZE: Notified to check with Zoning Yes ( ) No ( oning Approval l/ House ( ) Mobile Home ( ) Business ( Other ( ) Flow Rate: ,® 5-' gpd Bedrooms: Bathrooms: Special Fixtures: Other: Fixtures in Basement - Yes ( ) No ( ) Pump System Yes( ) No ( Basement - Yes ( ) No ( ) ,. Garbage Disco 1 Unit Yes ( ) No ( 1.- Water Supply: Private ( ) Public ( °) TANK SIZE: t, /�SJO D gallons Comments/Special Instructions: NITRIFICATI ELD: . . Number of Lines Length and width of Lines System must be installed as shown` Any • -a. (a) Bed System / changes will be made only with prior Health (b) Trench System 36" x )( /7 Department approval. If unforeseen problems or Trench System 30" X arise during installation, contractor must Total Square Footage, ePtil._Qf_ .QUE_ call Health Department. I •CERTIFY THAT I REVIEWED AND AGREE TO THE P VI IONS TIZ/ghMIT. J i) j } Owner Sanitar' Final approval of this septic tank system shall in no w be taken a uarantee that the system will function satisfactorily for any given perio` of time. li SITE AND SEPTIC TANK PLAN 6 ki ,I 11;4.<1-------- ---'---------------A k. i it . .. ,:- 1 �-" �1 1,I ,' I `�w ' . IL it I i I, ..... ,...; I V LHealth Department Copy So Site Factor: soil Group Soil Texture Class Application Rate Slope and Landscape Position PS - U Soil Drainage if. PS - U Sandy Clay Soil Depth 101P-� PS - U III Fine i oam 0.6-0.4 J Restrictive Horizon - PS - U Loams Clay Loam Available Space �� PS - U Silty Clay Other S y .PS } U Sandy Clay (Specify) Soil Characteristics: PS, - U., - IVa" Clays Silty Clay 0.4-0.2 Required: Yes (G' No ( ) Clay ii:Repair_Area *Bed systems are allowed only in soil Gxouo III. 9 M - . h % CATAWBA COUNTY HEALTH DEPARTMENT NEWTON, NORTH CAROLINA COMPLETION PERMIT FOR SEPTIC TANKS !� PERMIT N° 1205 4 `,11\e �fYFf__ DATE : 6_ 3_, R'L1 OWNER /2„el,.7,64_, I,C,A-497e,s(1,,e1 ADDRESS BUILDING CONTRACTOR SUBDIVISION LOCATION ee., Tr. LOT # LOT SIZE BLOCK OR SECTIO HOUSE ( ) MOBILE HOME ( ) BUSINESS OTHER ( ) FHA-VA LOAN ( ) SEPTIC TANK: (SIZE /mod GALS) WATER SUPPLY: NO. BEDROOMS NO FIXTURES INDIVIDUAL PUBLIC GARBAGE DISPOSAL UNIT:YES ()NO ( ) IF WELL, TYPE: BORED DRILLED DUG AUTO WASHING MACHINE: YES ( ) NO ( ) DISTANCE FROM SEPTIC TAtiK OR NEAREST NITRIFICATION FIELD: /6,C949 SQ.FT. POLLUTION: -4 FT. 1) NUMBER OF LINES SEPTIC TANK STALLED $.Y , 2) LENGTH AND WIDTH OFtINES c (,7) , I r0 K , C ° PERMIT FEE7:2_47 a) BED SYST ( ) CERTIFI E ' OLETI BY: b) TRENCH SYSTE' ( ) lJ . 3) DEPTH OF STONE IN LINES / REMARK _ ADEQUATE FALL (GRADE) ON: 1) BUILDING (HOUSE) SEWER LINE: YES ( NO ( ) 2) NITRIFICATION LINES: DATE INSTALLED: 6- ' q— i[.T YES (2/NO ( ) „� `___--- �` —� SEPTIC TANK LAYOUT IC ► J �. -- c itPa,r f d,., 13 H / EII7! o E-+ 4 a o D 1 (( • 7,...---- ---.......s. . 4 HEALTH DEPARTMENT COPY .4 ti� 1 A.S.qpreL ITY HEALTH DEPARTMENT ►;z„f' �tY9' 77/121 RO MENT,P Rt•S T 4 pc,ilq At .. i .... e .,FOR SEPTIC TANKS • Permit I�'o. Ci)642 14773 NA:'EOF' 0 DATE P - ���-- WI DRESS OF OWNER // / 8 3 6 e- at..1 / PHONE I) NAME OF CONTRACTOR ADDRESS 1) f J LOCATION 4; 7" 'dA A a is-Tr6erie/ if..cflop.e.--0 ...._ .)I ) SUBDIVISION LOT NO. SECTION OR BLOCK • '1 LOT SIZE FHA, VA LOAN -d '1HER Septic Tank Contractor must f'llow all ( HOUSE ( ) MOBILE HOME ( ) BUSINESS ( ) Details of this permit (layou ) . NO. BEDROOMS ( ) NO. FIXTURES ( ) SEPTIC TANK LAYOUT J GARBAGE DISPOSAL UNIT: YES ( ) NO ( ) ` S PLUMBING UNDER B EMENT FLOOR: YES ( ) NO ( ) '� — - 'v.", � - .