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Home My WebLink AboutBLDR-11-11-22857 Carport.tif $A C CATAWBA COUNTY PERMIT BUILDING (R) Addition V ►j�� P. O. Box 389 Phone: 828 -465 -8399 PERMIT NO: BLDR -11 -11 -22857 100A Southwest Blvd Newton FAX: 828 - 465 -8962 APPLIED: 11/08/2011 Newton, North Carolina 28658 Hickory FAX: 828 - 322 -6814 ISSUED: 11/15/2011 I $ 4 SM EXPIRES: 05/13/2012 www.catawbacountync.gov Catawba County Internet Citizen Access Portal: energov.catawbacountync.gov /cap/ APPLICANT OWNER CONTRACTOR DEANNA LYNN WISE -POPE DEANNA LYNN WISE -POPE HUTCHISON CONSTRUCTION, LLC 3318 WELLMAN RD 3318 WELLMAN RD 8140 14UTCHISON LN VALE NC 28168 VALE NC 28168 VALE NC 28168 - P. 828 -461 -6555 P. 828 -461 -6555 P. (828)302 -5888 F. 704 -462 -2091 EMAIL: twhutchI454 @aol.com PROPERTY ID#: 267701095747 STREET ADDRESS: 3318 WELLMAN RD, Vale, NC LOT# 1 PROJECT DESCRIPTION: ATTACHED 28'X 30' CARPORT DIRECTIONS: HWY 127 S TO HWY 10/ TURN RT/ GO APPROX 5 MI PAST BANOAK ELEM TO RHONEY FARM RD/ TURN RT/ GO APPROX 1 MI TO WELLMAN RD/ TURN LT/ HALF MILE TO 3318 COMMENTS: TYPE OF USE: Addition TOTAL SQ FT # OF STORIES: 1 VALUE: 9,000.00 ZONING: NUMBER OF UNITS: 1 CODE EDITION: IRC 2009 TOTAL # OF ROOMS: FEE DESCRIPTION DATE FEE AMOUNT Permit Placard Fee 11/08/2011 $5.00 New Residential Building Fee 11/08/2011 $211.85 Home Ow ners Recovery Fund 11/08/2011 $10.00 TOTAL FEES 5226.85 Catawba County has an agreement with Garbage Disposal Service, Inc. granting them an exclusive license to transport and dispose of all solid waste, including construction and demolition debris in the unincorporated areas of the County. The approval of your application for a construction/building permit is made specifically contingent upon your agreement not to utilize any other business or company to transport and/or dispose of solid waste from construction site(s). Failure to comply with this provision may result in assessment of fines up to $500 per day. This permit is issued on the express condition that the above work shall conform in all respects to the statements certified to in the application for such permit, and that all work shall be done in accordance with all applicable zoning, building, electrical, plumbing and mechanical ordinances of the County of Catawba and the State of North Carolina. A permit issued for work under this Code shall expire by limitations six months after the date of issuance if the work authorized (FOOTINGS ARE CONSIDERED 1st INSPECTION ON NEW CONSTRUCTION) has not been commenced. If after commencement the work is discontunued for a period of 12 months, the permit therefore shall expire. If a project expires, a minimum fee per the current fee schedule will be charged for each building and trade permit to reactivate the project. r * * *AN ADDITIONAL CHARGE PER THE CURRENT FEE SCHEDULE MAY BE ASSESSED FOR EACH UNWARRANTED INSPECTION SCHEDULED. * ** If there are any questions, please contact the office between 8:00a.m. and 5:00p.m. permit 11/15/2011 12:00 Page I oft CATAWBA COUNTY PERMIT c BUILDING (R) Is 2 BLDR - 11 - 11 - 22857 Addition AFFIDAVIT OF WORKER'S COMPENSATION COVERAGE AND STATE PRIVILEGE LICENSE REQUIREMENTS N.C.G.S.87 -14 The undersigned applicant for Building Permit # BLDR - - - 22857 being the Unlicensed Contractor Owner d&0:�-Officer /Agent of the Contractor do hereby aver under penalties of perjury that the person(s), firm(s) m(s) or corporation(s) performing the work set forth in the permit: has/have three(3) or more employees and have obtained workers compensation insurance to cover them. has/have one or more subcontractor(s) and have obtained worker's compensation insurance covering them. has/have one or more contractor(s) who has/have no employees and has waived and has waived in writing their right to coverage by their contractor or have their own policy or worker's compensation covering themselves hEs/have not more that two (2) employess and no subcontractors. has renewed