HomeMy WebLinkAboutEHPR-3-11-9676 (2).TIF C. � THIS IS NOT A PERMIT Case # EHPR - - 11 - 9676
CATAWBA COUNTY HEALTH DEPARTMENT
OP' Plan Review Application for Environmental Services
1842 SM Environmental Health Plan Review - OSWP
IMPROVEMENT
NAME TO APPEAR ON PERMIT
Helen Coffey
SITE ADDRESS: 2039 COLLIE TR, Vale, NC Pin#: 267903229727
NAME of SUBDIVISION: Lot # 3B & PT 3, Section/Block/Phase
PROPERTY SIZE: Square Feet Acres 1.049
DIRECTIONS: Old Shelby Rd South / Left Providence Church Rd / Right Collie Trail / house on right
APPLICANT OWNER CONTRACTOR
Helen Coffey Helen Coffey
2042 Collie TR 2042 Collie TR
Vale NC 28168 -8898 Vale NC 28168 -8898
828 - 310 -4104 828 - 310 -4104
PRIMARY CONTACT: Owner APPLICATION FOR: New Construction
DIM EXISTING STRUCTURE: 28 x 80 EXISTING FACILITY TYPE: House
NUMBER OF EXISTING BEDROOMS: 4 SEWER TYPE: Septic Tank
NUMBER OF EXISTING OCCUPANTS: 4 EXISTING WATER SUPPLY IN USE: Private Well
CALCULATED DESIGN FLOW:
Public water is **NOT ** available for this property.
PUBLIC WATER TYPE AVAILABLE: N/A
DESCRIBE WORK: Above Ground pool 33' Diameter
DESCRIPTION OF house
EXISTING STRUCTURES
ON SITE (IF ANY)
PROPERTY EASEMENTS: none
PROPOSED CONSTRUCTION
ACCESSORY STRUCTURES
DESCRIPTION: 33' diameter above ground pool
# OF NEW BEDROOMS: 0 STRUCTURE DIMENSIONS: 33 ' diam ACC DWELLING? No
PLUMBING? # OF STRUCTURE OCCUPANTS:
I understand that this is a formal application for a well permit, Improvement permit or Authorization to Construct 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 an Improvement Permit issued as a result of this information is
transferable and may be eligible for a non - expiring date, but may be revoked if this information, site plans or intended use changes for the proposed
facility. A Well Permit and Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable.
Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or
structure location should conform to applicable setbacks.
Date:(x /��J, ( ( t Signature of Applicant or Agent
f j
An Environmental Health Specialist will contact you within 2 worki g days of applic 'data()
If you need further information or assistance please call 828 - 466 -7291
AREA2
Minimum Setbacks: Front: 30 Side: 10 Rear: 5 Side St: Max Height:
03/03/11 16:23
(e,A CATAWBACOUNTY Case# EHPR -3 -11 -9676
G Public Health Department
ti Subdivision
Environmental Health Division - Plan Review
\�0 a PO Box 389, 100 -A Southwest Blvd, Newton, NC 28658 , Lot 3B & PT 3A
X842 5M PIN# 267903229727
Applicant/Owner Helen Coffey, 2042 Collie TR, Vale NC 28168 - 8898
Site Address: 2039 COLLIE TR, Vale, NC
Property Size: SF 1.049 ACRES
Directions: Old Shelby Rd South / Left Providence Church Rd / Right Collie Trail / house on right
FEE NAME DATE AMOUNT BALANCE DUE
Improvement Permit Fee 03/03/2011 $150.00
TOTAL FEES $150.00
CHANGE WORK ORDER REQUIRING REDESIGN AND /OR RETRIP WILL INCURE AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
03/03/11 16:23
�7 THIS IS NOT A PERMIT
RUG CATAWBA COUNTY HEALTH DEPARTMENT nno 9 u'lLe
114 Q Application for Environmental Services 1 Page 1
/842 )M
Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑
Septic Expansion ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑
Well Repair ❑ Existing System Inspection (Pre- Approval Required) ❑
Application is for New Construction ❑ Existing Facility ❑
Property Address
p rty oW , � Y Cv/./o• Subdivision
Lot # Acres
Section/Block/Phase
Driving Directions to Property ( 5 7Jt
W
a NAME TO APPEAR ON PERMIT? Owner ❑ Applicant ❑ Contractor
Applicant Contact Information
k.) Name 1.1.16 11 4. C u,
i t Address .2b3q (IA? — 6 , 10 Val Al 2.x!(0%
tfl
Phone zzg - 3 (b _4( Cell Phone R Zc_ 3t0 - OS/0 ( (,(,,
Owner Contact Information
Z Name t( .
