HomeMy WebLinkAboutRBPR-10-2023-45913.TIF �G THIS IS NOT A PERMIT Case# RBPR-10-2023-45913
d CATAWBA COUNTY HEALTH DEPARTMENT
(-7- './ PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES
\8A/ Residential Building Plan Review-Building Alteration
AUTH CONST- EXPANSION- IPa2 Permit Fee
AA St d
Owner CHAD HOWARD,7144 LYNBROOK CREEK RD,DENVER NC 28037
C:7046224670 CHOWARD0731@HOTMAIL.COM
NAME TO APPEAR ON PERMIT
Chad Howard
SITE ADDRESS: 7144 LYNBROOK CREEK RD,DENVER NC 28037 PIN# 460605184020
NAME of SUBDIVISION: CRESCENT LAND AND TIMBER CORP Lot# 50 Section/Block
PROPERTY SIZE: Square Feet Acres 1.05
DIRECTIONS: S NC16 Business Hwy,Left Campground Rd, Left Catawba
PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank
GALLO, • - - •_Y: 480 WATER SUPPLY: Private Well
•ESCRIBE WORK: , 11/28/23 revised a2 IP received **A2 IP, County Issued AC**Finish Existing Unfinished Basement 2
Bedrooms,2 Baths&Kitchen from Zoning&speaking with Mr Howard-Expanding Septic***Zoning Permit not
required as long as project remains Single Family detached Unit
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? Yes
Are there any easements or right-of-ways on this property? No
APPLICATION FOR: Existing Structure
STRUCTURE TYPE: . PRIMARY RESIDENCE
FACILITY TYPE: Single Family Residence OTHER DESCRIPTION:
DESCRIPTION OF 95x68 SFD 2 bedrooms, Unfinished Basement
EXISTING STRUCTURES
ON SITE(IF ANY)
DIM EXISTING STRUCTURE: 95x68
NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 4
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: Fin Basement 2 Bedrooms,2 Baths,Kitchen
#OF NEW BEDROOMS:: 2
BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED?Yes
Desired system types(Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL:
OTHER: INNOVATIVE: ANY:
Other described:
ehapplicauom 11/28/2023 10:03 Page 1 of 3
Permit#:
a '' ' ROY COOPER •Governor
lic.,,' ; , •• NC DEPARTMENT OF KODY H. KINSLEY•Secretary
`� ; `I I• ;�, HEALTH AND MARK BENTON•Deputy Secretary for Health
HUMAN SERVICES
-. .: SUSAN KANSAGRA•Assistant Secretary for Public Health
Division of Public Health
Submittal Includes: ❑� (a2)Improvement Permit ❑(a2)Construction Authorization ❑ Fee$
IMPROVEMENT PERMIT FOR G.S. 130A-335(a2)
County: Catawba
PIN/Lot Identifier: 460605184020
Issued To: Chad Howard
Property Location: 7144 Lynbrook Creek Rd
Subdivision(if applicable) Lot#: 50 Block: Section:
LSS Report Provided: Yes❑✓ No❑
If yes,name and license number of LSS: Miranda Stamper, 1258
New❑✓ Expansion E System Relocation ❑ Change of Use ❑
Proposed Structure: Expansion of septic system
Number of bedrooms: 4 Number of Occupants: 8 Other:
Design Wastewater Strength:0 domestic ❑high strength ❑industrial process
Proposed Design Daily Flow: 480 GPD Proposed LIAR(Initial): 0.375 Proposed LIAR(Repair): 0.15
Proposed Wastewater System Type*: 25%reduction chamber (Initial) Pump Required: ✓❑Yes ❑ No ❑May be required
Proposed Wastewater System Type*: subsurface drip (Repair) Pump Required: Q Yes ❑No ❑ May be required
*Please include system classification for proposed wastewater system types in accordance with 15A NCAC 18A.1961 Table V(a)
Saprolite System(initial):❑Yes ❑✓ No Saprolite System(repair):❑Yes 0 No
Fill System(Initial):❑Yes ❑✓ No If yes,specify:❑New ❑Existing (when adding more than 6 inches of fill to system area provide a fill plan)
Fill System(repair):❑Yes ❑✓ No If yes,specify:❑ New ❑ Existing (when adding more than 6 inches of fill to system area provide a fill plan)
Usable Soil Depth(Initial): 48 __ Usable Soil Depth(Repair):25
Max.Trench Depth(Initial)': 33" Max.Trench Depth(Repair)t: 6-8" *Measured on the downhill side of the trench
Artificial Drainage Required: ❑Yes ❑✓ No If yes,please specify details:
