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HomeMy WebLinkAboutEHPR-11-2023-45932.tif • Permit#: ROY COOPER•Governor }' H P _)(-)c)3 ,�593,) NC DEPARTMENT OF KODY H. KINSLEY•Secretary G H E A L.T H AND MAR BENTON••Deputy Secretary for Health HUMAN SERVICES ( SUSAN KANSAGRA•Assistant Secretary for Public Health Division of Public Health Submittal Includes: EI'(a2)Improvement Permit ' (a2)Construction Authorization ❑Fee$ n ' IMPROVEMENT PERMIT FOR G.S. 130A-335(a2) County: l Dkal.w\4a- PIN/Lot Identifier:yI00q 5(5)"&ict Issued To: V(Z CGCm,S LL- C_ / Property Location: SC.tcjd/L.UrU[,K ;j41bG[rv,5 a.Al SI)e,rril1s ,j �� 028co') 3 •— Lot._1r �1,�1,:. LcxleT Subdivision(if applicable) S nc)c1 1t,brCz'iC.. _ Lot#: - Block: Section: LSS Report Provided: Yes pr No❑ If yes,name and license number of LSS:J.YYvu, 1 Asti deA (LeAc. % -Ik ta2 \ New lEr Expansion ❑ System Relocation ❑ Change of Use ❑ Proposed Structure: cr,x,(n �s�c�t.,l�ia Number of bedrooms: 3 Number of Occupants: (D Other: Design Wastewater Strength:[+domestic ❑high strength ❑industrial process C 5 �. V� . Proposed Design Daily Flow: ��(�} GPD Proposed LTAR(Initial): Proposed LTAR(Repair): - Proposed Wastewater System Type*:ff'131 1_, , 33 rt (Initial) Pump Required: Eries ❑No ❑May be required Proposed Wastewater System Type*: P ,25- (Repair) Pump Required: lErces ❑No ❑May be required *Please include system classification for pr posed wastewater system types in accordance with 15A NCAC 18A.1961 Table V(a) Saprolite System(initial):❑Yes No Saprolite System(repair):[]Yes 10-N6—r Fill System(Initial):❑Yes j 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 to If yes,specify:0 New ❑Existing (when adding more than 6 inches of fill to system area provide a fill plan) Usable Soil Depth(Initial): SI"7° Usable Soil Depth(Repair): 5 / �7 - 7U Max.Trench Depth(Initial?: ._S- Max.Trench Depth(Repair?: *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:["Five years[site plan submitted pursuant to GS 130A-334(13a)] ❑No expiration[plat submitted pursuant to GS 130A-334(7a)] Permit condlti ns: Gt� �05 Licensed Soil Scientist Print Name: 1jry Licensed Soil Scientist Signature: f� s ®�(ti�'L� Date: The LSS 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,BLilding 3,Raleigh,NC 27609 MAILING ADDRESS:1632 Mail Service Center,Raleigh,NC 27699-1632 Li U T U Q 2023 www.ncdhhs.gov • TEL:919-707-5854 • FAX:919-845-3972 AN EQUAL OPPORTUNITY/AFFIRISATIVE ACTION EMPLOYER Environmental Health Saddlebrook lots: 1-5, 7-11, 13, 14, 16-20, 22, & 23 Permit#: This Section for Local Health Department Use Only Initial submittal received: 10/30/2023 by RP Date 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 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 as the Improvement Permit. The review for completeness of tlw.x..lmprovement Permitswas conducted in accordance with G.S. 130A-335(a3).plus4_Improvement Permits determined to be: af9- ©Incomplete(If box is checked, information in this section is required.) The following items are missing: Cannot issue a stand alone IP with the the(a2)Construction Authorization box checked on the IP common form. Copies of this were sent to the LSS and the Applicant on 1 1/3/23 Date State Authorized Agent: 4,0a, ,"w�'(� Date: 11/3/23 ❑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 SflL & l UR E TRY SERVICES OF THE CAROLINAS, PA www.soilandforestryservices.com Project#: 23-0015 October 17th, 2023 VR Farms LLC Attn: Ray Short Email:vrshortir@aol.com RE: Soil &Site Evaluation for a 3 Bedroom Residence at