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Home My WebLink AboutRBPR-07-2013-17624.TIFTHIS IS NOT A PERMIT Case # RBPR-07-2013-17624 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Swimming Pool IMPROVEMENT ■� 1 Fr �W .0 Contractor SHELTON POOL AND SPA, 2424 MYRA LN, LINCOLNTON NC 28092- Qevi S�SJI C:(704)201-1030 OTHER:(704)774-8118 Owner JASON REYNOLDS, 6211 STARTOWN RD, MAIDEN NC 28650 -7 1101 C:8283025249 NAME TO APPEAR ON PERMIT SHELTON POOL AND SPA SITE ADDRESS: 6215 STARTOWN RD, MAIDEN NC 28650 PIN # 362716842376 NAME of SUBDIVISION: Lot # A Section/Block PROPERTY SIZE: Square Feet 87,120.00 Acres 2 DIRECTIONS: Off Startown Rd PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: WATER SUPPLY: Private Well DESCRIBE WORK: 16x 3 In -ground swimming pool SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is "YES", then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? No Are there any easements or right-of-ways on this property? APPLICATION FOR: New Structure STRUCTURE TYPE: ACCESSORY STRUCTURE _ FACILITY TYPE: Other OTHER DESCRIPTION: DESCRIPTION OF Single Family Dwelling EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: ('3) # OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 16 x 32 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified conditions. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. I have read this application and certify that the information provided herein is true, complete and prrect. Authorized Alesponsible ls are granted right of entry to conduct necessary inspections to determine compliance with applicable laws a rules. I understand for the proper identification and labeling of allroperty lines and corners and making the site acce i e so that omp ete serformed. Date:_ �° — j Signature of Applicant or Agent _/�7 , An Environmental Health Specialist will contact you wit i 2 N rki g days of application date. If you need further information or assistance pleas c 828-466-7291 AREA2 L9 - chapphcat ion 07/12/2013 09:31 Page I of 4 S� A CATAWBA COUNTY Case # RBPR-07-2013-17624 h� 2 Public Health Department Subdivision d �a� Environmental Health Division PIN# 362716842376 PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Ig 2 SM NAME ON PERMIT: SHELTON POOL AND SPA, 2424 MYRA LN, LINCOLNTON NC 28092 - Site Address: 6215 STARTOWN RD, MAIDEN NC 28650 Property Size: Square Feet 87,120.00 Acres 2 Directions: Off Startown Rd MINIMUM SETBACKS FRONT: 80 SIDE: 10 REAR: 10 MAX HEIGHT: FEENAME DATE FEE AMOUNT Improvement Permit (Existing) Fee 07/03/2013 $90.00 TOTAL FEES $90.00 SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 1 1) - chapplicauon 07/12/2013 09:31 Page 2 of4 �yA G THIS IS NOT A PERMIT Case # RBPR-07-2013-17624 -e �, M CATAWBA COUNTY I IEALTH DEPARTMENT 0 , "x t�❑' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES r • 1842 SM Residential Building Plan Review - Swimming Pool L • rl ! IMPROVEMENT r; _„fig, Contractor SHELTON POOL AND SPA, 2424 MYRA LN, LINCOLNTON NC 28092- C:(704)201-1030 OTHER:(704)774-8118 Owner JASON REYNOLDS, 6211 STARTOWN RD, MAIDEN NC 28650 2:8283025249 NAME TO APPEAR ON PERMIT SHELTON POOL AND SPA SITE ADDRESS: 6215 STARTOWN RD, MAIDEN NC 28650 PIN # 362716842376 NAME of SUBDIVISION: Lot # A Section/13lock PROPERTY SIZE: Square Feet 87,120 00 Acres 2 DIRECTIONS: Off Startown Rd PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY : Private Well DESCRIBE WORK: 16 x 32 In -ground swimming pool SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is "YES', then supporting documentation is required. Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? No Are there any easements or right-of-ways on this property? APPLICATION FOR: New Structure STRUCTURE TYPE: ACCESSORY STRUCTURE FACILITY TYPE: Other OTHER DESCRIPTION: DESCRIPTION OF Single Family Dwelling EXISTING STRUCTURES ON SITE (IF ANY DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: 4 # OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 16 x 32 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTEDALTERNATIVE. CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described' Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified conditions