Type of Water Supply: ❑✓ Private well ❑Public well ❑Shared well ❑Municipal Supply ❑Spring ❑Other:
Drainfield location meets requirements of Rule.1945: Yes No❑ Drainfield location meets requirements of Rule.1950: Yes❑✓ No❑
Permit valid for:0 Five years[site plan submitted pursuant to GS 130A-334(13a)] ❑No expiration[plat submitted pursuant to GS 130A-334(7a))
Permit conditions:
See Design
Licensed Soil Scientist Print Name: Miranda Stamper
Miranda Stamper Digitally signed by Miranda Stamper
Licensed Soil Scientist Signature: p Date:2023.10.05 13:26:22-04'00' Date:
The LS5 evaluation is being submitted pursuant to and meets the requirements of G.S.130A-335(a2).
*See attached site sketch* RECEIVED
NC DEPARTMENT OF HEALTH AND HUMAN SERVICES • DIVISION OF PUBLIC HEALTH
LOCATION:5605 Six Forks Road,Building 3,Raleigh,NC 27609 NOV 2 8 ?023
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 Environmental Health
Permit#:
This Section for Local Health Department Use Only
Initial submittal received: by
Date Initials
G.S. 130A-335(a3)states the following:
When an applicant for an Improvement Permit submits to a local health deportment an Improvement Permit application,the permit fee charged by the local health
department,the common form developed by the Department,and a soil evaluation pursuant to subsection(a2)of this section,the local health department shall,
within five business days of receiving the application,conduct a completeness review of the submittal.A determination of completeness means that the improvement
Permit includes all of the required components.If the local health department determines that the Improvement Permit is incomplete,the local health department
shall notify the applicant of the components needed to complete the Improvement Permit.The applicant may submit additional information to the local health
department to cure the deficiencies in the Improvement Permit.The local health department shall make a final determination as to whether the Improvement Permit
is complete within five business days after the local health department receives the additional information from the applicant.if the local health department fails to
act within any period set out in this subsection,the applicant may treat the failure to act as a determination of completeness.The Department shall develop a
common form for use os the Improvement Permit.
The review for completeness of this Improvement Permit was conducted in accordance with G.S. 130A-335(a3). This Improvement
Permit is determined to be:
['Incomplete(If box is checked,information in this section is required.)
The following items are missing:
Copies of this were sent to the LSS and the Applicant on
Date
State Authorized Agent: Date:
❑Complete
State Authorized Agent: Date:
This Improvement Permit is issued pursuant to G.S. 130A-335(a2)and(a3)using the signed and sealed LSS/LG evaluation(s)
attached here. The issuance of this permit by the Health Department in no way guarantees the issuance of other permits.The
permit holder is responsible for checking with appropriate governing bodies in meeting their requirements.This permit is subject
to revocation if the site plan,plat,or the intended use changes. The Improvement Permit shall not be affected by a change in
ownership of the site. This permit is subject to compliance with the provisions of the Laws and Rules for Sewage Treatment and
Disposal and to the conditions of this permit.
The Department,the Department's authorized agents,and the local health departments shall be discharged and released from
any liabilities,duties,and responsibilities imposed by statute or in common law from any claim arising out of or attributed to
evaluations,submittals,or actions from a licensed soil scientist or licensed geologist pursuant to GS 130A-335(a2).