Contractor License. has/have applied for permit where the cost is under $30,000 and I am therefore exempt from Licensed General Contractor requirements specified by G.S. 87 -14. has/have applied for permit under owner exception to the licensing requirements mandating occupancy of the premise for 12 months following the completion of the project, while working on the project for which the permit is sought. It is understood that the Inspections Department issuing the permit may require certificates of coverage and/or waivers of worker compensation insurance coverage prior to issuance of the permit and at any time during the permitted work for any person, firm or corporation carrying out the work. SIGNATURES ARE TO BE WITNESSED BY INSPECTIONS PERSONNEL OR NOTARIZED. FIRM NAME: BY (PRINT): ` "�� .� TITLE: SIGNATURE: DATE: 5 SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY OF , 20 SIGNATURE OF NOTARY: MY COMMISSION EXPIRES , 20 OFFICL.4L .YE.4L l 1/15/201 1 12:00 Page 2 oft DC Newton Office (828) 465 -8399 CATAWBA !a - COUNTY P.O. Box 389 Newton Fax (828) 465 -8962 APPLICATION FOR BUILDING PERMIT Newton NC 28658 Hickory Fax (828) 322 -6814 www.catawbacountvnc.gov All submittals/re- submittals of commercial plans must be accompanied by a $10.00 plan processing fee Name of Project: c' Date of Application: 2& 0 Z X i c `� Address of Project: Parcel ID #: 3318 �t�m RD . V4 Lt /,C- Z / 6S 14-170109 Applicant: Phone . Fax: Address of Applicant: Email: 3 31e Owner: - '7 Phone#: Fax: Address of Owner: Email: General Contractor: Phone#: Fax: Cv� c ,v.✓ LLB s32Y - 302 ,Yk936 State License#: License Classification: Federal ID #: S&16_ Z (i.e., H1, P1, Limited) , !�`� . j�y8�to Address of Contractor: '` Email: Architect/Designer: Phone#: Fax: Address of Arch /Designer: Email: Contact Person for Project: Phone#: Fax: Address of Contact Email: Does the Project have a Fire Alarm System? [ ] Yes [&Ko Does the Project have a Sprinkler 1 Standpipe System? * [ ] Yes f_ o * Sprinkler Plan Submission to the County, City of Hickory, Conover or Newton Fire Bureaus' is the responsibility of the customer. Plan Approval must be forwarded to the Permit Center when completed and approved. Will this Project require Environmental Health Review? * [ ] Yes W-Ao • *If yes, submit one set of plans to Environmental Health with appropriate fee (Page 4 of this application Provides explanation as to when these are required and the fee amounts.). Type of Sewage Disposal: Is Public Sewage available on or adjacent to this project? * [ ] Yes "o - - * If No, a Septic Permit must be applied for prior to project review approval, if not already approved. Type of Water Service: Is Public Water available on or adjacent to this project? * [ ] Yes [ o * If No, a Well Permit must be applied for prior to project review approval, if not already approved. Are you disturbing more than 1 acre of soil? * [ ] Yes o • * If yes, 5 sets of erosion control plans and one set of calculations will need to be submitted. A fee of $200 for the first • acre and $150 for each additional acre of disturbed soil will be collected at the time of plan submittal. Additional applications will be required. Forms are at permit centers, or can be obtained from our website(See above for website address Is this Project being submitted for Phased Construction? * [ ] Yes [ o *If yes, please check which phase? I [ ] Footing / Foundation [ ] Shell / Hull -in [ ] Up-Fit Continue to Next Page 1 Updated 04 /15/2011 Newton Office (828) 465 -8399 CATAWBA _a COUNTY P.O. Box 389 Newton Fax (828) 465 -8962 APPLICATION FOR BUILDING PERMIT Newton NC 28658 Hickory Fax (828) 322 -6814 www.catawoacountync.gov 1 Describe work to be done under this permit: i TYPE OF WORK ❑New Building [vjrAddition ❑ Alteration ❑ Mixed Add /Alter ❑ Demolition ❑ Accessory Structure ❑ Deck I Porch ❑ Re -Roof ❑ Pier ❑ Repairs ❑ Swimming Pool ❑ Footing /Found ❑ Shell -In ❑ NC Rehab ❑ Up -fit ❑ Retaining Wall ❑ Relocate Dwelling (Prior Address of Dwelling) STRUCTURE USE/OCCUPANCY (check all that apply) Occupancy Classification I (See Classification list on sheet 5, enter multiple if mixed occupancy) ❑ Condominium ❑ Modular Office ❑ Retaining Walls (Sealed Plans) ❑ Addition ❑ Covered Deck ❑ Modular Dwelling ❑ Single Family (site built) ❑ Agricultural ❑ Deck only ❑ Multi- Residential ❑ Townhouse ❑ Alteration 1 Exterior ❑ Mixed Occupancy ❑ Modular Garage ❑ Alteration I Interior ❑ Hanger, Mixed Use ❑ Pier (Sealed Plans) Other TYPE OF CONSTRUCTION Protected or Unprotected construction refers to whether the (Circle) 1 11 111 IV V Protected (A) Unprotected (B) building is designed with specific fire rated construction methods. PROJECT DATA Total Sq Ft yG` Heated Sq Ft — Unheated Sq Ft (basement, garage, covered porches, etc) Garage Sq Ft Bonus Rm Sq Ft (finished /unfinished) Basement Sq Ft (finished /unfinished) 1 Floor Sq Ft 2n' Floor Sq Ft Exterior Finish Material _u l� �— Total # Rms # of Units # of Stories # Full Bathrooms # Half Bathrooms (Toilet & Sink only) # Bedrooms Building Height Fireplace openings _ (masonry, prefab /gas, prefab /wood) Type of Heat Type of Foundation I' SUBCONTRACTORS NEEDED FOR PROJECT ❑ Electrical ❑ Plumbing ❑ Heating / A/C ONE POWERIUTILITY COMPANY Servicing the Location: Type of Gas Service (Nat. or Propane) Is a Temporary Saw Pole Needed for this project? ❑ Yes PTko Will there be more than one electrical Meter for this building? ❑ Yes [ No (If Yes, provide Number of Meters ) I hereby certify that all information in this application is correct and all work will comply with the State Building Codes and all other applicable State and local laws and ordinances and regulations. I understand that a Certificate of Occupancy is required prior to occupying the premises and the Building Services Department will be notified of any changes in the approved plans and specifications for the project permitted herein. (For Plan Review) Owner / Agent Signature Date 'Est. Project cost (Fo r Permit) Contractor /Agent Signature Date 2 Updated 04 /15/2011 $A C CATAWBA COUNTY PERMIT ZONING AUTHORIZATION (R) Addition V �+� �►j� � P. O. Box 389 Phone: 828 - 465 -8380 PERMIT NO: ZONR -11 -11 -22858 100A Southwest Blvd FAX: 828 - 465 -8484 APPLIED: 11/08/2011 Newton, North Carolina 28658 ISSUED: 11/08/2011 I $ 4 SM www.catawbacountync.gov EXPIRES: 05/06/2012 Catawba County Internet Citizen Access Portal: energov.catawbacountync.gov /cap/ APPLICANT OWNER CONTRACTOR DEANNA LYNN WISE -POPE DEANNA LYNN WISE -POPE HUTCHISON CONSTRUCTION, LLC 3318 WELLMAN RD 3318 WELLMAN RD 8140 HUTCHISON LN VALE NC 28168 VALE NC 28168 VALE NC 28168 - P. 828 - 461 -6555 P. 828- 461 -6555 F. 704 - 462 -2091 EMAIL: twhutchl454 @aol.com PROPERTY ID #: 267701095747 STREET ADDRESS: 3318 WELLMAN RD, Vale, NC LOT# 1 PROJECT DESCRIPTION: ATTACHED 28'X 30' CARPORT COMMENTS: 28'X 30' ATTACHED OPEN CARPORT FLOOD ZONE? OWNER TYPE: Residential (Private) 100 YEAR FLOOD ZONE PLAIN? No LAND OWNER: Private FLOOD PLAIN, STRUCTURE? No FEE DESCRIPTION DATE FEE AMOUNT Residentia Zoning Fee 11/08/2011 $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 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 f�thheldate ssu ance unless a building permit is secured and remains activ. E' / t lSli L APPLICA T NA 4E (PRIN APPLICANT SIGNATURE ZONING APPROV COMPANY NAME ZONING FEES ARE NON - REFUNDABLE * * * ** permit 11/08/2011 11:59 Page 1 of I Catawba County, North Carolina N l hu map product was prepared fronn the Catenrba Contra'. NC, Geographic hJormatton System. Catawba Counm has made substantial eff orts to ensure the occuraq oflocation and labeling information contained on this map. Catmvba County promotes and recommends the independent verification of am data contained on this mVp product b) the user. The Count)- of Catawba, its emplot ees, agents and personnel disclaim. and shall not be held liable for am' and all damages, loss or hahrlitt, whether direct, indirect or