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Home My WebLink AboutRBPR-07-2012-15949.TIF$A G THIS IS NOT A PERMIT Case # RBPR-07-2012-1 X949 Q' �. CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Ig 2 SM Residential Building Plan Review - Building New IMPROVEMENT- AUTH CONST - NEW WELL Contractor KELLY CUSTOM BUILDERS, INC., PO BOX 3276, MOORESVILLE NC 28117-3276 i v B:7049877755C:7049367874 RAY@KELLYCUSTOMBUILDER.CCOM Owner TODD KRUGER, 1305 GREENMONT CIR, VIENNA NC 26105-3295 NAME TO APPEAR ON PERMIT Kelly Custom Builders, Inc. SITE ADDRESS: 8480 QUEENS CT, CATAWBA NC 28609 PIN # 471004540723 NAME of SUBDIVISION: ASTORIA Lot /f $ SectionBlock PROPERTY SIZE: Square Feet Acres 0.99 DIRECTIONS: Molly's Backbone / merger lift at stop sign onto Monbo Road / Right Hopewell Church Rd / Right Regal Drive / Right Astoria, Right onto Queens Cr / Lot at end of cul-de-sac PRIMARY CONTACT: Contractor ' SEWER TYPE: N/A GALLONS PER DAY: 450 WATER SUPPLY: N/A Public water is **NOT** available for this property. DESCRIBE WORK: New Dwelling APPLICATION FOR: STRUCTURE TYPE: FACILITY TYPE: Single Family Residence DESCRIPTION OF EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: PROPERTY EASEMENTS: none NEW STRUCTURE DIM:: 66 x 101 New Structure PRIMARY RESIDENCE OTHER DESCRIPTION: # OF OCCUPANTS: PROPOSED CONSTRUCTION APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: 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 location should conform to applicable setbacks. C"�orking Date: 7W2` z- Signature of Applicant or Agent�'� An Environmental Health Specialist will contact you withof application Mte. If you need further information or assistance please call 828-466-7291 AREA1 MINIMUM SETBACKS FRONT: 30 SIDE: 15 REAR: 30 MAX HEIGHT: C9 - �happlic.uu�n 07/05/2012 16:36 Pagel of4 L. 1842 SM THIS IS NOT A PERMIT Case # RBPR-07-2012-15949 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Building New IMPROVEMENT -A UTHCONST - NEW WELL Contractor KELLY CUSTOM BUILDERS, INC., PO BOX 3276, MOORESVILLE NC 28117-3276 _ B:7049877755_C:70.4_9367874_ RAY@KELLYCU_STOMBUILDER.COM Owner TODD KRUGER, 1305 GREENMONT CIR, VIENNA NC 26105-3295 NAME TO APPEAR ON PERMIT Kelly Custom Builders, Inc. SITE ADDRESS: 8480 QUEENS CT, CATAWBA NC 28609 PIN # 471004540723 NAME of SUBDIVISION: ASTORIA Lot # 8 Section/Block PROPERTY SIZE: Square Feet Acres 0.99 DIRECTIONS: Molly's Backbone / merger lift at stop sign onto Monbo Road / Right Hopewell Church Rd / Right Regal Drive / Right Astoria, Right onto Queens Cr / Lot at end of cul-de-sac PRIMARY CONTACT: Contractor SEWER TYPE: N/A GALLONS PER DAY: 450 WATER SUPPLY: N/A Public water is **NOT** available for this property. DESCRIBE WORK: New Dwelling APPLICATION FOR: STRUCTURE TYPE: FACILITY TYPE: Single Family Residence DESCRIPTION OF EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: PROPERTY EASEMENTS: none NEW STRUCTURE DIM:: 66 x 101 New Structure PRIMARY RESIDENCE OTHER DESCRIPTION: # OF OCCUPANTS: PROPOSED CONSTRUCTION APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: 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 location should conform to applicable setbacks. Date: Signature of Applicant or Agent 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 AREA1 MINIMUM SETBACKS FRONT: 30 SIDE: 15 REAR: 30 MAX HEIGHT: L9-:happhcalion 07/05/2012 16:36 Page I of pA CATAWBA COUNTY Case # RBPR-07-2012-15949 