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HomeMy WebLinkAboutRBPR-07-2014-19567.TIFContractor THIS IS NOT A PERMIT Case # RBPR-07-2014-19567 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Building New AUTH CONST -NEW WELL E Kil 10 * JCM CUSTOM HOMES, LLC (JUSTIN MORRISON), 1998 KIRSTEN ST, NEWTON NC 28658 C:828 -217-3862F:8289707475 JCMCUSTOMHOMES@GMAIL.COM Owner JOHN COOPER, 10550 TILLMAN RD, CLARENCE NY 14031 C:716-622-2207 NAME TO APPEAR ON PERMIT John Cooper SITE ADDRESS: 7780 LYNWOOD LN, SHERRILLS FORD NC 28673 NAME of SUBDIVISION: Lot # PROPERTY SIZE: Square Feet Acres 1.8 DIRECTIONS: 16S to Denver/ left Campground Rd/ right Kisler Store Rd/ right on Lynwood Ln PRIMARY CONTACT: Contractor SEWER TYPE GALLONS PER DAY: 360 WATER SUPPLY DESCRIBE WORK: 1 story dwelling w/ attached garage 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? No APPLICATION FOR: New Structure STRUCTURE TYPE: FACILITY TYPE: Single Family Residence DESCRIPTION OF vacant lot EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: PRIMARY RESIDENCE OTHER DESCRIPTION: PIN # 460604718824 4 Section/Block Septic Tank Private Well # OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 65 x 55 # OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? No Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: OTHER: INNOVATIVE: Other described: PLUMBING REQUIRED? Yes CONVENTIONAL: ANY: YES APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO E9 - chapplication 07/22/2014 10:51 Page 1 of SQA CATAWBA COUNTY Case # RBPR-07-2014-19567 Public Health Department Subdivision Q Environmental Health Division PIN# 460604718824 PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Ig 2 SM NAME ON PERMIT: ( JOHN COOPER), 10550 TILLMAN RD, CLARENCE NY 14031 ( John Cooper) Site Address: 7780 LYNWOOD LN, SHERRILLS FORD NC 28673 Property Size: Square Feet Acres 1.8 P S Directions: 16S to Denver/ left Campground Rd/ right Kisler Store Rd/ right on Lynwood Ln 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 aV4 correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws a A /so I un rs d that I am solely responsible for the proper identification and labeliinng 9f I property lines and corners and making the site accessi/besot a c to site evaluation can be performed. Date: r% / oZ�/ / Signature of Applicant or Agent An Environmental Health Specialist will contact you withi working d s o pplication date. If you need further information or assistance please call 828-466-7291 AREA1 MINIMUM SETBACKS FRONT: 30 SIDE: 15 REAR: 30 MAX HEIGHT: FEENAME DATE -.^_ FEE AMOUNT .. ...._._.... _ . _...... m..._.... _._ Authorization to Construct Fee (New/Expansion) 07/22/2014 $150.00 Fee Well Permit & Inspection Fee 07/22/2014 $300.00 TOTAL FEES $450.00 FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9 - chapplication 07/22/2014 10:51 Page 2 of 4 fflTHIS IS NOT A PER CATAWBA COUNTY HEALTH DEPARTMENT ;�j FlaComhnoT+. Application for Environmental Services Page 1 Improvement Permit ❑ Authorization to Cons uct E]" Septic Repair F] Septic Malfunction E:1Septic Expansion El New Well Permit,Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre -Approval Required) ❑ Application is for New (Construction ❑ Existing Facility ❑ Property Address '77'�S D 1­zZ0f-- Subdivision �Y c (-,t (LS U rc� , �- J L`7 --2, Lot # Acres ll 11 Sec 'on/Block/Phase Driving Directions to Property a C, r j I-� -{- C, �J 1 �{ ii d �J v Iry tvty w (110 QC_ 1 ' NAME TO APPEAR ON PERMIT? ❑ Owner ❑ Applicant ©-Co tractor Applicant Contact Information NameC Address cLJ+UW C Phone �. _ � 7 <2�, ?S (, J Cell Phone Owner Contact Information Name's / _ , Address 1f),S's D 1 ' i. I IrC �2 �J �OaC� j L( 1Z PC4Jc6 &) T Phone '7(6:;, - (, ,Z, - _)-,Z0_7 I Cell Phone Contractor Contact Information Name J�f /� / Address'( .� U �C4 ` Phone I Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant ['lffo-ntractor Description of Existing Structures on Site ' C i-3- # of Bedrooms *t _ Structure Dimensions # of Occupants Basement ❑ Yes D No Basement Fixtures 0 Yes No The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the propertyin question. If the answer to any question is "yes", applicant must attach supporting documentation. 11 Yes No Does the site contain any jurisdictional wetlands? 13 Yes No Does the site contain any existing wastewater systems? 0 Yes 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? 