HomeMy WebLinkAboutEHPR-6-11-11090 (2).TIF �� �� THTS IS NOT A PERMIT Case # EHPR-6-11-11090
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� ' a CATAWBA COUNTY HEALTH DEPARTMENT
U -� ��`;� �a� '�' Plan Review Application for Environmental Services
I842 5M Environmental Health Plan Review - OSWP
1� + � e�isc� IIVIPROVEIl�EIVT A AUTH COIVST - IVEVI/ lNELL
�j ; s�' ���- SE� .��CILS NAME TO APPEAR ON PERMIT
BRIE BEANE
s�TE A��RESS: 3094 MATTIE WADE RD, Sherrills Ford, NC Pin#: 369804921373
NAME of SUBDIVISION: Lot # 1 Section/Block(Phase
PROPERTY SIZE: Square Feet Acres 0.779
DIRECTIONS: HOPEWELL CHURCH RD TO MATTIE WADE, PROPERTY ON LEFT PAST POWERLINE
APPLICANT OWIYER CONTRACTOR
BRIE BEANE PHILIP CLARKSON ��� �p�
3972 KIMBERLY PL 2117 COLONY HILL DR �'fl�' she/t� Its �'�� �`� .
TERRELL NC 28682- CHARLOTTE NC 28214 , ��'
(910)431-5252 S'j,�'/f i ilS � � � � � °�
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PRIMARY CONTACT: Contractor APPLICATION FOR: New Construction
DIM EXISTING STRUCTURE: EXISTING FACILITY TYPE: N/A
NUMBER OF EXISTING BEDROOMS: SEWER TYPE: Septic Tank
NUMBER OF EXI5TING OCCUPANTS: EXISTING WATER SUPPLY IN USE: N/A
CALCULATED DESIGN FLOW: 480
Public water is *"NOT"" available for this property.
PUBLIC WATER TYPE AVAILABLE: N/A
DESCRIBE WORK: NEW CONSTRUCTION PRIVATE RESIDENCE W1LL BE 3 BR BUT WANT SEPTIC SYSTEM SIZED
FOR FUTURE ADDITION OF POSSIBLE 4TH BR.
PROPOSED FUTURE ADDITIONS NONE
OR IMPROVEMENTS:
PROPERTY EASEMENTS: NONE
PROPOSED CONSTRUCTION
PRIMARY RESIDENCE
NEW RESIDENCE? New Residence
# OF NEW BEDROOMS: 4 # OF STRUCTURE OCCUPANTS: 3
PROJECT DESC: NEW PRIVATE RESIDENCE
PROJECT DIMENSION: 55 X 69
BASEMENT? Yes BASEMENT FIXTURES? Yes
APPLICATION FOR WELL COfVSTRUCTION/ABANDONiViENTIREPAIR
PROPOSED WELL TYPE: Individual Well ABANDONMENT TYPE:
WELL REPAI REQUESTED?
06/06/ 11 16:32
� CATAWBA COUNTY Case # EHPR-6-11-11090
� G� Public Health Department Subdivision
� `�� Environmental Health Division - Plan Review
`'"""'� `�' PO Box 389, 100-A Southwest Blvd, Newton, NC 286�8 L�� 1
Ig 2 ;� PIN# 369804921373
Applicant/Owner BRIE BEANE, 3972 KIMBERLY PL, TERRELL NC 28682-
Site Address: 3094 MATTIE WADE RD, Sherrills Ford, NC
Property Size: SF 0.779 ACRES
Directions: HOPEWELL CHURCH RD TO MATTIE WADE, PROPERTY ON LEFT PAST POWERLINE
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-lo ation should conform to applicable setbacks.
�
Date: ���( Signature of Applicant or Agent `���-Q�
An Environmental Health Specialist will contact you withm 2 warkin� days of application date.
Ifyou need further information or assistance please call 828-466-7291
AREA1
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�Vin�mam Setbacks Front: 30 Side: 15 Rear: 50 Side St: Max Height:
FEE NAME DATE AMOUNT BALANCE DUE
Autharization to Construct Fee (New/Expansion) Fee 06/Ol/2011 $275.00 $0.00
�,....... _..__.,., _,�. __,,..� .._. ,,.,... �. ___ .,. ,_ .,..�.,. .__ ..�.�.... ..... �,,,._..�_ ...........
Improvement Permit Fee 06/O1/2011 $150.00 $0.00
......... _. ... ._,.. ...__ �_.._. _ .,,.,., .. �..� ., __ . ... �. _ . _ ____ .... __,_ ._., _.�..._ _..,_ ._ �._.�._.�. . __,_. � ___, __
Well Permit & Inspection Fee 06/O1/2011 $300.00 $0.00
TOTAL FEES $725.00 $O.QO
CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
06/06/ 11 16:32