Public Health Department Subdivision ASTORIA d a►s '� Environmental Health Division PIN# 471004540723 v PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 NAME ON PERMIT: KELLY CUSTOM BUILDERS, INC., PO BOX 3276, MOORESVILLE NC 28117-3276 Site Address: 8480 QUEENS CT, CATAWBA NC 28609 Property Size: Square Feet Acres 0.99 Directions: Mollv's Backbone / merger lift at stop sign onto Monbo Road / Right Hopewell Church Rd / Right Regal Drive I Right Astoria, Right onto Queens Cr / Lot at end of cul-de-sac FEENAME DATE FEE AMOUNT Authorization to Construct Fee (New/Expansion) 07/05/2012 $300.00 Fee Improvement Permit Fee 07/05/2012 $150.00 Well Permit & Inspection Fee 07/05/2012 $300.00 TOTAL FEES $750.00 CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) F.0 - ehapi lication 07/05/2012 16:36 Page 2 of �L;A THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT • ¢ �� Application for Environmental Services Page 1 184? SM Improvement Permit ❑■ Authorization to Construct ❑■ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit 0 Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre -Approval Required) ❑ Application is for New Construction ❑I■ Existing Facility ❑ Property Address 8480 Queens Ct Subdivision Astoria Catawba, NC 28609 Lot # 8 Acres •99 Section/Block/Phase Driving Directions to Property Molly's Backbone merge left at stop sign onto Monbo Rd, turn right onto Hopewell Church Rd, turn right onto Regal Dr, turn right onto Astoria, turn right onto Queens Ct. Lot at the end of cul de sac. GATE ACCESS CODE IS #0008 NAME TO APPEAR ON PERMIT? ❑ Owner ❑ Applicant ❑E Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name Address Phone I Cell Phone Contractor Contact Information Name Kelly Custom Builders, Inc Address PO Box 3276, Mooresville, NC 28117 Phone 704.987.7755 (a, Q, . Cz I Cell Phone 704.936.7874 WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant ❑■ Contractor Description of Existing Structures on Site n/a # of Bedrooms *T 4 Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes ❑ No Planned Future Additions or Improvements (Building Permit NOT requested at this time) Describe New home with basement Proposed Future Structure Dimensions 66'x101' # of Bedrooms *T if applicable 4 Are there easements or right-of-ways recorded on this property ■❑ Yes ❑ No Describe Lake buffer 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) W W ca THIS IS NOT A PERMIT '. CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 IS Z SM Proposed Facility Type e ❑0 Primary Residence ❑i New Residence ❑ Addition to Residence # of New Bedrooms * j Project Description New home Structure Dimensions 66'x101' # of Occupants 4 VA Basement IYes ❑ No Basement Fixtures xYes [:]No ��'r�ZdJ 1i� ]ti. ❑ Accessory Structure(s) Describe # of New Bedrooms *f if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi -Family Residence # Units #Bedrooms per Unit*T Total # Bedrooms *f 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 f 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. tlf 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) 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 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 PrintednN mJe of Owner or AgentQ/ Date ! �� / ] ;� Ra W• ASTOMA (5OF 9 PLAT BK. 53 PG. 134 Curve Radius Chord Bearing and Diatance Arc Length Cl 51.00' N 24' 24' Be W 81.17' 83.87' Lina Bearing Distance .