Saddlebrook Subdivision Lot 1,0.76 ac Parcel, PIN#(460904507318)Sherrills Ford, NC 28673. Mr.Short: At your request Soil & Forestry Services of the Carolinas (S&FS) has performed soil/site evaluations on parcel noted above.The Lot size is noted on the attached survey map& soil evaluation form.The purpose of our work was to identify soil areas with potential to support subsurface wastewater disposal systems and provide design details for Session Law submittal to Catawba County Health Department. Site Conditions At the time of our evaluation land cover on the property was partially cleared/graded for the house pad and open field.Topography within the evaluated area was gentle slope near the house site and proposed drainfield area. Property lines and corners were marked at the time of the evaluation by Derek Bunton Surveying.The client provided an Autocad File of the subdivision with house envelopes as a basemap.The proposed septic layout was located via GPS&tape measures and used to produce the attached Site Plan.The house envelope was located via Surveyed by Derek Bunton Surveying. Backhoe pits were located via GPS. Methodology We evaluated soil areas through the use of backhoe pits. Soil morphological conditions including color, texture, structure,etc. were reviewed in the field with six backhoe pit locations on the property flagged and located via tape measure.All of the backhoe pits are located in or adjacent to the proposed septic layout.Soil suitability was determined by referencing 15A NCAC 18A.1900 "Laws and Rules for Sewage Treatment and Disposal Systems".Soil&Site Evaluation Forms were utilized to record the soil morphological data for each pit.The house envelope was located via survey.An on-ground layout of system and repair was performed using a laser level. Pin flag locations of the layout were also located by GPS and tape measures. Detailed system & repair information is summarized in the following paragraph for this Lot. Saddlebrook Subdivision- Lot 1 (See Attached Design) The septic layout for this lot (9'centers)yielded a total of 688 linear feet of line.The primary system is proposed as 240 linear feet of Modified Conventional (50% Reduction)drainfield with low pressure distribution.Trench depth is specified at 33 inches(Low Side).The repair system is proposed as 240 linear feet of Modified Conventional (50% Reduction)drainfield with low pressure distribution.Trench depth is specified at 33 inches(Low Side).There is 448 linear feet of repair available. Session Law Requirements All information needed to issue the IP must be submitted with the application.The application shall include all information described in 15A NCAC 18A.1937(d) and be accompanied by a signed and dated statement from the applicant (owner or owner's legal representative)that reads as follows: "The LSS/LG evaluation(s)attached to this application is to be used to issue an Improvement Permit in accordance with G.S. 130A-335(a2)and(a3)." Owner Date Print Name .A Signature /� /%L/��i,1, _ %'��' -� Z.7 The LSS evaluation shall include a statement bearing the SS seal and signature that reads as follows: "The LSS evaluation is being submitted pursuant to and meets the requirements of G.S. 130A- 335(a2)." Disclaimer This report reflects the findings of S&FS, PA. This LSS evaluation is being submitted pursuant to and meets the requirements of G.S. 130A-335(a2)."Any site modifications that impact the proposed septic areas on the site may nullify this design for Lot 1-Saddlebrook Subdivision, Sherrills Ford, NC 