consequential which arises or mar arise front this map product or the use thereof by am person or enim Legend Selected Parcel Number: 2677 -01 -09 -5747 1 inch = 60 feet Prepared for: 342.35 c r 2. CAA 2z 47 o � o 95 , , - 14. C� THIS IS NOT A LEGAL DOCUMENT \� Tuesdac, No-. ember 08, 2011 11:14 ANN CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 2677 -01 -09 -5747 Name: WISE DEANNA LYNN Name2: Address: 3318 WELLMAN RD Address2: City: VALE State: NC Zip: 28168 -7573 Account: 127337 Calc Acreage: 2A Tax Map: 007 B 04003 LRK: 6767 Deed Book: 2183 Deed Page: 0401 Subdivision Name: Subdivision Block: 00 Lots: 1 4IJ6 Plat Book: 49 Plat Page: 100 Building Number: 3318 Street Name: WELLMAN RD Site Zip: 28168 Township: BANDY'S Fire Code: COOKSVILLE City Code: COUNTY State Road: 1107 Total Bldgs Value: $61,900 Land Value: $19,300 Total Value: $81,200 Year Built: 2000 Year Remodeled: Last Sale Date: Last Sale Amount: 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: 1007 Small Area Plan: PLATEAU Agricultural District: Printed: Tuesday, November 08, 2011 11:09 AM � i � P ti ` tis��3``��5 , T'� ' s�+r � >, "Efi�F•�` �a'e 1��6 '� FR' �,� i+ �. �rf � ..Y t .4 •�, �� Ay - . ON _ - ri:: i $A THIS IS NOT A PERMIT Case # EHPR -1 1 -1 1 -13271 CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services 1842 SM Environmental Health Plan Review - OSWP IMPROVEMEN NAME TO APPE ON P ERMIT DEA LYN WIS -POPE _ SITE ADDRESS: 3318 WELLMAN RD, Vale, NC _ Pin#: 267701095747 NAME of SUBDIVISION: Lot # 1 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 2.4 DIRECTIONS: HWY 127 S TO HWY 10/ TURN RT/ GO APPROX 5 MI PAST BANOAK ELEM TO RHONEY FARM RD/ TURN RT/ GO APPROX 1 MI TO WELLMAN RD/ TURN LT/ HALF MILE TO 3318 APPLICANT OWNER CONTRACTOR DEANNA LYNN WISE -POPE DEANNA LYNN WISE -POPE 3318 WELLMAN RD 3318 WELLMAN RD VALE NC 28168 VALE NC 28168 828 - 461 -6555 828 -461 -6555 PRIMARY CONTACT: Contractor APPLICATION FOR: Existing Structure DIM EXISTING STRUCTURE: 28 X 40 EXISTING FACILITY TYPE: House NUMBER OF EXISTING BEDROOMS: 3 SEWER TYPE: Septic Tank NUMBER OF EXISTING OCCUPANTS: EXISTING WATER SUPPLY IN USE: Private Well CALCULATED DESIGN FLOW: 360 Public water is ""NOT"` available for this property. PUBLIC WATER TYPE AVAILABLE: DESCRIBE WORK: ATTACHED 28'X 30' CARPORT h X 2.0 & ) DESCRIPTION OF MODULAR DWELLING ( f- EXISTING STRUCTURES ` ON SITE (IF ANY) PROPERTY EASEMENTS: NA PROPOSED CONSTRUCTIO PR RESIDENCE � NEW RESIDENCE? Add/Alt to Residence # OF NEW BEDROOMS: 0 # OF STRUCTURE OCCUPANTS: 2 PROJECT DESC: 28 X 30 ATTACHED CARPORT PROJECT DIMENSION: BASEMENT? No 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 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 to ation should conform to applicable setbacks. Date: Signature of Applicant or Agent ti _ An Environmental Health Specialist will contact you within 2 working days of application date. If you need further information or assistance please call 828 - 466 -7291 AREA2 Minimum Setbacks Front: 80 Side: 15 Rear: 30 Side St: Max Height: 11/08/11 12:04 CATAWBA COUNTY Case # EHPR -11 -11 -13271 Q Public Health Department Environmental Health Division - Plan Review Subdivision .i PO Box 389, 100 -A Southwest Blvd, Newton, NC 28658 Lot# 1 �n 2 PIN# 267701095747 Applicant/Owner DEANNA LYNN WISE - POPE, 3318 WELLMAN RD, VALE NC 28168 Site Address: 3318 WELLMAN RD, Vale, NC Property Size: SF 2_4 ACRES Directions: HWY 127 S TO HWY 10/ TURN RT/ GO APPROX 5 MI PAST BANOAK ELEM TO RHONEY FARM RD/ TURN RT/ GO APPROX 1 MI TO WELLMAN RD/ TURN LT/ HALF MILE TO 3318 FEE NAME DATE AMOUNT BALANCE DUE Improvement Permit Fee 11/08/2011 $150.00 TOTAL FEES $150.00 CHANGE WORK ORDER REQUIRING REDESIGN AND /OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 11/08/11 12:04 y,A THIS IS NOT A PERMIT r CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page I 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) ❑ Applicatio nis for New Constr ction ❑ Existing Facility ❑ Property