� Lt S 2D' 38' 29' W 35.95' L2 S 63' 32' 53' W 20.35' L3 S 11' 37' 50' E 10.37' L4 N 37 09' 48' E 48.84' / LOT 10 E] MMO s/s' REIM / / LOT 8 EXISIVIa / 5/8' REEIM i PROPOSED PROPOSED r / g HVAAc y / EXISTING R / s� �AR PROPOSED HOUSE �. / v - 04 X Vn ' 1N w. ` 5EXISTM 76 1 34 1 1SIT REBAR Em EXWMC e/'s' REHAR / LOT 7 _ LOT a ' T000 A. KBS GM and t719® ANGELA D. CCS ` DEED BK. 2393 PG. 0001 PIN 04710-04-54-0723 \\ NOTES: J 1, TRAVERSE ADJUSTED BY COMPASS RULE ADJUSTMENT METHOD. 2. AREAS DETERMINED BY COORDINATE COMPUTATIONS. 50 25 0 50 100 3. ALL DISTANCES ARE HORIZONTAL GROUND DISTANCES I4{ ` � REFERENt:ES` DEEDS AND HAPS SHOWIR HEREON. I7r_m 6m „. SCALE OF DRAWING IS 1 INCH = 50 FEET d 0 r� SITE VICINITY MAP —NTS - 00> El/M11NG�IRON NOTED B o POINT N;?AS SET Sita Pian For KEL Y WSW BUILMS 8480 011e COURT CATAVOA TOWNSHIP CATAMIA CO., N. C. F�ojxrt f12OMS-1 Datm I G% 2W2 B0 r�' EN .SURVEYING 704-6HJ-5266 b'z MAPPING UNCOLNW4 LALMM Sr AALa, . ' CATAWBA COUNTY HEALTH DEPARTMENT P051e-d Telephone: (828) 465-8270 TDD: (828) 465-8200 WLS#204/ -O/oy7 IP ��....AC Rpr. Pratt. Opt. Prmt. Sys. Type Well Prmt. Replacement Well Well Rpr. Prmt. O%v-A[ ?AC SP 1 G1G+- a lz4TF%1. - Phone Address ,q��h► ,�,�� Subdivision C•A. Al0 ('-1 9 Section/Block/Phase Lot# R Lot SizeQ,6c✓Zfa— Directions:��Ays a t5�a-�G,LI� �L:/�� m 4 N�6 ?i �� .t!'T.pS� cTl'C1/I% �[. �n U f F CJ�9t✓LA �. !S L : Z61.4 14 ow -1 �wACPropertyAddress �.�1- /� Facility: House Mobile Home Business Multi -family . Other: Pin Number412/6 p/ ,.�s- Other Zoning Approval # # Bedrooms if # Seats # Employees . Application Rate GPD Flow—Y-90 Hot Tub or Spa yesAopecial Fixtures ,Basemen yes 100% Repair Are es o Basement Plumbing es o Water Supply: Private Well Public Semi -Public Type of System: Trench— Bed -- Pump Pump/Panel • Panel LPP Other-,. ,401 &FQctea' 6A 44 Septic Tank Size Pump Tank Size --- Nitrification Field: Total Square Feet ' Depth of Stone Bed Size Trench Width Total Length of All Trenches -» Number of Trenches Trench Length —t—/= Feet on Center maximum Trench Depth --r' Distance of Nearest Well' *DO NOT INSTALL SEPTIC WET* *WELL RECORD REQUIRED AT COMPLETION* Topo % Slope I �� Texture C� ! o Structure t y 6y Clay Min. I \ Soil Wetness f - , j Soil Depth I �tprM.Apase-D Restric. Hoz. at Available space yes/no Overall Class S PS U Comments: .$'t E .Sbe/G Nd 1 G �2aPasr� _ t I�►4A I � sirG I I s 00 v I � W Filter Required Riser required when tank is more than 6 inches deep. inches OR WARRANTY -f-3 ED OR GIVEN f.S ['(T THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** pp I�s ' *Improvement Permit has no exptr date and is tra era e,�ttim4ay �r�cbked if site plans or intended use changes for the proposed facility. An Authorization to Construct is d for (5) the years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well loc ,installation, and protection must meet state and local regulations, and must be inspected and approved by a representative of the C tawba 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 guaranteed at any site by the Health Department. Permit Date Ttr&�R /3;,'Roo I EHS Owner/Agent Septic Tank Installed By Date EHS Well Installed By Well Grout Approval Date Well Head r I Date Date Sample Collected Date of Res Results EHS White - Office Blue - Building Inspection Operation Permit Yellow - Owner/Agent Green - Building Inspection Authorization to Construct