HomeMy WebLinkAboutEHPR-4-11-10371 (2).TIF �� C O� THIS IS NOT A PERMIT Case # EHPR-4-i 1-10371
�"
v �' � CATAWBA COUNTY HEALTH DEPARTMENT
,�: ''C Plan Review Application for Environmental Services
1842 SM Environmental I3ealth Plan Review - OSWP
IMPROVEMENT
NAME TO APPEAR ON PERMIT
Brady Little
SITE ADDRESS: E BANDYS CROSS RD Catawba, NC Pin#: 367904943842
NAME of SUBDIVISION: Lot # 3 Section/Block/Phase
PROPERTY SIZE: Square Feet Acres L29
DIRECTIONS: NC 16 S FROM NEWTON TO BUFFALO SHOALS RD, TURN LEFT ON BUFFALO SHOALS, TRAVEL
APPROX 3 MILE, TURN RIGHT ON E BANDYS CROSS RD LOT ON RIGHT APPROX 200 YARDS
APPLICANT OWNER CONTRACTOR
Brady Little Brady Little
1598 Buffalo Shoals RD 1598 Buffalo Shoals RD
Catawba NC 28609 Catawba NC 28609
(828)241-2004 (828)24 I-2004
PRIMARY CONTACT: Owner APPLICATION FOR: New Construction
DIM EXISTING STRUCTURE: EXISTING FACILITY TYPE: House
NUMBER OF EXISTING BEDROOMS: SEWER TYPE: Septic Tank
NUMBER OF EXISTING OCCUPANTS: EXISTING WATER SUPPLY IN USE: N/A
CALCULATED DESIGN FLOW:
Public water is *"NOT"" available for this property.
PUBLIC WATER TYPE AVAILABLE:
DESCRIBE WORK: SUBDIV[DING PROPERTY TO LATER BUILD HOME
PROPOSED FUTURE ADDITIONS NONE
OR IMPROVEMENTS:
PROPERTY EASEMENTS: NONE
PROPOS CONSTRUCTION
PRIMARY RESIDENCE �
NEW RESIDENCE? New Residence
# OF NEW BEDROOMS: 3 # OF STRUCTURE OCCUPANTS: 6
PROJECT DESC: HOUSE WITH BASEMENT
PROJECT DIMENSION: 30X60
BASEMENT? Yes BASEMENT FIXTURES? No
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 norrexpiring 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: � ��2 -/� Signature of Applicant or Agent
An Environmental Health Specialist will contact you within 2 wor, ing days of application date.
If you need further information or assistance please call 828-466-7291
AREA 1
****�*�*********�******�******************�**�***�******�**�****�*��*�****************�*�*�*************���*�*�***�*�*
Minimum Setbacks Front: Side: Rear: Side St: Max Height:
04/12/11 10:I5
�qA CATAWBA COUNTY Case # EHPR-4-1 1-10371
y � G Public Flealth Department
Q � Subdivision
a Environmental Health Division - Plan Review
� o� `�' PG Box 389, 100-A Southwest Blvd, Newton, NC 28658 Lot# 3
Ig 2 5� PIN#
367904943842
Applicant/Owner Brady Little, 1598 Buffalo Shoals RD, Catawba NC 28609
Site Address: E BANDYS CROSS RD, Catawba, NC
Property Size: SF 129 ACRES
Directions: NC 16 S PROM NEWTON TO BUFFALO SF[OALS RD, TURN LG['T ON E3UPFALO Sf-IOALS, TRAVEL APPROX 3
MILE, TURN RIGHT ON E[3ANDYS CROSS RD LOT ON RIGHT APPROX 200 YARDS
FEE NAME DATE AMOUNT BALANCE DUE
Improvement Permit Fee 04/12/201 1 $150.00
TOTAL FEES $150.00
CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
04/l2/11 10:1�
� �� THIS IS NOT A PERMIT
��`a �,�' � CATAWBA COUNTY HEALTH DEPARTMENT
, Q �g � Application for Environmental Services Page 1
1� � �
Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑
Septic Expansion ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑
Well Repair ❑ E�sting System Inspection (Pre-Approval Required) ❑
Application is for New Construction ❑ Existing Facility ❑
Property Address Subdivision
( , O(/ . G- - � ��Q � Lot # 3 Acres /. � q
Section/Block/Phase
Driving Directions to Property rjP/� �/ t' �- /1/• G/� .�` T,�C�,r� ,�,i �= !.v �/V y O
l3 U�"/=�'t v.� �� ��s i�.0 - 7 L C: �r d� i3 vfF�9� o��a,� � s�
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� >c �J � /'I3d f �i� r� i s �? �� ���,D �' o,� /r'�G-h�r
�
Q, NAME TO APPEAR ON PERNIIT? ,� Owner ❑ Applicant ❑ Contractor