28673. System design requirements and site requirements shall be adhered to for installation and Operations Permits to be issued by the local Health Department. If you have questions regarding these requirements a Pre-Construction meeting should be scheduled to discuss. Please contact S&FS if you have any questions regarding this report or the attached information. S&FS also offers septic system inspection,wetland delineation and forestry services. Sincerely, (..ac9 61-A. RO. <<%/1, ( /f/ kf $ hS OrA tO cz, r44, XM' ,ti 123A O/ ��- ' U S.Ashley Rollans, LSS `�. . A' A'O -T� Attachment: Septic Design N. •� SOIL & FORESTRY SERVICES OF THE CAROLINAS, PA www.soilandforestryservices.com Attached is a proposed design for an PPBPS Septic System w/Low Pressure distribution for a 3 bedroom single family residence at Saddlebrook subdivision Lot 1,Sherrills Ford,NC 28673, Catawba County, PIN#(460904507318) Contents: Page Information for the Installer 1 Design Information Design Specifications - 2-3 Layout Specifications - 4 System Tapsheet 5 Site Plan/System Plan 6 Calculations 7 Profile Descriptions 8 Application for Services n_e_ 9 IP Form 10 op CA Form 11 07 �I + frR.nM,elk of 2 3 Q- h'O RTH October 17,2023 Project#: 23-0015 Design By: Soil& Forestry Services of the Carolinas, PA 1 INFORMATION FOR THE INSTALLER: The permit should be read very carefully prior to bidding. The following are details that must be considered along with all other considerations. - Tanks shall be approved by NC DHHS, and certification supplied by the manufacturer. - Tanks shall be water tested prior to installation. - The installer shall be responsible to the owner for placement of the tanks and to insure that final grades are returned to the original natural grade, with exception of added structural features. - The supply trench shall be compacted to eliminate cavities during initial fill placement. - Installation of the system shall be during dry conditions in order to protect the soil structure. - All fittings shall be pressure rated fittings. - All joints shall be cleaned with PVC pipe cleaner and a heavy bodied glue applied to weld all joints. - Where required by the county health department,post installation inspections by the designer must be scheduled 5 week days in advance. - Trenches shall be carefully excavated so the bottom is within 2" from the highest to . the lowest points of elevation within the trench. If the bottom elevation needs adjusting after it has been trenched, it will be done by removing high points rather than filling low points. It is extremely important to insure that trenches are not over excavated during initial trenching. All fine grading within the trench will be hand done with a shovel. No loose material will be left in the trench - All pipe openings in the tanks shall be properly grouted. This also applies to the joints around the riser. - All tanks shall be properly back filled and compacted to prevent slump at a later date. - Earth dams, constructed of relatively impervious material, shall be installed at the beginning and end of each lateral. - No heavy equipment shall be used on the field during or after installation. The use of a small loader(i.e. Bobcat) or a trencher(i.e. Ditch Witch 2300/2310)may be used for installation. - Elevations at pinflag locations should be checked by the installer prior to excavation - Pumptank riser should be 6"above grade, control panel should be 12"above grade. - Septic tank riser shall be a minimum of 6" above finished grade. - System is specified as a PPBPS