An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable, Improvement Permits and Well Permits are transferrable Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility I have read this application and certify that the information provided herein is true, complete and correct Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws an � rules I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessib so that a comp) to 464ticration can be performed. Date: 7^ -Z ^ 13 Signature of Applicant or A,ent ., An Environmental Hbealth Specialist will contact you gaits 2 wking days of application date. If you need lunther information or assistance please call 828-466-7291 AREA2 MINIMUM SETBACKS FRONT' 80 SIDE: 10 REAR: 10 MAX HEIGHT: 1 9 - ,happin ah on 07/03/2013 16 52 Pagc I of g7ACATAWBA COUNT\' Cae # Y SubdiviPublic Health Department sion Environmental I lealth Divisum PIN# PO Box 389. 100-A Southwest Blvd, Newton. NC 28658 NAME ON PERMIT: SHELTON POOL AND SPA; 2424 MYRA LN, LINCOLNTON NC 28092 - Site Address: 6215 STARTOWN RD, MAIDEN NC 28650 Property Size: Square Pcet 87,120.00 Acres 2 Directions: Off Startown Rd FEENAME Improvement Permit (Existing) Fee TOTAL FEES RBPR-07-2013-17624 362716842376 DATE FEE AMOUNT 07/03/2013 $90.00 $90.00 SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 1 9 -:happlrcmnm 07/03/2013 16 52 Pagc 2 of CAI'AWBA THIS IS NOT A PERMIT .� COUNTY /.��.� CATAWBA COUNTY HEALTH DEPARTMENT moo. �e.e 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) ❑ Application is for New Const uction El Existing Facility E:1Property Address �� S/�i/ %(%lC%N �i� Subdivision Lot # Acres n Section/Block/Phase Driving Directions to Property�'� t S ('/i A LC wx-) /C NAME TO APPEAR ON PERMIT? ❑ Owner ❑ Applicant Contractor Applicant Contact Information Name SX e Ih,)Aj Pin/ 1 A)d <�-/)fl Address Z y /%J yeA LAN P Phone 70 y — 2 0/ — /0 0 Cell Phone '70 y '20 / —/03(o Owner Contact Information Name s) A SQ1 �fZ�O t° K �`yi �/C7criS Address Phone 92 OR/ - .q 2-1f 9 Cell Phone Contractor Contact Information r Name s/�/�0. SPAJ (Addressy�v MYNA GAni� Phone 70Lf— 71f -/l DI Cell Phone 7A5%21-oq/ —/6 WHO WILL BE THE PRIDIARY CONTACT? ❑ Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site /ft 1.i42 # of Bedrooms * 1 12`Structure Dimensions VNo # of Occupants Basement ❑ Yes ❑ Basement Fixtures ❑ Yes ❑ No The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in question. If the answer to any question is "yes", applicant must attach supporting documentation. ❑ Yes A'No Does the site contain anyjurisdictional wetlands? Yes �%'o Does the site contain any existing wastewater systems? Yes XNo Is any wastewater going to be generated on the site other than domestic sewage'? ❑ Yes NNo Is the site subject to approval by any other public agency? ❑ Yes A il0 Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well ❑ Community Well ❑ Semi -Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes ❑ No If applying for an Improvement Permit or Authorization to Construct, Please Indicate Desired System Type(s): (systems can be ranked in order of ,your preference) 0 Accepted ❑ Alternative 0 Conventional ❑ Innovative ❑ Other 0 Any Cip, TA 7q� /,��7L� THIS IS NOT A PERMIT n V coun— �CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms * j Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes ❑ No ❑ Accessory Structure(s) Describe Poo � # of New Bedrooms *-'I if applicable Structure Dimensions 2— # # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi -Family Residence # Units #Bedrooms per Unit* j Total # Bedrooms *'I 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 Page 2 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 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. t 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. SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified conditions. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. I have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent Date Printed Name of Owner or Agent %1--V o S� ' -IWTAUNT17HEALTH DEPARTMENT G�s� / / Telephone (828) 465-8270 T D (828) 465-82 WLS # a DJ o - D o j l j Improvement Permit ✓ AC \/ Repair Permit; Operation Petmrt.