Address /p Gd j fin/ Subdivision Lot # Acres p / Section /Block/Phase Driving Directions to Property /74 — y / `7 S jc- _V � L ter=% e-s ri �/ 311 Q. NAME TO APPEAR ON PERMIT? M6wner ❑ Applicant ❑ Contractor O Applicant Contact Informatio U Name ,�� -4 - — W Address EL�rni4 any �c �_ CO Phone g12 F Cd1l Phone Owner Contact Information Name Z Address _Q Phone Cell Phone Contractor Contact Information H Name Address = Phone , c�.. r5 �}S ell Phone -3,:9 Z WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant [✓]Contractor Z Description of Existing Stres on Site ruc u _Q # of Bedrooms *fi Structure Dimensions # of Occupants 2— Basement ❑ Yes (� o Basement Fixtures ❑ Yes �Io Planned Future Additions or Improvements (Building Permit NOT requested at this time) O Describe U. Proposed Future Structure Dimensions # of Bedrooms *t if applicable ? Are there easements or right -of -ways recorded on this property ❑ Yes F Describe Is a public water supply available on or adjacent to the above property ** ❑ Yes li I o 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) �n THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 1 2 ti Proposed Facility Type ❑ Primary Residence ❑ New Residence Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions Z� X -�) (-) # of Occupants Z Basement ❑ Yes 0 Basement Fixtures ❑ Yes ZI No Accessory Structure(s) Describe GCS ' 1AW )cp, # of New Bedrooms *t if applicable Structure Dim-en 'ons Z41 Y - uj # of Occupants CU Accessory Dwelling ❑ Yes �o Plumbing ❑ Yes 0 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) # Employe p er 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- si te 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. tIf 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 W 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 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 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 transfer 1 zi Signature of Owner or Agent l Printed Name of Owner or Agent 7 l LAC J Date // CATAWBA CO TIC HEALTH EPARTMENT N _ 9 91 � �TeIephone: (828) 465 -8270 DD- 28) 465- 20 � Imp. Prmt, u to Const. Rpr, Prmt. Opr. Print. Sys. Type Well Prmt.`— Well Rpr. Print. Owner /Agent Phone A 7 S Address Subdivision Section/Block/Phase Lot# Lot Size Directions: On► Facility: House Mobile Home Business Multi - family . Other: Tax Map or Pin Number ;2, (p p 0 4 1' 7 Other . Zoning Approval k O 0 a — 7 7 # Bedrooms k Seats # Employees . Application Rate GPD Flow 0 Hot Tub or Spa ye n pecial Fixtures Basement yes /no 100% Repair Are /no Basement Plumbing yes /no Water Supply: Private Well_L�blic Semi- Public Type of System: Trench 4 ---- Bed Pump Pump /Panel Panel LPP Other r/ Septic Tank Size 0 DO Pump Tank Size Nitrification Field: Total Square Feet ZX0 8 Depth of Ston Bed Size Trench Width Total Length of All Trenches k oo Number ofTrenches Trench Length a U / �?�/ / /_ Feet on Cente Maximum Trench Depth — 9Y Distance of Nearest Well *DO NOT INSTALL SE C WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* Topo %Slope Texture Structure Clay Min. �� Q Soil Wetness . Soil Depth Restric. Hoz. at Available space no C Overall Class S U ` Comments: n \ I g��' ► , Filter Required Riser required when tank is more than 6 inches deep. * *NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME TH S 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) rive years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. The siting of the well by the Health Department staff is to provide protection from known possible sources of contamination. No volume of water is guarantee I at a y site by t Ith Department. Permit Date — EHS Owner/A nt ) --�r S eptic•T.tnk I stalled By Date — EHS r Well Installed By Well Grout Approval Date W Well Head Approval Date y �� Date Sample Collected Date of Results Results EHS �} White - Office Blue - Building Inspection Operation Permit Yellow - Owner /Agent Green - Building Inspection Authorization to Construct