installation with low pressure distribution. - Repair is specified as a PPBPS installation with low pressure dist. - Backfill 4- 6" of material (County Approved)over panels,rake trench walls, lime side- walls, install trenches 24" wide and have no more than 1/4" fall in 10 feet. 2 LP HPPBPS SYSTEM FOR WASTEWATER TREATMENT Owner/Applicant: VR Farms LLC Current Address: 7172 Long Island Rd Catawba,NC 28606 Phone: 704.516.2344 County: Catawba Location: Bridle Court- Lot 1 I Sherrills Ford, NC'28673 Source of Wastewater Flow: 3 Bedroom Single Family Residence Estimated Gallons Per Day Flow: 360 gpd System Flow: 22.14 gpm Design Specifications Drainfield Size: 240 Loading Rate (gpd/ft.2): 0.25 Depth of Gravel in Trench: NA (PPBPS ) Gravel Size: NA(PPBPS ) Trench Depth (LOW SIDE): 33 in., Repair 33in. Trench Depth Trench Width: 24 in. Septic Tank Size: 1000 Pump Tank Size: 1000 Estimated Supply Line Length: 6 Supply Line Diameter: 2 in. SCH 40 PVC Supply Line Volume: 1.04 Dosing Volume: 194.40 Supply Manifold: N/A Supply Manifold Length: N/A Supply Manifold Volume: N/A Recommended Float Controls: SJE Sensor Float Control Switches as Required for Control Panel or County Approved Equivalents Recommended Control Panel: SJE-Rhombus Model 112 (NEMA 4x) Control Panel or County Approved Control Panel. Pressure Head: 2 ft. Friction Head: 0.08 Elevation Head: 5.90 Total Dynamic Head: 9.17 Threaded Union: In Tank Gate Valves: 1 in Tank 1 per lateral Check Valves: In Tank Anti-Siphon Hole: NA Additional Comments: Soil suitability was performed by Soil & Forestry Services of the Carolinas, PA 3 Bridle Court- Lot 1 LP HPPBPS DESIGN FLOW (gpd): 360 SOIL APPLICATION RATE (gpolft.2): 0.25 TOTAL AREA TRENCH BOTTOM: 720 TOTAL LATERAL LENGTH: 240 NUMBER OF FIELDS: 1 LATERAL LENGTH REQUIRED PER FIELD: 240 SUPPLY LINE LENGTH: 6 TOTAL DYNAMIC HEAD: 9.17 MANIFOLD SIZE: N/A DOSING VOLUME: 194.40 PUMP TANK DRAW DOWN*: 9.3 SEPTIC TANK SIZE: 1000 PUMP TANK SIZE: 1000 "Pump tank draw down based on a volume basis of 21 gallons per inch. Draw down may vary among pump tank manufacturers. 4 Layout Specification-Bridle Court-Lot 1 Project#:23-0015 LAYOUT FOR 3 BEDROOM HOME October 17,2023 FLAG FLAGGED DESIGN LINE# COLOR BS HI FS ELEVATION LINE LENGTH LINE LENGTH TBM (RIGHT REAR) 4.3 104.3 100.00 INSTR. 1 HOUSE CNR P.TANK 5.4 98.90 1 PINK 4.10 100.20 49 49 2 YELLOW 4.20 100.10 83 83 3 BLUE 4.40 99.90 93 93 4 YELLOW 4.70 99.60 100 80 5 ORANGE 5.00 99.30 123 80 6 PINK 5.30 99.00 127 80 7 RED 5.40 98.90 80 80 8 BLUE 5.30 99.00 33 33 Total 688 578 SOIL LINE LTAR SYSTEM LTAR TRENCH TRENCH LENGTH GPD/FT2 TYPE GPD/FT2 SYSTEM DISTRIBUTION DEPTH(LOW SIDEI *System 240 0.250 MOD. 0.250 PPBPS LOW 33" CONY. PRESSURE Repair 448 0.250 MOD. 0.250 PPBPS LOW 33" CONY. PRESSURE Notes: **All septic lines and pits located via GPS and tape measures **All measures in feet **Nitrification lines are demonstrated on contour via colored pin flags 5 LP PPBPS TAPSHEET -Bridle Court- Lot 1 ` SYSTEM Line# Color Elevation Length Hole Size Flow/hole Trench Area Number of Panels 4 YELLOW 99.60 80 0.156 0.41 240 18 5 ORANGE 99.30 80 0.156 0.41 240 18 6 PINK 99.00 80 0.156 0.41 240 18 total feet = 240 gal/min= 22.14 54 Des.Flow 360 Pump Run= 8.78 soil LTAR 0.25 LTAR+5% 0.2625 LTAR with mod. 0.5 LTAR with mod..+5% 0.525 .156 equals 5/32 inch hole ._) U s-. _,_ 5 " I 01) 0 �� 86 °00' 30W 122 . 7 • 42. 7 6,3 � �� �r N 34,a' � � 21,5' "' 50' W E HUSE , SE 1S _AB ,B Z `0 0 . 760 SCALE 45,z +�}� 1"=40' 0 w in ACRE O ir cA t_ � cv: M C� ui � ri LO in cp al 71 Q, M r 0 6-, � M ►� 7.6- Q. r 1,1 32' ai > p1A co P1 • D2Al P2 G1\ 120 . 