‘ j SIZE OF TANK —0 C) LIQUID GALLONS ' • 4k NITRIFICATION FIELD:I. `_( 1. Number of lines <A . 3 �t , 2. Length and width of li nes; l a. Bed System ft./ 000 t b. Trench system ft. -9?F4' c ' 3. Total Depth of stone 1;2_ inches o.,; GROUNDWATER INTERCEPTOR DRAIN: \\ . (IF REQUIRED) :�. WATER SUPPLY: PRIVATE PUBLIC ( ) . 0 OWNER NOTIFIED TO CHECK ZONING: YES NO ( ) • OWNER AGREES WITH LAYOUT: YES (-) , OWNER AGREES WITH SPECIAL INSTRUCTIONS: YES (6_21C_(r-) I (. .- -----Th'.- • OWNER OR CONTRAC OR SIGNATUR / , PERMIT FEE $ I/C/d-(„/ C PERMIT VOID AFTER 36 MONTHS LMPROVEtiEN fIT I ED 6;;: . ��0 SANITARI -1 HEALTH DEPT. COPY SOIL CLASSIFICATION: SUITABLE ( ) PROVISIONALLY SUITABLE (if UNSUITABLE ( ) SITE FACTORS: 1. SLOPE (Z) S -- PS - U 7. SOIL PERMEABILITY S - PS - U 2. SOIL TEXTURE (12-48 IN.) S - PS - U UNDER 60 MIN. - OVER 60 MIN. SANDY, LOAMY, CLAYEY 8. OTHER S - PS - U 3. SOIL STRUCTURE (12-48 IN.) S - PS - U (SPECIFY) 4. SOIL DEPTH (IN.) S• - PS - U 9. SOIL SERIES: 5. RESTRICTIVE HORIZONS (IN.) S - PS - U A. CECIL ( ) B. HIWASSEE ( ) (IMPERVIOUS STRATA, ROCK) C. MADISON ( ) D. APPLING ( ) _ i, SOIL DRAINAGE - GROUNDWATER S - PS - U E. PACOLET ( ) F. FLOOD PLAIN ( ) (EXTERNAL - INTERNAL) G. 2-1 CT AY SOIL H. OTHER-SPECIFY t // fi i.. .ram (4.? OPERATIONS PERMIT FOR TYPE III WASTEWATER SYSTEM PERMIT NUMBER 2000-00276 In accordance with the provisions of Article 11 of Chapter 130A, General Statutes of North Carolina as amended, and other applicable Laws and Rules PERMISSION IS HEREBY GRANTED TO Dennis Lawrence Scronce operation of a wastewater collection, treatment, and disposal system to server---PIN 3657-0285-6573 pursuant to 15 A NCAC 18A 1900 et seq and in conformity with the application, improvement permit, and other supporting data subsequently filed and approved by the Catawba County Health Department and considered a part of this permit Facilities to be served (Address and specific type of facility) 2853 Water Plant Road System Type IIIA Maiden NC 28650 The approved wastewater collection, treatment, and- disposal system - consists of (1) 2000 Gallon Septic Tank (2) 2500 Gallon Pump Tank (3) Zoeller N-140 Effluent Pump (4) NEMA 4X control box (5) 2" supply line to 4" pressure manifold (6) 1667 linear feet of drainline with 12" stone The owner shall be subject to all applicable provisions of Article 11 of Chapter 130A of the General Statutes and 15A NCAC 18A 1900 et seq The owner is especially referred to Rules 1935 (31) , 1937 (e) , 1938 (g) , 1945 (a,b) , 1950 (a through i) , 1961 (a through d) , 1965, 1967, and 1968 The owner shall also be subject to the following specified conditions and limitations as they apply I GENERAL CONDITIONS This permit is effective only with respect to the number and type of proposed facilities and volume and nature of wastes specified p\�? \\ ATAWBA COUNTY HEALTH DEPART NT '-,y caz76 Telep ne (828)465-8 7 TDD (828)465-8200 905-° No 9 fl Q 7 IP a X. Rpr Prmt. Opr Prmt. Sys Type .. Well Pi-mt. Replacement Well t Well Rpr Prmt. P P Owner/Agent 0 „ .a uc SCi.owl� Phone Address 2ir5 <ify-r QA Subdivision iticti citti NC/ - e io /Blo k/Phas c lift# Lot Siz D'rect'o s / Q.