Address l 2 0 3q i `7sra j f V o t kJC - . gag
Phone 2g - to - (.a Li Cell Phone q Z - 3 (,p _ 4O& 1(.(,
1": Contractor Contact Information
W Name
Address
= Phone Cell Phone
2 WHO WILL BE THE PRIMARY CONTACT? [Owner ❑ Applicant ❑ Contractor
Description of Existing Structures on Site 14 00- `.e
O # of Bedrooms **!' L f Structure Dimensions A S X c # of Occupants L(
l► Basement ❑ Yes ® No Basement Fixtures ❑ Yes [ No
Planned Future Additions or Improvements (Building Permit NOT requested at this time)
CC Describe
Proposed Future Structure Dimensions # of Bedrooms *f if applicable
? Are there easements or right -of -ways recorded on this property ❑ Yes ❑ No
Describe
Is a public water supply available on or adjacent to the above property ** ❑ Yes ❑ No
Check type available ❑ Community Well ❑ Semi - Public Well ❑ County/City/Township Water Line
Existing water supply in use ❑ Individual Well ❑ Community Well ❑ Semi - Public Well
❑ County/City/Township Water Line
❑ I WOULD LIKE TO SCHEDULE A COMBINED FLAGGING AND SOIL EVALUATION
(SEE COMBINED EVALUATION PROCEDUES)
THIS IS NOT A PERMIT
CATAWBA COUNTY HEALTH DEPARTMENT
`''n 0 -1 Application for Environmental Service Page 2
/842 94
Proposed Facility Type
❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *1
Project Description
Structure Dimensions # of Occupants
Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes ❑ No
11 Accessory Structure(s) Describe A b .,.€ Boa
# of New Bedrooms *t if applicable D Structure Dimensions 33 ' - c .
# of Occupants c7 Accessory Dwelling ❑ Yes E] No
Plumbing ❑ Yes EI No Describe Plumbing Needed
❑ Multi - Family Residence # Units #Bedrooms per Unit *t
Total # Bedrooms *t Structure Dimensions
❑ Food Service Specify Type
# Seats Floor Space - Entire Food Service Facility (Sq Ft)
# Employees per Shift # of Shifts Dining Area (Sq. Ft.)
❑ Business Specific Type of Business Retail Floor Space
# of Employees per Shift # of Shifts
❑ Other Facility Type Specify
If Church # of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy
Application for Well Construction/Abandonment /Repair
Proposed Well Type ❑ Individual Well ❑ Semi - Public Well ❑ Community Well
Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown
Well Repair Requested ❑ Yes ❑ No Describe
Calculated Design Flow, Commercial t Additional information may be required to
determine design flow from certain facilities. This value will be determined during consultation with on-
site staff.
*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 house plans as a
bedroom at the time of building permit issuance. This may prevent the need for septic system size increase in the future. l'If
structure is plumbed but no bedrooms, calculated design flow is required.
** If No, a well permit must be issued with the Authorization to Construct.
Note: You must obtain Zoning approval prior to locating a home or structure on this property. Any representation by you of
house or structure location should conform to applicable setbacks.
CHANGE WORK ORDER REQUIRING REDESIGN AND /OR RETRIP WILL INCURE AN
ADDITIONAL CHARGE (SEE FEE SCHEDULE)
a I understand that this is a formal application for Environmental Services and authorize Catawba County Environmental
Health employees to go on this property for evaluation purposes. I certify the above information to be correct and understand
O that an Improvement Permit issued as a result of this information is valid for 5 years or may be non - expiring under certain
V specified conditions. Improvement Permits and Well Permits are transferrable, but may be revoked if this information, site
plans or intended use changes for the proposed facility. An Authorization to Construct issued by this department is valid for
(5) five years from the date issued and is not transferable
Signature of Owner or Agent (4)&. ( #1 , f ,
Printed Name of Owner or Agent Pekin A. 1. (
Date 3(3(
Catawba Cou nty, Nor Carolina
N This map product wa p r ep ared from the Catawba Count NC, Ge o g rap hic lnjorm System. ation
Cat awba County has made substan ef to ensure the ac o locat and la beling infor
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• i cation of any
A data c ontained on this map product by the user. The County o f Catawba, its emp loyee s, agent
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N This map product was prepared from the Catawba County, NC, Geographic 1nfortnation System.
