HomeMy WebLinkAboutRBPR-07-2012-16019.TIFTHIS IS NOT A PERMIT Case # RBPR-07-2012-16019
CATAWBA COUNTY HEALTH DEPARTMENT
PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES
Residential Building Plan Review - Building Alteration
IMPROVEMENT - AUTH CONST - EXPANSION
Owner NORMA GREENE, 3139 MOUNTAIN CREEK RD, SHERRILLS FORD NC 28673-6001
H:704-489-9275
NAME TO APPEAR ON PERMIT
Norma Greene
SITE ADDRESS: 3139 MOUNTAIN CREEK DR, SHERRILLS FORD NC 28673 PIN # 369803208996
NAME of SUBDIVISION: 'M(d_1(Yt"r.\ri c1<--rV, `1�_'dcr_ Lot # a� Section/Block
PROPERTY SIZE: Square Feet Acres , - a T J
DIRECTIONS: 150E/ LEFT LITTLE MOUNTAIN RD/ RT INTO MOUNTAIN CREEK RIDGE/ LOT ON LEFT / LOT 24
PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank
GALLONS PER DAY: 480 WATER SUPPLY: Private Well
Public water is **NOT** available for this property.
DESCRIBE WORK: Finish Bonus Room to be Bedroom ** current septic system sized for 2 bedroom - owner will be selling house
as 4 bedroom house
APPLICATION FOR: Existing Structure
STRUCTURE TYPE: PRIMARY RESIDENCE
FACILITY TYPE: Single Family Residence OTHER DESCRIPTION:
DESCRIPTION OF Single family Home
EXISTING STRUCTURES
ON SITE (IF ANY)
DIM EXISTING STRUCTURE: 93 x 45
NUMBER OF EXISTING BEDROOMS: 3 # OF OCCUPANTS: 1
PROPERTY EASEMENTS: none
PROPOSED CONSTRUCTION
# OF NEW BEDROOMS:: 1
BASEMENT? No BASEMENT FIXTURES? No
PLUMBING REQUIRED? Yes
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 represent tion by ou f house or
structure locatio should conform to applicable setbacks. /'
Date: /� Signature of Applicant orA /��%�
An Environmental Health Specialist will contact you withi�t-2-w6rking days of�pRication date.
If you need further information or assistance please call 828-466-7291
MINIMUM SETBACKS FRONT: 30 SIDE: 15 REAR: 30 MAX HEIGHT:
FEENAME DATE FEE AMOUNT
Improvement Permit Fee 07/20/2012 $150.00
Authorization to Construct Fee (New/Expansion) 07/20/2012 $300.00
Fee
TOTAL FEES $450.00
L() ,happliriium 07/20/2012 15:34 Page I of
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A THIS 1S NOT A PERMIT
4 T ! \ CATAWBA COUNTY HEALTH DEPARTMENT
-r Application for Environmental Services Page 1
1842 �+
Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑
Septic Expansion X New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑
Well Repair ❑ Existing System Inspection (Pre -Approval Required) ❑
Application is for New Construction ❑ Existing Facility V
Property Address 3139 Mountain Creek Drive Subdivision Mountain Creek Ridge
Sherrills Ford, NC 28673 Lot # 24 Acres 1 114
Section/Block/Phase
Driving Directions to Property Highway #16 S from Newton. Take the exit for old #16 S. go abt. a block and tum onto Mount Beulah Rd.
Go to end of this road and turn Right onto Little Mountain Rd. Go .4 (4 tenths) of a mile and tum Left into Mountain Creek Ridge
Subdivision. This road is Mountain Creek Drive. Go two short blocks and look to your left for the brick house on the hill with a
three car garage.
NAME TO APPEAR ON PERMIT? ❑■ Owner ❑ Applicant ❑ Contractor
Applicant Contact Information
Name Norma D. Greene (formerly Robert A. Greene)
Address 3139 Mountain Creek Drive, Sherrills Ford, NC 28673
Phone (704) 489-9275
Owner Contact Information
Name Same
i Address
�I Phone
Contractor Contact Information
Name
Address
Phone
Cell Phone (828) 310-7335
Cell Phone
Cell Phone
WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant ❑ Contractor
Description of Existing Structures on Site Brick home with 2600 sq. ft. heated on one level and 600+ sq. ft. heated tonus room
# of Bedrooms *t4OLtr- ( Structure Dimensions 93x4f # ofOccupants one
Basement ❑ Yes ❑M No Basement Fixtures ❑ Yes ❑ No
Planned Future Additions or Improvements (Building Permit NOT requested at this time)
Describe I need two additional lines to serve two existing bedrooms.