Improvement Permit Expiration Date:
*See attached site sketch*
G.S. 130A-335(a2)Common Form 2 V.2023.07
eitimmt,
Permit#:
Re-submittal of Improvement Permit
LHD USE ONLY: This IP resubmittal received: by
Date Initials
The following items are being resubmitted pursuant to G.S. I 30A-335(a3)for issuance of the Improvement Permit:
I, hereby attest that the information required to be included with this re-submittal
Licensed Soil Scientist(Print Name)
is accurate and complete to the best of my knowledge and that the proposed Improvement Permit meets all applicable federal,
State,and local laws,regulations, rules,and ordinances.
Signature of Licensed Soil Scientist Date
The section below is for Local Health Department use after submittal of items noted as missing above.
LHD Follow-up Completeness Review of Improvement Permit
The review for completeness of this Improvement Permit re-submittal was conducted in accordance with G.S. 130A-335(a3). This
Improvement Permit is determined to be:
❑ Incomplete(If box is checked, information in this section is required.)
The following items are missing:
Copies of this were sent to the LSS and the Applicant on
Date
State Authorized Agent: Date:
❑Complete
State Authorized Agent:_ Date:
G.S. 130A-335(a2)Common Form 3 V.2023.07
Olik,il,+4 is+, Permit#:
7144 Lynbrook Creek Ln
This Section for Local Health Department Use Only
Initial submittal received: 1 1/1/2023 by RP
Dote Initials
G.S. 130A-335(a3)states the following:
When an applicant for an Improvement Permit submits to a local health department an improvement Permit application,the permit fee charged by the local health
department,the common form developed by the Department,and a soil evaluation pursuant to subsection(a2)of this section,the local health department shall,
within five business days of receiving the application,conduct a completeness review of the submittal.A determination of completeness means that the Improvement
Permit includes all of the required components.If the local health department determines that the Improvement Permit is incomplete,the local health deportment
shall notify the applicant of the components needed to complete the Improvement Permit.The applicant may submit additional information to the local health
department to cure the deficiencies in the Improvement Permit.The local health department shall make a final determination as to whether the Improvement Permit
is complete within five business days after the local health deportment receives the additional information from the applicant.If the local health department fails to
act within any period set out in this subsection,the applicant may treat the failure to act as a determination of completeness.The Department shall develop a
common form for use as the Improvement Permit.
The review for completeness of this Improvement Permit was conducted in accordance with G.S. 130A-335(a3). This Improvement
Permit is determined to be:
Incomplete(If box is checked, information in this section is required.)
The following items are missing:
1- Apply slope correction to the downhill trench depth for the initial system.
2-Permit type is Expansion not New. 3-Check the a2 IP box and uncheck the a2 AC box on the IP common form.
Copies of this were sent to the LSS and the Applicant on 11/7/23
Dote
State Authorized Agent: Date:
11/7/2023
❑Complete
State Authorized Agent: Date:
This Improvement Permit is issued pursuant to G.S. 130A-335(a2)and (a3)using the signed and sealed LSS/LG evaluation(s)
attached here. The issuance of this permit by the Health Department in no way guarantees the issuance of other permits.The
permit holder is responsible for checking with appropriate governing bodies in meeting their requirements.This permit is subject
to revocation if the site plan,plat,or the intended use changes. The Improvement Permit shall not be affected by a change in
ownership of the site. This permit is subject to compliance with the provisions of the Laws and Rules for Sewage Treatment and
Disposal and to the conditions of this permit.
The Department,the Department's authorized agents,and the local health departments shall be discharged and released from
any liabilities,duties,and responsibilities imposed by statute or in common law from any claim arising out of or attributed to
evaluations,submittals,or actions from a licensed soil scientist or licensed geologist pursuant to GS 130A-335(a2).
Improvement Permit Expiration Date:
*See attached site sketch*
G.S. 130A-335(a2)Common Form 2 V.2023.07