60 119 . 96' , = 85°49 ' 54" W 1049 . 7= S 7 CALCULATIONS Location Bridle Court- Lot 1 Sherrills Ford, NC 28673 Project Number 23-0015 Lot No: 1 No. of Bedrooms 3 Design Flow 360 gal/day LTAR 0.25 gal/ z ft day PPBPS? (YES OR NO) YES Supply Line Length 6 ft. Supply Line Volume 1.044 gal. FRICTION FACTOR INTERPOLATER Required Feet of Line 240 ft. 2" SCH 40 PVC Amount of Line from Layout 240 ft. GPM f 20 0.84 Gallons per Minute 22.14 gal/min -0.88 25 1.27 Required Septic Tank Capacity 1000 gal. -1.28 Pump Tank Capacity 1000 gal. 30 1.78 -1.76 Panel Volume 3.6 gal. 35 2.37 #of Panels 54 -2.25 Dosing Volume 194.40 gal. 40 3.03 Note: Dosing Volume based on 100%of#of 43.07 3.48 panels times 3.6 gal/panel 45 3.77 48.14 4.28 50 4.58 57.11 5.89 60 6.42 Tank Draw Down 9.3 Generic Draw Down of 21 gal.per in. Pump Run Time 8.78 minutes Elevation Head 5.9 ft. Pressure Head 2 ft. Friction Factor 1.27 ft./100 ft. (From the interpolates) Friction Head 0.08 ft. Total Dynamic Head (+15%) 9.17 ft. Sheet 1 of 1 PROPERTY ID#: 460904507318 COUNTY: Catawba SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM (complete all fields in full) OWNER: VR FARMS LLC APPLICATION DATE: ADDRESS: 7172 Long Island Rd,Catawba NC 28609 DATE EVALUATED: 1/31/2023 PROPOSED FACILITY: 3 Bedroom Residential-360 GPD PROPERTY SIZE: 33,133 SF LOCATION OF SITE: Saddlebrook subdivision-Lot 1 PROPERTY RECORDED: 1',1(. WATER SUPPLY: ❑Private ❑ Well El Spring I Other County water EVALUATION METHOD: 0 Auger Boring 0 Pit ❑Cut TYPE OF WASTEWATER: CI Sewage 0 Industrial Process ❑ Mixed P R O SOIL MORPHOLOGY OTHER F .1940 HORIZON (.1941) PROFILE FACTORS LANDSCAPE I DEPTH PROFILE POSITION/L CLASS E SLOPE% (IN.) .1941 .1941 .1942 .1943 .1956 .1944 &LTAR STRUCTURE/ CONSISTENCE/ SOIL SOIL SAPR RESTR TEXTURE MINERALOGY WETNESS/ DEPTH CLASS HORIZ relit au 0-8 FILL PS 8-21 RBSCLWFSBK FRSSSPSEXP 0.275 OVER 21" 1 L/4% 21-52 RRCWFSBK FRSSSPSEXP C WHITE/YELLOW LITHO FEW SAP INCL FEW FE DEPL 52-69 RBSCLWFSBK FRSSSPSEXP FEW SAP INCL 61" 0-7 BSCLWFSBK FRSSSPSEXP PS 7-34 RBCWMSBK/ABK FRSSSP FEW FE DEPL 0.25 SHALLOW 2 L/4% 34-67 RBSCLWMSBK FRSSSP FEW SAP/LITHO COLORS 0.3 DEEP 67" 0-11 FILL PS 11-41 RBCWMSBK/ABK FRSSP FEW SAP INCL COMPACTED 18" 0.S DEEP i 3 L/5% 41-59 RBCLWFSBK FRSSSP C SAP 48" 0-3 FILL PS 3-14 BRCWMSBK FSSP FE DEPL COMPACTED 0.3 DEEP 4 L/4% 14-40 BRCWMSBK FRSSP 54" 40-57 RBCLWFSBK FRSSSP C SAP 0-6 BSLGR FRSSSPSEXP PS 6-15 RBSCLWFSBK FRSSSPSEXP 69" 0.25 SHALLOW 1A L/3% 15-43 BRCWMSBK FRSSP FEW FE DEPL TO 27" 10.3 DEEP 43-69 RBCLWFSBK FRSSSP FEW TO C SAP INCLU 0-8 BSLGR FRSSSPSEXP COMPACTED PS 8-14 RBCLWMSBK FRSSSPSEXP 0.275 2A U3% 14-40 RBCWMSBK/ABK FRSSP 70" 40-70 RBCLWFSBK FRSSSP FEW TO C SAP =.a-.r, � 5 0 ? (_ 5�.� .' "91.- / Rif ��$. ' U o.., ice; .. 'tN' �3 ,..) • / f '',Or,.: '. ''' 1 •-• cz- ' //��{ DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): SITE CLASSIFICATION(.1948): PS Available Space(.1945) PS PS EVALUATED BY: Ashley Rollans System Types(s) PPBPS 50%-Low Pressure PPBPS 50%-Low Pressure OTHER(S)PRESENT: Chad Wagner&Mason Freeman Site LTAR 0.25 0.25 COMMENTS: 1 ,•rt ,, 44 ROY COOPER•Governor .• ,;:w NC DEPARTMENT OF /I HEALTH +�, KODY El.E(INSLEY^Secretary { S MARK DE�:NTON^'�`- �'I�� � HUMAN :a�E ��I(;;�,a�, Deputy Secretary for Health °`?