Catawba County has made substantial efforts to ensure the accuracy of location and labeling information
A contained on this map. Catawba County promotes and recommmends the independent verification of any
data contained on this map 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
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Selected Parcel Number: 2679 -03 -22 -9727
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CATAWBA COUNTY NC - Parcel Report
Information Regarding Selected Parcel(s)
Parcel ID: 2679 -03 -22 -9727
Name: COFFEY KEITH L
Name2: COFFEY HELEN M
Address: 2042 COLLIE TRL
Address2:
City: VALE
State: NC
Zip: 28168 -8868
Account: 13506150 •
Calc Acreage: 1.05 •
Tax Map: 004AB 01004
LRK: 3842
. Deed Book: 2044
Deed Page: 0194 •
Subdivision Name:
•
•
Subdivision Block:
Lots: 3B & PT 3A
Plat Book: 26
Plat Page: 17
Building Number: 2039
. Street Name: COLLIE TR
Site Zip: • 28168
Township: BANDY'S
Fire Code: COOKSVILLE
City Code: COUNTY
State Road: •
Total Bldgs Value: $79,300
Land Value: $7,900
Total Value: $87,200
Year Built: 1998
Year Remodeled:
Last Sale Date: 3/1/1993
Last Sale Amount: $6,000
Neighborhood: 89
Watershed: WS -III Protected Area
Watershed Split: NO
•
Voter Precinct: P2
E911 District: COUNTY
Zoning: R -40
Zoning2:
Zoning3:
Zoning Split:. N
Zoning Overlay: WP -O • •
Zoning District: COUNTY
Split Zoning Dist: N
Split Zoning Dist(1): 0
Split Zoning Dist(2): 0
•
• School District: • COUNTY
Elementary School:•BANOAK
Middle School: JACOBS' FORK
High School: FRED T FOARD
School Split: NO
P &Z Case Number:
Census Tract 2010: 011802
Census Block 2010: 2009
Small Area Plan: PLATEAU
Agricultural District: PROXIMITY
Printed: Thursday, March 03, 2011 04:26 PM
•
�.�3� 06306
'` "*Op. Permit and /or Cert. Op. Require ust be completed prior to final)
CATAWBA COUNTY H DE PARTMENT
(704) 465 -8270
Lot Eval. X Improve. Permit Y Repair Permit Cert. of Comp. Permit ,Oper. Permit
Owner /Agent Ke 4 CO at j1 Phone 3 aa1 - �/5 4e (v)
Address � 130Y ` , 2 ? Subdivision
}
Section /Block /Phase Lot#
Lot Size t c 1S / y Directions: U w • - ad co u- ° - rrt
/ 4- cc r O• i?/4lrt
Facility: House Mobile Home y Business . Other: Tax Map # 4 4 /3 - / - L i
Multi - family Other . Zoning Approval # Z--q-30 //Z-3
Bedrooms 3 Seats Employees Application Rate - GPD Flow 3(0 0
Hot Tub or Spa yes 40 Special Fixtures . 100% Repair Area yes /no REPAIR NOTICE:
Basement yes / C0o Basement Plumbing yes /no . REPAIRS MUST BE WITHIN 30 DAYS OR
Water Supply: Private Public . DAYS FROM DATE OF PERMIT.
Type of System: Trench k Bed Pump Pump /Panel Panel LPP Other
Tank Size: Septic Tank /000 *y / Pump Tank
Nitrification Field: Total Square Feet 900 Depth of Stone /Z. Bed Size
Trench Width 44, Total. Le � ----- of All Trenches � Number of Trenches -----
Individual Trench Length! _ / Feet on Center 6 7 Maximum Trench Depth 2 y
Distance of Nearest Well SO Lot Evaluation: Approved ( /no (Void After 24 months)
*********************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Topo —C % Slope Sketch of lot Evaluation Site - System Design - Final
Texture r/.a, er 1450
Structure ,al0rlc y
Clay Min. /4 1 `,
T'
Soil Wetness S L
Soil Depth YY "
Restric. Hoz. at " /
Available space o N .e
Overall Class SZ�1 \ (�
Comments: N 1 \
1
I
l►5, 2,
3 11
irs Q
Septic Tank Contractors
3G -2/ 6
MUST contact the
Sanitarian BEFORE I 2 UYrO
changing permit.
* *NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN THROUGH THE ISSUANCE OF THIS PERMIT **
Permit Date / ' 3 (Improveme t - ermit vv. after 60 months)
Owner /Agent / Sanitarian Z L- _1! -=.�
Installed By " .+ AWAFOr Date / Sanitari' !� ./�i[ !
_i �'
(Note any changes /informatio irr ` � red or by sketch on .ack)
IF A PERMIT HAS TO BE REDESIGNED AND /OR RETRIPS MADE TO THE PROPERTY, THERE
IS AN ADDITIONAL $25 CHARGE. ' •
White - Office Blue -Bldg. Insp. Comp. Yellow- Owner /Agent Green -Bldg. Insp. I.P.
144 IN L u51
• CATAWBA COUNTY HEALTH EPARTMENT
Telephone: (704) 465 270 TDD: (704) 465 -8200
Improve. PermitAAuthorization to Construct Repair Permit Oper. Permit x System Type C2)1
1 /1 3d / • l 070 en
Owner /Agent P � � `� C[1 �� � Phone y - o
Address 2 t 39' 6 If/4 % Subdivision .