Proposed Future Structure Dimensions
# of Bedrooms *f if applicable
Are there easements or right-of-ways recorded on this property ❑ Yes M 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 X Individual Well ❑ Community Well ❑ Semi -Public Well
❑ County/City/Township Water Line
011 WOULD LIKE TO SCHEDULE A COMBINED FLAGGING AND SOIL EVALUATION
(SEE COMBINED EVALUATION PROCEDUES)
THIS IS NOT A PERMIT
CATAWBA COUNTY HEALTH DEPARTMENT
Application for Environmental Services Page 2
1842 +u
Proposed Facility Type
❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *f
Project Description
Structure Dimensions
Basement ❑ Yes ❑ No
# of Occupants
Basement Fixtures ❑ Yes ❑ No
❑ 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
Total # Bedrooms *f
❑ Food Service Specify Type
#Bedrooms per Unit* f
Structure Dimensions
# 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. 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.
W CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN
ADDITIONAL CHARGE (SEE FEE SCHEDULE)
LU
OJ. 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 transferable
Signature of Owner or Agent
Printed Name of Owner or Agent Norma D. Greene
Date July 12, 2012
I inch = 50 feet
Catawba County, North Carolina
This map product was prepared from the Catawba County, NC, Geospatial Information System.
Catawba County has made substantial efforts to ensure the accuracy of location and labeling information
contained on this map. Catawba County promotes and recommends 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
or consequential which arises or may arise from this map product or the use thereof by any person or entity
Selected Parcel Number: 3698-03-20-8996
Prepared for:
PM1
23 �-'r
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THIS IS NOT A LEGAL DOCUMENR
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Date: 7/20/2012
Time: 4:44:57 PM
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CATAWBA COUNTY NC - Parcel Report
Information Regarding Selected Parcel(s)
Parcel ID:
3698-03-20-8996
Name:
GREENE NORMA D HEFNER
Name2:
Address:
3139 MOUNTAIN CREEK DR
Address2:
City:
SHERRILLS FORD
State:
NC
Zip:
28673-6001
Account:
159763166
Calc Acreage:
1.24
Tax Map:
LRK:
802646
Deed Book:
2708
Deed Page:
0404
Subdivision Name:
MOUNTAIN CREEK RIDGE
Subdivision Block:
Lots:
24
Plat Book:
60
Plat Page:
126
Building Number:
3139
Street Name:
MOUNTAIN CREEK DR
Site Zip:
28673
Township:
MOUNTAIN CREEK
Fire Code:
SHERRILLS FORD
City Code:
COUNTY
State Road:
Total Bldgs Value:
$363,000
Land Value:
$43,400
Total Value:
$406,400
Year Built:
2006
Year Remodeled:
Last Sale Date:
11/10/2005
Last Sale Amount:
$54,000
Neighborhood:
128
Watershed:
WS-IV Critical Area
Watershed Split:
NO
Voter Precinct:
P31
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:
BALLS CREEK
Middle School:
MILL CREEK
High School:
BANDYS
School Split:
NO
P&Z Case Number:
Census Tract 2010: 011501
Census Block 2010: 3017
Small Area Plan:
SHERRILLS FORD
Agricultural District:
Printed: Friday, July
20, 2012 04:44 PM
PIN �loTt?_0.� ? 0 WLSK 0 0i7F:
Catawba Countv Health Department Operation Permit
System Type: C.. Description: r ;.J�,lz --/;2<7 Types V and VI systems expire in 6 years.
(In .Accordance With Table Va ) Owner must contact health department 6 months prior to expiration for permit renewal.
Tt1 rn I -1A Mr= S d fl- c)9Kc' A)DAjrmv--T _
Owner's Frame Authorized State Agent
o
System Installer Date of Operation Permit Issuance
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and (\
all conditions of the Improvement Permit and Construction Authorization. V
SYSTEM CODE I
PERMIT CONDITIONS:
I. Perfonnance: System shall perform in accordance with Rule. 196 1.
II. Monitoring: As required by Rule. 1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
ow�
CATAWBA COUNTY HEALTH DEPARTMENT
• Telephone: (828) 465-8270 TDD: (828) 465-8200 WLS #_;Z Q80; - 06-T.2 S4
Improvement Permit AC_�, Repair Permit._ Operation Permit. System Type Well Permit. Replacement Well
Owner/Agent 'i V �L3 I'16-9 ey A&I 4W(, (, Phone :Lc,/ _ 2n /
Address '2/ 39 �pu,y;-div �q,£r-� �GL�tr ` Subdivision mAUti7T,9.,ti/ G/Z c2uu-:,
.5�4cnP7., t-" AMD n/. e .2 T-iC 2':� Section/Block/Phase Lot# „2 4�
Lot Size /. at jlu:Lg7i Directions: l6 S n_ ' 1'-7fir- mt)(-
-96 XV - H.. C
Property Address��3 g g, �y �¢,�j G>2 �' 04?)