• S ) 40 J Property Address �. :�. ►��� '� Facility. e , Mobil- Ho Business An .M I i-family Other Pin Number 3arr r,: ._ Other . l l L f, - t35 r Zoning Approval# 2/ „��tt// / k e #Bedrooms _# Seats #Employees - Application Rate , '7 GPD Flow /2{7 Hot Tub or Spa ye• no a ial Fixtures Basement ye 4i"� 100% Repair Area yes/no Basement Plumbing • Water Supply. Private Well Public Semi-Public Type of System: Trench Bed Pump Pump/Panel Panel LPP__ Other is Septic Tank Size 250 Pump Tank Size Z5 C Nitrification Field. Total Square Feet U Depth of Stone , z �` t, Bed Size rench Width •"10 Total Length of All Trenches /. 67 • mber of Trenches ry ji Trench Length 'N' /° / / Feet on Center Maximum Trench De.th Z(-L Z ►istance of Nearest Well *DO NOT INSTALL SEPTIC WHEN WET* *WEL- l _e. 'i REQUIRED AT COMPLETION* ********************* ******************************# **************************************** ********************** Top % Slope ,�dS t n tl d iu rru - (o(vd `'�`' S 26a /_ I_ Texture SU - .t;lS; Qtf P()i -a! Structure it ri FL/u1f rur, Clay Min. Soil Wetness " - 4 •-ke iit4U" h,e)-- 1 eil - 2S(� -r'} Soil Depth 4 •D [ _ 41� �.� Restric Hoz. at " 12 Cireti. , -' kli T Available space yes/no arVil Overall Class S PS U _, i��`�" ' 00 Comments. , 1 ``` ((fl�1J \0 / 0 _ f/ - awl, 1(14 , , ifitil_MAL ...-- ,...._ L___ .....,..-- 165___-- - i ,__ 0—i tO,,l- V Civ.-"-/ _-----'- ...- _ _____J-- ...- . ----- ,j_6---_____ \)(im'it ‘,6\ gS Clilitl_t i os--- ____05------- -2_0d I e 9,.- .t. 1 t17 S [ .. !- ,, - Filter Required Riser required when tank is more than 6 jy t/ inches deep. !l di[ Wil4 W 11 ' **NO GUARANTEE OR WARRANTY t D OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** f°-1 (10-a *********************** ************************************************************************************************* *Improvement has no expiration date and is transferable,but may be revoked if site plans or intended use changes for the proposed fab"" t Authorization to Construct is valid for(5)five years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location,installation,and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. The siting of the well by the Health Department staff is to provide protection from know possible sources of contamination. No volume of water is guaranteed at.ny site by the ealth Department. Permit Date, r / O / EHS � Own, �; Septic Tank Ins it d W IJ At le, CelPill Date Ob.-0-41 EH' `M' II Well Installed By_ Well Grout Approval Date Well He lat val Da e+ Date Sample Collected Date of "-suits Results EHS White-Office Blue-Building Inspection Operation Permit Yellow-Owner/Agent Green-Building Inspection Authorization to Construct ; �$A • CATAWBA COUNTY 5 41 '} 100A SOUTHWEST BLVD ` NEWTON,NORTH CAROLINA 28658 RECEIPT VK ° PHONE:828.465.8399 Tuesday,October 10,2023 1842 sM www.catawbacountync.gov PAYOR: Moster,Bryan PAYMENTS TRANSACTION NUMBER: TRC-75094094-10-10-2023 PAYMENT DATE: 10/10/2023 PAYMENT TYPE: Credit Card 311767729 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 10-23-429092 110-580200-663000 Improvement Permit Fee $150.00 TOTAL PAYMENTS: $150.00 EHPR-10-2023-45701 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 2853 WATER PLANT RD,MAIDEN NC 28650 Applicant CHILD DEVELOPMENT SCHOOLS,816 CAMARON ST 3.10,SAN ANTONIO TX 78212 B:2242775078 CBARNES@CHILDDEVELOPMENTSCHOOL.COM Paid By BRYAN MOSTER,50 W 5TH ST,CINCINNATTI OH 45202 **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 10/10/2023 10:27 Page 1 of 1