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HomeMy WebLinkAboutRBPR-07-2013-17703.TIFA CSG THIS IS NOT A PERMIT Case # RBPR-07-2013-17703 CATAWBA COUNTY HEALTH DEPARTMENT 0aei PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 11842 sM Residential Building Plan Review - Building New � AUTH CONST - NEW WELL Applicant ERICH SAINE, 2108 JOE JOHNSON RD, CATAWBA NC 28609 0:7048042923 Owner JIM & PHYLLIS SAINE, 2172 JOE JOHNSON, CATAWBANC 28609 C:8282442716 OTHER: 8282441667 NAME TO APPEAR ON PERMIT Erich Saine SITE ADDRESS: 2108 JOE JOHNSON RD, CATAWBA NC 28609 PIN # 369903313256 NAME of SUBDIVISION: Lot # Section/Block PROPERTY SIZE: Square Feet Acres 52.71 DIRECTIONS: 16 S LEFT BUFFUALO SHOALS RIGHT ON LITTLE MTN LEFT OF JOE JOHNSON. LOT ON RIGHT PASS CREEK. PRIMARY CONTACT: Applicant SEWER TYPE: GALLONS PER DAY: 480 WATER SUPPLY: DESCRIBE WORK: 75 x 34 New home with 4 bedrooms 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? No 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? Yes Are there any easements or right-of-ways on this property? APPLICATION FOR: New Structure STRUCTURE TYPE: FACILITY TYPE: Single Family Residence DESCRIPTION OF None EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: PRIMARY RESIDENCE OTHER DESCRIPTION: # OF OCCUPANTS PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 75 x 34 # OF NEW BEDROOMS:: 4 BASEMENT? No BASEMENT FIXTURES? No Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: OTHER: INNOVATIVE: Other described: Septic Tank Private Well PLUMBING REQUIRED? Yes CONVENTIONAL: ANY: YES APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO L9 - chapplicatx,n 07/19/2013 14:36 Page I of 4 yA CATAWBA COUNTY Case# RBPR-07-2013-17703 Public Health Department Subdivision Fav Environmental Health Division PIN# 369903313256 va® 'PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 184 sM NAME ON PERMIT: ERICH SAINE, 2108 JOE JOHNSON RD, CATAWBA NC 28609 Site Address: 2108 JOE JOHNSON RD, CATAW BA NC 28609 Property Size: Square Feet Acres 52.71 Directions: 16 S LEFT BUFFUALO SHOALS RIGHT ON LITTLE MTN LEFT OF JOE JOHNSON. LOT ON RIGHT PASS CREEK. 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 a,9 correct. Authorized county state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rubs. I understand that I m olely responsible for the proper identification and labeling of all property lines and corners and making the site acc ssible o t at a c ete site ev tion can be performed. Date: % — (� ^ 2� / Signature of Applicant or Agent ✓ An Environmental Health Specialist will contact you within 2 orking ays of ap tc ton date. If you need further information or assistance phase call 8-466-729 AREA1 MINIMUM SETBACKS FRONT: 80 SIDE: 15 EAR: 30 MAX HEIGHT: FEENAME DATE FEE AMOUNT Authorization to Construct Fee (New/Expansion) 07/19/2013 $300.00 Fee Well Permit & Inspection Fee 07/19/2013 $300.00 TOTAL FEES $600.00 SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) F) - 6arplicatum 07/19/2013 14:37 Page 2 of CATAWBA THIS IS NOT A PERMIT COUNTY --� CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page l Improvement Permit L 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 Construction Property Address�0g J OC w. t r N 0 �� � ���, u �_ CM (to� Driving Directions to Property ❑ Existing Facility ❑ Subdivision Lot # Acres Section/Block/Phase NAME TO APPEAR ON PERMIT? Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name �; ; f c� Y•Jl �' Address Phone Owner Contact Information Name Address a\V�) Joe JahOSafN Phone �i-1 Joe ��hNson ��� Cahn, Nc Cell Phone QaA v ­,,,_)b , _\�L D_ 6CI Cell Phone " rl pts kd q- - AGS a 'DD Contractor Contact Information Name Address Phone I Cell Phone WHO WILL BE THE PRIMARY CONTACT?Owner F-1Applicant ❑ Contractor Description of Existing Structures on Site , # of Bedrooms *t Structure Dimensions # of Occupants Basement ❑ Yes ❑ No 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 -0-5o Does the site contain any jurisdictional wetlands? ❑ Yes -8-No Does the site contain any existing wastewater systems? ❑ Yes E3 -No Is any wastewater going to be generated on the site other than domestic sewage? '❑'Yes ❑ No is the site subject to approval by any other public agency? ❑ Yes ,Q -No 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) ❑ Accepted ❑ Alternative ❑ Conventional 0 Innovative Cl Other �y LATA A THIS IS NOT A PERMIT crn.UN n, � -__ CATAWBA COUNTY HEALTH DEPARTMENT North Ca--'� Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence eNew Residence ❑ Addition to Residence # of New Bedrooms *t Project Description UuS (L Structure Dimensions ri 5 X 314 # of Occupants Basement ❑ Yes .Z -No Basement Fixtures ❑ Yes ❑ No ❑ Accessory Structure(s) Describe # of New Bedrooms *t 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 *t Structure Dimensions ❑ Food Service Specify Type # Seats Floor Space -Entire Food Service Facility (Sq Ft) # Employees per Shift # of Shifts Ditung 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 uction/Abandonment/Repair Application for Well C71ndividual Proposed Well Type 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-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 i 1 inch = 100 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. LUbb Selected Parcel Number: 3699-03-31-3256 Prpnnrprl fnr- THIS IS NOTA LEGAL DOCUMENT 1 11 1 t ,r• _ _ _ __ __ v , =r r Date:7/10/2013,. Time',,11:16:40AM ! I L___, CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3699-03-31-3256 Name: SAINE JIMMY DARRELL Name2: SAINE PHYLLIS M Address: 2172 JOE JOHNSON RD Address2: City: CATAWBA State: NC Zip: 28609-8150 Account: Calc Acreage: 52.71 Tax Map: 002 X 01022 LRK: 1677 Deed Book: 2792 Deed Page: 1348 Subdivision Name: Subdivision Block: Lots: Plat Book: Plat Page: Building Number: 2172 Street Name: JOE JOHNSON RD Site Zip: 28609 Township: MOUNTAIN CREEK Fire Dist: BANDYS City/Tax: State Road: 1817 Total Bldgs Value: $204,800 Land Value: $283,500 Total Value: $488,300 Year Built: 1990 Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 128 Watershed: WS -IV Protected Area Watershed Split: NO Voter Precinct: P31 E911 District: COUNTY Zoning: R-40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: WP -0 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: 3001 Small Area Plan: SHERRILLS FORD Agricultural District: Proximity Printed: Wednesday, July 10, 2013 11:10 AM M LEGEND o EXISTING IRON (TYPE NOTED) O NEW IRON (TYPE NOTED) ® PK NAIL O MAG NAIL. • RIR SPIKE ® CONCRETE MONUMENT STONE X COMPUTED POINT n NAIL 0 NGS/NCGS GRID MONUMENT UTILITY POLE ❑ LIGHT POLE O DUKE POWER Box TELEPHONE PEDISTAL SANITARY SEWER MANHOLE STORMDRAIIV MANHOLE " WATERLINE MANHOLE WATER METER ® WATER VALVE ® SEWER CLEAN OUT © GAS VALVE R/W ' — • — OWRHGID UllUIIES FENCE " -- SANRARY SEWER ITR LINE LINES Wr SURvCKD Q+ rw[; ImxMNt MND N, .TONES OB 2553 PC 630 S 82"44.57"'E 632.67' - 600.02" LOT 2 3.16 ACRES TOTAL 0.24 AC. IN R/W ,, 2.92 ACRES NET 50 0 50 100 150 GRAPHIC SCALE - FEET FENCC LOT 1 •TIMMY D SAINE OB 1791 PG 1348 F.E.M.A. CERTIFICATION NEW LINOS IN ACCORDANCE WITH THE NATIONAL FLOOD INSURANCE RATE MAPS PUBLISHED BY THE UNITED STATES DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (HUD). FEDERAL INSURANCE ADMINISTRATION, AND PROVIDED BY THE FEDERAL EMERGENCY MANAGEMENT AGENCY (FEMA). FEDERAL INSURANCE ADMINISTRATION (CATAWBA COUNTY NORTH CAROUNA)• FIRM PANEL NO. 3 7 1 03 688001. EFFECTIVE