�a•+w � �P SUSAf!i ICANSAGRA Assistant Secretary for Public Health Division of Public Health Application for Services This application,in conjunction with the common form established in G.S.130A-335(a3)and(a5),is optional for local health departments to be used for applications submitted in accordance with G.S.130A-335(a2),(a3),and(a5). (hereinafter,G.S. 130A-335(a3)and(a5)permits referred to as(a2)improvement Permit and(a2)Construction Authorization] Applying for: -Er— - (a2)Improvement Permit lag)Construction Authorization 0 (a2)Repair/Construction Authorization Please check one of the following: NlE N w Construction , 0 Expansion ❑ System Relocation 0 Change of Use 0 Repair ear Expiration Requested(site plan provided) ❑ Non-Expiring Permit Requested(plat provided,as definedlIn G.S. 130A-334(7a) Property Owner Name:VAL. cgtrv..S L(L Property Owner Mailing Address:-]all Lore 1.40,,A '1 CatrAw6. W. als-L, A Property Owner Phone Number: -1 - g(ta- Z3gq Property Owner Email Address: V CS1nock c Q 401,Cr.Ar Applicant Name: V . co.crres LI C, Applicant Mailing Address:1a`1 t LU '("Slar-et gr,A Cc\-VG►..)bc, 4C a51'1.,c- Applicant Phone Number: ---10-1_ 51 (.p .V-{y Applicant Email Address: V(4 kk j(PkOl.�Cy. - Does the property include,or Is subject to,any of the following: ['Yes ['�No Previously identified jurisdictional wetlands Yes ©'fVo Existing or proposed easements,rights-of-way,encroachments,or other areas subject to legal restrictions Yes do Approval by other public agencies A site plan or plat is required,OR the site sketch submitted from the LSS/AOWE,must include the following: (A)existing and proposed facilities,structures,appurtenances,and wastewater systems (B)proposed wastewater system showing setbacks to property line(s)or other fixed reference point(s) (C)existing and proposed vehicular traffic areas (D)existing and proposed water supplies,wells,springs,and water lines;and (E)surface water,drainage features,and all existing and proposed artificial drainage,as applicable. Requesting DHHS review: Yes lag-0 I understand that the documentation and fees,as required In G.S.130A-335(a2),(a3),(aS),and(a6),attached to this application are to be used to issue an Improvement Permit and/or Construction Authorization pursuant to G.S.130A-335(a2),(a3),and(a5).I understand that authorized county and state officials are granted right of entry to the property Indicated on this application to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that if the information in the application for an improvements Permit and/or Construction Authorizati•• is fa ified,changed,or the site is altered,then the Improvement Permit and • s - tion Authorization s all be �•- . Applicant Signatur=,�� C _ _ � !�i YliaY•F '�' i Date: // eOes , wner's Signatur tr ' Date5� r NC DEPARTMENT OF HEALTH AND HUMAN SERVICES • DIVISION OF PUBLIC HEALTH LOCATION:5605 Six Forks Road,Building 3,Raleigh,NC 27609 MAILING ADDRESS:1632 Mall Service Center,Raleigh,NC 27699-1632 www.ncdhhs,gov • TEL:919-707-5854 FAx:919-845-3972 AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER THIS IS NOT A PERMIT Case# EHPR-11-2023-45932 CATAWBA COUNTY HEALTH DEPARTMENT v 0 7 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 842 sM Environmental Health Plan Review-OSWP iPa2 Permit Fee Applicant TINA LITTLE,7257 LONG ISLAND RD,CATAWBA NC 28609 TINATOWNEBUILDERSLLC@GMAIL.COM Owner *VR FARMS LLC,7271 LONG ISLAND RD, B:8284687175 C:7045162344 VRSFIORTJR@AOL.COM AOL.COM NAME TO APPEAR ON PERMIT *VR Farms LLC SITE ADDRESS: BRIDLE CT,SHERRILLS FORD NC 28673 PIN # 460904507318 NAME of SUBDIVISION: SADDLEBROOK Lot# 1 Section/Block PROPERTY SIZE: Square Feet 32,670.00 Acres .75 DIRECTIONS: E NC 150 HWY,LEFT SHERRILLS FORD RD,ON RIGHT PAST MOLLYS BACKBONE RD PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: 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? Yes Property Easements Description: NON ACCESS EASEMENT 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: 6 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 50 X 70 #OF NEW BEDROOMS:: 3 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: eltapplicatw❑ I1/02/2023 17:15 Page 1 of3 CATAWBA COUNTY Case# EHPR-11-2023-45932 (,...._, v• Public Health Department Subdivision SADDLEBROOK Environmental Health Division PIN# 460904507318 PO Box 389,100-A Southwest Blvd,Newton,NC 28658 w NAME ON PERMIT: *VR FARMS LLC ( ),7271 LONG ISLAND RD, *VR Farms LLC ( ) Site Address: BRIDLE CT,SHERRILLS FORD NC 28673 Property Size: Square Feet 32,670.00 Acres_ .75 Directions: E NC 150 HWY,LEFT SHERRILLS FORD RD,ON RIGHT PAST MOLLYS BACKBONE 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 AREA4 ***************t**********►****************************************,***$************************************ FEENAME DATE FEE AMOUNT IPa2 Permit Fee 11/02/2023 $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) chapplicau,m Il/02/2023 09:05 Page 2of3 Catawba county public health Application for Environmental Health Services THIS IS NOT A PERMIT Application is for: ❑ New Construction LL ❑ Existing Factlity �] Improvement l'crmit Authorization to Construct ®New Septic ❑Septic Repair/Malfunction ❑Septic Relocation ❑ Septic Expansion ❑Existing System Inspection or Reconnection ❑ New Well 0 Replacement Well ❑Well Abandonment ❑ Well Repair Property Address Acres .76 Subdivision Saddlebrook Lot# 1 Driving Directions to Property Take hwy 10 to Murry Mill road, turn left on to Sherrill Ford rd site is on the left Describe work install new septic Applicant Name Tina Little Applicant Address 7257 Long island rd Catawba, Catawba NC 28609 Phone 828-468-7175 Email tinatownebuildersllc@gmail.com Owner Name Owner Address VR Farms (Virgil Ray Short Jr Phone 704-516-2344 Email vrshortjr@aol.com Contractor Name Contractor Address Bumgamer Septic Tank Phone 828-396-1795 Email bseptictank@gmail.com Name to Appear on Permit? ®Owner 0 Applicant ❑Contractor Who will he the Primary Contact? ❑Owner ® Applicant ❑Contractor Proposed New Construction-Residential Primary Residence ® New Residence ❑ Addition to Residence #of New Bedrooms*t 3 #of Occupants Project Description Structure Dimensions,also specify dimensions of decks&porches (Choose One) ❑Basement ❑Crawl Space RI Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes 0 No Retaining Wall>2' ❑ Yes ❑ No Accessory Dwelling #of New Bedrooms*1' #of Occupants Structure Dimensions (Choose One) 0 Basement 0 Crawl Space 0 Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes ❑ No Retaining Wall>2' ❑ Yes 0 No Accessory Structure(s)Describe Structure(s)Dimensions Plumbing ❑Yes 0 No Describe Plumbing Needed (Choose One) ❑Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' ❑ Yes ❑ No Multi-Family Residence #of Apartments #Bedrooms per Apartment*t Total#Bedrooms in Structure*j #of Occupants Structure Dimensions (Choose One) ❑Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall 2' ❑ Yes ❑ No Well Construction/Abandonment/Repair Proposed Well Type Individual Wellit. p yp ❑ 0 Semi-Public Well 0Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested 0 Yes ❑No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank?❑Yes 0 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 Describe Structure Dimensions #of Bedrooms* #of Occupants Basement ❑ Yes ❑ No Basement Plumbing ❑Yes ❑ No Existing Water Supply wt ❑ Individual Well ❑Shared Well—Number of Connections ❑Community Well ❑County/City/Township Water Line Is a public water supply available? ** ® Yes ❑No Commercial ❑ Proposed PSew 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 ❑Yes ❑No Residential Kitchen ❑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 VI No Does the site contain any jurisdictional wetlands? ❑ Yes CS No Does the site contain any existing wastewater systems? ❑Yes IR No Is any wastewater going to be generated on the site other than domestic sewage? ❑Yes 151 No Is the site subject to approval by any other public agency? ❑Yes 55 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) 0 Accepted ❑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 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,augering,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. ��/� /f i Signature of Owner or Legal Agen�C®����'�GGx— , , � /Date Printed Name of Owner or Legal Agen /� lij� I '.�� Catawba County Environmental Health 1.06 C3 <. its •7476 0 •7462 (� r 675.20 714.75 25.00 113.73 ti N to CFA i'12. �T 7498 15 00 •• sa •7648 :1 215.03 4 7 ►7,' a •7552 7 .r 1494 1 E7456 165,13 21 t.'•' '' SHERRILLS FORD RD . 4 •7655 •7473 a Parcel: 460904507318, 7552 SHERRILLS FORD 1 in=300ft RD SHERRILLS FORD, 28673 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 11/02/2023 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 460904507318 Owner: VR FARMS LLC Parcel Address: 7552 SHERRILLS FORD RD Owner2: City: SHERRILLS FORD, 28673 Address: 7271 LONG ISLAND RD LRK(REID): 803342 Address2: Deed Book/Page: 3801/0784 City: CATAWBA Subdivision: GABRIEL PARK-PH 1 State/Zip: NC 28609-8241 Lots/Block: 2-7/ School Information: Last Valid Sale: Plat Book/Page: 67/131 School District: COUNTY Elementary School: SHERRILLS FORD Legal: LOT 4 PLAT 67-131 Middle School: MILL CREEK Calculated Acreage: 20.920 High School: BANDYS Tax Map: Township: MOUNTAIN CREEK School Map State Road #: 1848 TaxNalue Information: Tax Rates Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoning1: R-20 Building(s) Value: $0 Zoning2: Land Value: $51,900 Zoning3: Assessed Total Value: $51,900 Zoning Overlay: wp-o Year Built/Remodeled: / 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 828-465-8436 Current Tax Bill Miscellaneous: Firm Panel Date: Building Permit Address Search for this parcel. Firm Panel #: If available, Building Permits for this parcel. Septic 2010 Census Block: links are not permits. 2010 Census Tract: 011503 Septic Final Permits prior to 08/2018, contact Agricultural District: PROXIMITY Environmental Health. Building Details WaterShed: WS-IV Protected Area Voter Precinct: P31/ 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. Y'A COS CATAWBA COUNTY ' �� 100A SOUTHWEST BLVD a NEWTON,NORTH CAROLINA 28658 RECEIPT v �/P� ,, ' PHONE:828.465.8399 �� Thursday, November 2, 2023 j$4' 55M www.catawbacountync.gov PAYOR: *VR Farms LLC *VR Farms LLC PAYMENTS TRANSACTION NUMBER: TRC-76836746-02-1I-2023 PAYMENT DATE: 11/02/2023 PAYMENT TYPE: Check 702 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 11-23-429932 110-580200-663000 IPa2 Permit Fee $150.00 TOTAL PAYMENTS: $150.00 EHPR-11-2023-45932 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: BRIDLE CT,SHERRILLS FORD NC 28673 Applicant TINA LITTLE,7257 LONG ISLAND RD,CATAWBA NC 28609 TINATO WNEBUILDERSLLC@GMAT L.COM Owner *VR FARMS LLC,7271 LONG ISLAND RD, B:8284687175C:7045162344 VRSHORTJR@AOL.COM **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 11/02/2023 09:04 Page I of 1