Se� t ion /Block /Pase Lot#
Lot Size Directions: /t ?'ztl 0- /' �?/• Ch • . '777, t l
/s - Atd L A."-1 pit, 17,4447
a?d 3q LI T,-
Facility: House Mobile Home a Business . Other: Tax Map # 4 ms- / " `/
Multi- family Other . Zoning Approval # eg706.5�/
# Bedrooms G/ # Seats # Employees . Application Rate 0 y GPD Flow 4 '
Hot Tub or Spa yesla Special Fixtures 100% Repair Area 6s /no
Basement y es / r0 Basement Plumbing yes /no
Water Supply: Private Well K Public -
Type of System: Trench YL Bed Pump Pump /Panel Panel LPP Other
Tank Size: Septic Tank Size odo 6- ,v - 'r/^i.J 6, Pump Tank Size
Nitrification Field: Total Square Feet 300 Depth of Stone /Z Bed Size
Trench Width 345 Total Length of All Trenches /017 Number of Trenches /
Individual Trench Length X60/ / / / Feet on Center 9 Maximum Trench Depth zy
Distance of Nearest Well 104 *DO NOT INSTALL WHEN WET*
'
Topo S" V t Slope
Texture eiOrey
Structure )?6,07k , l/
Clay Min. //
Soil Wetness 5 "
Soil Depth 7 " 1 x
Restric. Hoz. at ----" a �n/5
Available space a /no '1 e �
Overall Class S U
Comments:
3 ' 1
0 ce7yz_ ae-P. Vee
VI //
� 3 1( eo! 64
* *NO GUARANTEE OR WARRANTY IS IMPLIED OR 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) five ears from date issued and is not transferable. /
/
Permit Date , �/" - 97
Owner /Agent ! C A .ar Sanitarian `4_ t,,_ /e, . 4,,,,,� ,
Installed By /�,l.W0T., Date .. S- nitaria' �/ /� i!
White - Office Blue - Building Inspection Operation Permit Yellow - 'Owner` /Agent Green - Building Inspection Authorization to Construct
'$A CO CATAWBA COUNTY PERMIT
• ZONING AUTHORIZATION (R)
( L i Swimming Pool
`'S' P. O. Box 389 Phone: 828-465-8380 PERMIT NO: ZONR- 3- 1145783
100A Southwest Blvd FAX: 828 - 465 -8484 APPLIED: 03/02/2011
r� Newton, North Carolina 28658
ISSUED: 03/03/2011
18 4 SM www.catawbacountync.gov EXPIRES: 08/30/2011
Catawba County Internet Citizen Access Portal: energov.catawbacountync.gov /cap/
APPLICANT OWNER CONTRACTOR
Helen Coffey Helen Coffey •
2042 Collie TR 2042 Collie TR
• Vale NC 28168 -8898 Vale NC 28168 -8898 &1 „` , , . ;t; .. _
P. 828 - 310 -4104 • P. 828- 310 -4104 * * * * ** NO CONTRACTORS ASSIGNEj * * * * **
PROPERTY ID #: 267903229727
STREETADDRESS: 2039 COLLIE TR, Vale, NC LOT# 3B & PT 3A
PROJECT DESCRIPTION: Above Ground pool 33' Diameter
COMMENTS:
•
FLOOD ZONE? OWNER TYPE: Residential (Private)
100 YEAR FLOOD ZONE PLAIN? No LAND OWNER:
FLOOD PLAIN, STRUCTURE? No
REQUIRED SETBACKS FRONT: 30.00 REAR: 5.00 CORNER: SIDE: 10.00 MAX HEIGFIT: 45
FEE DESCRIPTION DATE FEE AMOUNT
Residential Zoning Fee 03/03/2011 $25.00
TOTAL FEES $25 :00 • •
The applicant hereby certifies that all information and attachments to this Certificate of Zoning Compiliance are true and correct, and
acknowledges that this permit was issued on the basis of the information required herein. The applicant further acknowledges that any construction,
alteration or addition which differs from this application shall be subject to removal or alteration so as to bring said structure into conformance with the
specifications and standards of the Catawba County Zoning Ordinance. Such corrective action shall be at the expense of the applicant.
It is the responsibility of Applicant to comply with all existing deed restrictions pertaining to the property. Issuance of this permit is not certification of
such compliance and does not relieve Applicant of the duty to comply.
* *This Zoning Authorization (R) Permit shall expire six months from the date of issuance unless uilding permit is secured and remains activ
10 ( -4:e/1-- 41
AP • LICANT NAME (PRIN I D) , APPLIC S IGNATURE L ZONING APPROVED BY
COMPANY NAME
* * * ** ZONING FEES ARE NON - REFUNDABLE * * * **
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