Facility: Housed Mobile Home Business Multi -family Other: Pin Number o;<99 n aO R9 yG
Other . Zoning Approval # 2OA) 2 D o 6; - ti A 2 9 4;
# Bedrooms ;2 # Seats # Employees . Application Rate 1, 71 GPD Flow —2Vn
Hot Tub or Spa ye no pecial Fixtures Basement ye<D . 100% Repair Area e�a
Basement Plumbing yes ffo Water Supply: Private Well Public Semi -Public
Type of System: Trench' Bed Pump -•— Pump/Panel -- Panel-- LPP Other GLS i roiJ -246
Septic Tank Size iD p n Pump Tank Size - - Nitrification Field: Total Square Feet 600 Depth of Stone /V//9
Bed Size Trench Width 3 ` Total Length of All Trenches 1;200 Number of Trenches 2
Trench Length jc. c• //a a/ -- /-- / - / — Feet on Center j� J Maximum Trench Depth o2 IA'4- Distance of Nearest Well 5At
*DO NOT INSTALL SEPTIC WHEN WET* *WE�L RECORD REQUIRED AT COMPLETION*
Topo % Slope
Texture
Structure
Clay Min.
Soil Wetness
Soil Depth
Restric. Hoz. at
Available space yes/no
Overall Class S PS U
Comments: I
Sa-e )P. wzs-ztoa -
OaSS6 I 7
J " = (, 0 i
1
eC
(9
t✓rc;,
1
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A
Filter Required rU
Riser requi hen
3� ► .3 � C -
tank is more than 6
inches deep.
**NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM
WILL FUNCTION**
************************************************************************************************************************
An Authorization to Construct is valid for (5) five 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 guaranteed at any site by the Health Department.
Permit Date Ap'?w DO1. EHS �. _., aQ S _
Owner/Ag�n4i �/Lt�' �epticTankInstalled 'imp --T rZPA,-i1.4 , Date/ -�-QaEHS��Vell Install d By Al/At- Well Grout Approval Date /U/^ Well Head
Approval Dae �/1//, Date Sample Collected 1
Date of Results Results EHS
White - Office Yellow - Owner/Agent Pink - Building Inspection Authorization to Construct
W C.5 ;x uu & — 0 0 ,!F- � 4/
12
DESCRIPTION
Available Space (.1945)
System Type(s)
Site LTAR
COMMENTS:
INITIAL SYSTEM
1-5 1
lvlh /V/10
. .13
REPAM SYSTEM OTHER FACTORS (.1946):
SITE CLASSIFICATION (.1948):5%t,—
15 ---- . z--d-
/3
EVALUATED BY:
OTHER(S) PRESENT:
LEGEND
use the following standard abbreviations
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DENR (######)
Review (#M#)
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SOIL CONVENTIONAL LPP
- --
MINERALOGY!
LANDSCAPE POSTITON
GROUP TEXTURE .1455 LIAR' .1457 LTAR*
CONSISTENCE STRUCTURE
CC (Concave Slope)
I S (Sand) • 1.2-0.9 0.6-0.4
NEXP (Non -expansive) G (Single Grain)
CV (Convex Slope)
LS (Loamy Sand)
SUP (Slightly Expansive) M (Massive)
D (Drainage Way)
EXP (Expansive) CR (Cramb)
DS (Debris Slump)
II SL (Sandy Loam) 0.9-0.6 0.4-03
GR (Granular)
PI' (flood Plain)
L (Loam)
SBK (Subangular Blocky)
FS (Foot Slope)
. ABK(Angular Blocky)
H (Head Slope)
III - SCL (Sandy Clay Loam) 0.6-03 0.3-0.15
PL (Platy)
L (Linear Slope)
SiL (Silt Loam)
PR (Prismatic)
N those Slope)
R (Ridge)
CL (Clay Loam)
SiCL (Silty Clay Loam)
MOIST WET
S (Shoulder Slope)
T (Terace)
Si (Silt)
VFR (Very Friable) NS (Nae -sticky)
IV SC (Sandy Clay) 0,4-0.1 0.2-0.05
FR (Friable) SS (Slightly Sticky)
SiC (Silty Clay)
FI (Firm) S (Sticky)
C (Clay)
VFI (Very Firm v. Very Sticky) VS (Very Sticky)
O (Organic) None
EFI (Extremely Finn) NP(N )
Plastic)
(SlightlySP
*Adjust LTAR due to depth, consistence, structure, soil wetness, landscape, position, wastewater flow and quality. P (Plastic)
NOTES
VP (Very Plastic)
HORIZONDEPTH
In inches below natural soil surface
DEPTH OF FILL
In inches from land surface
RESTRICTIVE HORIZON
Thickness and depth from land surface
SAPROLITE
.SOIL WETNESS
S(suitable) or U(unsuitable)
Inches from land surface to fi= watcr or inches from land surface to soil colors with chrome 2 or less - record Munsell color chip designation
CLASSIFICATION
S (Suitable), PS (Provisionally Suitable), or (Unsuitable)
Evaluation of saprolite shall be by pits.
Long -tern Acceptance Rate (LIAR): gal/day/ft'
Show profile locations and other site featupes (dimensions, reference or benchmark, and North).
53.at!
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Review (#M#)