� System Type r jNell Perm t Replacement Well Owner/Agent {', .erg Qo�_l,k.. vii- R{ M'I Phone -55"j8 !� Address U 1 q 1 16 51 ME- 14 t ako. N L a 660 1 Subdivision I / Section/Block/Phase Lot# Lot Size d oo Directions H,,jy to its LX Ste,rt-own (U C.raaJ Sal I (>,s} PL PrsiPa4- 2� J n 2t ' Property Address 6a15 Facility: House Mobile Home Business Multi-family_ Other- Pin Number 368'l 16 S 4 a 3 -1 G _ O Other i Zoning Approval # #Bedrooms # Seats # Employees Application Rate 3 GPD Flow ,bo Hotl Tub or Spa yes/no Special Fixtures Basement yes no 100% Repair Area0eno Baseno Basement Plumbing yes Water Supply Private Well Public Semi-Public_ #RittYtt########t#kkt#k###jtt;itt##;#Ykfikrt#tk#Rttt Type of System: Trench v Bed Pump Pump/Panel Panel_ LPP, Other Septic Tank Size t UJ O Pump Tank Size Nitrification Field: Total Square Feet ja UO Depth of Stone l r: Bedl Size Trench Width 31 Total Length of All Trenches u U o Number of Trenches 14 i i it Trench Length / )< / Itre/_// Feet on Center Maximum Trench Depth ri Distance of Nearest Well I o o tDd NOT INSTALL SEPTIC WHEN WET* j 'WELL RECORD REQUIRED AT COMPLETION• #k#i<k#rtk##k#rttrtkkYtt4k4ktkkkYYktYttkRtt##kkk##ki###tiikitiii##t####t#kit####kkk4kktk#krtkkkktiitk Rtk###t###tkfi####ktkk#i#;Y## j To po %Slope i tC�ap e II ��-ri-S S�yotic- Texture StruIClare Clay Min. Soil Wemess I I o %� r"- ^"` o ^ y to •' I' Sosll6(I tnca Restric ric Hoz. a[ _ � � � ti r, Pte.4 Available space yes/no Oveirall Class S PS U P� o t �'t �, �f N G, IS Conaril is i ra r¢-w 5 � '\� � \ p�m yL °� r � � ?'iJ .'H L. o •,..c, d n M1 Lr.s+c-i I I'kc.S or\ co��}ov/ i y /�o 4S K43� �\ \\\ / " Do r, ;+ r'rad� r)r J^-�i pt- 6 (` N yu I al ♦u��}e i rop-„r A I o I Filte - Required 2 f 5 Riser required when tank) is more than 6 u iJv !j inches deep. y a S�<riro w r ild •#NO GUARANTEE OR WARRANTY IS IM GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION" ####'#ti#####4#4#iikkkkttkkk####Rkkiktikk####Mtik#ii44iikkkkkkk4k44k4iiitiiiitkkkfk4k4kkkkkikikk Mkkkkkkkk#k4kkkkkk##{4kk ® 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 inspeicted 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 guaran[e�t, gyjEHS i�e by the Health Department. lJ Permit Date 1 b Owner/Agent j Septic Tank talled By is.,}Ie.Gt Date 6 loa (J EHS1 `, ' (5,,,,I Well Installed By Well Grout Approval Date Well Head ApproDate I \ Date Sample Collected Date of esults Results EHS White - Office Yellow - Owner/Agent Pink - Building Inspection Authorvation to Construct N i I inch= 80 feet IL Catawba County, North Carolina This map product was prepared train the Catawba County, NC, Geospatial Information System Catawba County has made substantial efforts to ensure the accuraev 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 Caluwba, Its emplo7ees, agents and personnel disclaim, and shall not be held liable for any and all damages, loss or habtlrty, whether direct, indirect or consequential which arises or may arise from this map product or the use thereof by anv person or entity Selected Parcel Number: 3627-16-84-2376 Prepared for: i THIS IS NOTA LEGAL DOCUMENT\ Date://XZOIo ronnee}%?<✓ fd P CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3627-16-84-2376 Name REYNOLDS JASON B Name2: REYNOLDS HOPE S Address: 6211 STARTOWN RD Address2: City: MAIDEN State: NC Zip: 28650-8753 Account Calc Acreage: 2 Tax Map: LRK' 701013 Deed Book 2694 Deed Page 1219 Subdivision Name. Subdivision Block. Lots A Plat Book: 62 Plat Page: 83 Building Number: 6215 Street Name' STARTOWN RD Site Zip. 28650 Township. JACOBS FORK Fire Dist' MAIDEN RURAL City/Tax, State Road 1005 Total Bldgs Value: $167,500 Land Value: $16,400 Total Value' $183,900 Year Built: 2006 Year Remodeled: Last Sale Date: Last Sale Amount' Neighborhood: 113 Watershed. Watershed Split. Voter Precinct: P34 E911 District: COUNTY Zoning' R-40 Zoning2: Zonmg3: Zoning Split: N Zoning Overlay' ED -0 Zoning District COUNTY Split Zoning Dist. N Split Zoning Dist(1):0 Split Zoning Dist(2): 0 School District. COUNTY Elementary School. MAIDEN Middle School MAIDEN High School: MAIDEN School Split. NO P&Z Case Number. Census Tract 2010 011702 Census Block 2010. 1030 Small Area Plan. STARTOWN Agricultural District: Printed: Wednesday, July 03, 2013 0413 PM