� Applicant Contact Information
�V Name ��j�� j r��—
W Address v L d s' /�/p �L .� G ��j� , G.� � O
m
y Phone 2�• Z 1� .- 2(>p � Cell Phone ��- z 3�- 2�� �
� Owner Contact Information
� Name � � s` /� v �/ L
Z Address
Q Phone Cell Phone
� Contractor Contact Information
W Name
� Address
�
= Phone Cell Phone
�
Z WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant ❑ Contractor
Z Description of Existing Structures on Site
� # of Bedrooms *�' Structure Dimensions # of Occupants
I� Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes ❑ No
�
Planned Future Additions ar Improvements (Building Permit NOT requested at this time)
OC Describe
� Proposed Future Structure Dimensions # of Bedrooms * j� if applicable
? Are there easements or right-of-ways recorded on this properiy ❑ Yes � No
Descr
Is a public water supply available on or adjacent to the above property ** ❑ Yes [Y�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)
� 4 G THIS IS NOT A PERMIT
" � CATAWBA COUNTY HEALTH DEPARTMENT
� � Application for Environmental Services Pa�e 2`�
18 su
Proposed Facility Type
❑ Primary Residence � New Residence ❑ Addition to Residence # of New Bedrooms *�' 3
Project Description _� a USL
Shucture Dimensions 3 d X (' � # of Occupants 6
Base ment � Yes ❑ No Basement Fixtures ❑ Yes � No
❑ Accessory Structure(s) Describe
# of New Bedrooms *�' if applicable Structure Dimensions
# of Occupants Accessory Dwelling ❑ Yes ❑ No
Plumbi ❑ Yes ❑ No Describ Plumbing Needed
❑ Multi-Family Residence # Units #Bedrooms per Unit*�'
Total # B e d rooms *�' S tructure Dimensions
❑ Food Service Specify Type
# Seats Floor Space -Entire Food Service Facility (Sq Ft)
# Employee p er Shift # o f S hifts Dining Area (Sq. Ft.)
❑ Business Specific Type of Business Retail Floor Space
# of Employ 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 j' 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 confumed by rooms identified on house plans as a
bedroom at the time of building pernut issuance. This may prevent the need for septic system size increase in the future. '�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
0 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 aze transferrable, but may be revoked if this information, site
W plans or intended use changes for the proposed facility. An Authorization to Construct issued by this department is valid for
m (5) five years from the date issued and is not transferable
= ~ G'��2��
Signature of Owner or Agent
� Printed Name of Owner or Agent L/ L.��
Date �- �/' �
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�cb� THIS IS NOT A LEGAL DOCUMENT Tuesday, April 12, 2011 09:45 AM
�
��A �o� caTaw�a couNTY, Nc
� ,..�, 100-A South West Blvd pLAN RECEIPT
E--] Newton, NC 28658-
U ����Q �' (828)465-8399 Tuesda A ril 12 2011
�► Y, p ,
1g 42 sM www.catawbacountync.gov
P�an �ase: EHPR-4-11-10371 �nvoice Number: INV-4-11-274039
Environmental Health Plan Review Invoice Date: 04/12/2011
Site Address: E BANDYS CROSS RD, Catawba, NC
APPLICANT OWNER CONTRACTOR
Brady Little Brady Little
1598 Buffalo Shoals RD 1598 Buffalo Shoals RD
Catawba NC 28609 Catawba NC 28609
(828)2 (828)24 ]-2004
Fee Name Fee Amount
Improvement Permit Fee Fixed $150.00
Total Fees Due: $150.00
PAYMENTS
PAYER: BRADY LITTLE
Date Pay Type Check Number Amount Paid Change
04/12/2011 Check 5846 $150.00 $0.00
Total Paid: $150.00
Total Due: $0.00
��lan receipl 04/12/201 I 10:32
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