DATE: 9/5/1007. THIS PROPERTY HAS BEEN DETERMINED TO LIE OUTSIDE OF A SPECIAL FLOOD HAZARD AREA. 1 i MAr. NAIL I CH = S 07'18'14-E I CH = 55.78' 1 ARC = 55.78' 1 RAD. = 2132 21' Z LA 0 W p Al P 1 07 "ItR 1 °'- N RIR SPIKC z1 1 � MND N, .TONES OB 2553 PC 630 S 82"44.57"'E 632.67' - 600.02" LOT 2 3.16 ACRES TOTAL 0.24 AC. IN R/W ,, 2.92 ACRES NET 50 0 50 100 150 GRAPHIC SCALE - FEET FENCC LOT 1 •TIMMY D SAINE OB 1791 PG 1348 F.E.M.A. CERTIFICATION NEW LINOS IN ACCORDANCE WITH THE NATIONAL FLOOD INSURANCE RATE MAPS PUBLISHED BY THE UNITED STATES DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (HUD). FEDERAL INSURANCE ADMINISTRATION, AND PROVIDED BY THE FEDERAL EMERGENCY MANAGEMENT AGENCY (FEMA). FEDERAL INSURANCE ADMINISTRATION (CATAWBA COUNTY NORTH CAROUNA)• FIRM PANEL NO. 3 7 1 03 688001. EFFECTIVE DATE: 9/5/1007. THIS PROPERTY HAS BEEN DETERMINED TO LIE OUTSIDE OF A SPECIAL FLOOD HAZARD AREA. IgA CATAWBA COUNTY r A y Public Health Department d®� Environmental Health Division PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 !g 2 sw 0 Fn 0 aCase # Subdivision } PIN# LOT# IMPV-07-2013-040071 369903313256 NAME ON PERMIT: JIM & PHYLLIS SAINE, 2172 JOE JOHNSON, CATAWBA NC 28609 Site Address: 2108 JOE JOHNSON RD, CATAWBA NC 28609 Property Size: Square Feet 137,649.60 Acres 3.16 Directions: 16 S LEFT BUFFUALO SHOALS RIGHT ON LITTLE MTN LEFT OF JOE JOHNSON. LOT ON RIGHT PASS CREEK. Improvement Permit Facility: Primary Residence Permit Category: New Septic Bedrooms 4 WATER SUPPLY: Private Well Basement? No Basement Plumbing? No INITIAL SYSTEM SPECIFICATIONS Permit Valid: Expires In Five Years: _X— No Expiration: Projected Daily Flow 480 g.p.d Proposed Wastewater System: 25% REDUCTION Type: II1G - OTHER NON -CONY TRENCH SYSTEMS Permit Conditions: Keep all parts of septic system and repair area minimum: 10' from property lines, 50' from any well, 5' from home including decks and porches. Lines to be installed on contour. Do not grade drive or fill over system or repair area. REPAIR SYSTEM SPECIFICATIONS Repair System Required? Required Proposed Wastewater System: 25% REDUCTION Type: IIIG - OTHER NON -CONY TRENCH SYSTEMS Landscaping or other site alterations that potentially divert groundwater or surface water toward the septic system, or prevent proper drainage away from the septic system, including the direction of gutter flows or foundation drains, is not aooroved, and may result in failure to approve the initial system installation, or the suspension/revocation of existing permits. The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the applicant/property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are met. This Improvement Permit is subject to revocation if the site plan, plat or the intended use changes, or if site conditions are altered. The Improvement Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina 'Laws and Rules for SewaLye Treatment and Disnosal Snstems' (15A NCAC 18A .1900). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for any given period of time. Jason Boyd 07/19/2013 AUTHORIZED STATE AGENT APPROVAL DATE Permit Expiration Date. 07/19/2018 No grading or construction activity is al/owed in areas designated for system and repair without approval of the Health Department. 1:9 - chpermit 07/19/2013 14-13 Page I of 3 G {} 2 U.wa CATAWBA COUNTY Public Health Department Environmental Health Division PO Box 389, 100A Southwest Blvd, Newton NC 28658 Permit # Name i Address PIN# 1842 srn (828) 465.8270 Fax (828) 465-8276 TDD(828)465-8200 Site Plan Improvement Permit ^1 �-j1�>vL A1�r 4 EH PR -6-13-17647 Jim and Phyllis Saine Joe Johnson Rd Catawba NC 369903313256 Scale -7 f ,� G4 ►� �l �,� 3 �`_ C 1�" a, r r-' Iso Scale