10 Yes i No Are there anVasements 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 >(N o If applying for an Improvement Permit or Authorization to Construct, Please Indicate Desired System Type(s): (systems can be ranked in order of your�ference) 0 Accepted 0 Alternative Conventional ❑ Innovative ❑ Other CAny CATAWBA THIS �1..IS NOT A PERNIITA� COUNTY -�" __. ATAWBA COUNTY HEALTH DEPARTMENT „ �Aoeno Application for Environmental Services Page 2 Proposed Facility Type 0—"Primary Residence 2/New Residence ❑ Addition to Residence # of New Bedrooms *t Project Description U-) kLom_ Structure Dimensions C'15 x`15 # of Occupants c ,� Basement ❑ Yes ':JNo Basement Fixtures EJ Yes GKo 3S�(-3 5_ LqQ'-A'ri & ❑ Accessory Structure(s) Describe V # 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 * j 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 # of Employees per Shift ❑ Other Facility Type Specify - # of Shifts Retail Floor Space 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 ❑ DriRed ❑ 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 fixture 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 ca be performed. Signature of Owner or Agent (sem' ....- Date Printed Name of Owner or Agent Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geospatial Information System. N 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: 4606-04-71-8824 -1 inch = 50 feet OWT % Prepared for: 8171 ig 2 IP � OD "N. o� 4 �0 � 3 - 0 THIS IS NOT A LEGAL DOCUMENT Date Saved: 6/11/2014 i e: 35 AM ,0 0 CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 4606-04-71-8824 Name: COOPER JOHN F Name2: COOPER LINDA MARY Address: 10550 TILLMAN RD Address2: City: CLARENCE State: NY Zip: 14031-2336 Account: Calc Acreage: 1.8 Tax Map: LRK: 800896 Deed Book: 3219 Deed Page: 0219 Subdivision Name: Subdivision Block: Lots: 4 Plat Book: 43 Plat Page: 21 Building Number: 7780 Street Name: LYNWOOD LN Site Zip: 28673 Township: MOUNTAIN CREEK Fire Dist: SHERRILLS FORD City/Tax: State Road: 1999 Total Bldgs Value: Land Value: $53,600 Total Value: $53,600 Year Built: Year Remodeled: Last Sale Date: 11/18/2013 Last Sale Amount: $35,000 Neighborhood: 129 Watershed: WS -IV Critical Area Watershed Split: NO Voter Precinct: P41 E911 District: COUNTY Zoning: R-30 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: CRC-O,WP-O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: SHERRILLS FORD Middle School: MILL CREEK High School: BANDYS School Split: NO P&Z Case Number: Census Tract 2010: 011504 Census Block 2010: 4042 Small Area Plan: SHERRILLS FORD Agricultural District: Printed: Tuesday, July 22, 2014 10:05 AM 3�z 3bo5pa �p CATAWBA COUNTY �4 Fc ?ubtic Health Department < C". S Frivironmental Health Division PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 0 Case # Subdivision PIN# LOT# IMPV-11-2013-043719 460604718824 4 M& NAME ON PERMIT: JACK COOPER, 10550 TILLMAN RD, CLARENCE NY 14031 Site Address: 7780 LYNWOOD LN, SHERRILLS FORD NC 28673 Property Size: Square Feet 78,408.00 Acres 1.8 Directions: HWY 16 TO DENVER, LEFT ON CAMPGROUND RD RIGHT ON KEISLER STORE, RIGHT ON LYNWOOD, LOT ON RIGHT PASSED THE 2ND DRIVE ON RIGHT Improvement Permit Facility: Primary Residence - House Permit Category: New Septic Bedrooms 3 WATER SUPPLY: Private Well Basement? No Basement Plumbing? INITIAL SYSTEM SPECIFICATIONS Permit Valid: Expires In Five Years: _X_ No Expiration: Projected Daily Flow 360 g.p.d Proposed Wastewater System: 25% REDUCTION Type: IIIG -OTHER NON -CONY TRENCH SYSTEMS Permit Conditions: REPAIR SYSTEM SPECIFICATIONS ............. _.. — ... . Repair System Required? Required Proposed Wastewater System: 25% REDUCTION Type: IIIG -OTHER NON -CONY TRENCH SYSTEMS PUMP *MAY BE* REOUIRED 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/7-oning 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 Sewaee Treatment and Disposal Svstems' (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. Robbie Phelps 11/13/2013 AUTHORIZED STATE AGENT APPROVAL DATE Permit Expiration Date: 11/13/2018 No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department. E9 - chpennit 11/14/2013 09:53 Page I of 3 A � �$ CATAWBA COUNTY Permit # G' Public Health Department Name .) Environmental Health Division (Address �lN# rig�1 � PO Box 389, 100A Southwest Blvd, Newton NC 28658 I8 2 w (828) 465-8270 F (828) 465-8276 TDD(828)465-8200 SITE PLAN 0 Scale %D o t y eusa —1p �u IMPV-11-13-043719 Jack Cooper 7780 Lynwood Ln `q" q o ( 63- wA i 1 Department of Environment, Health, and Natural Resources Division of Environmental Health On-site Wastewater Section SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM Owner: Jack C000er Address: 7780 Lvnwood Ln Proposed Facility: 3br Design Flow (.1949) 330 Location of Site: Water Supply: [ ] Public [ ] Individual [ )Well Evaluation Method: [ ] Auger Boring [ x ] Pit Type of Wastewater: [ ] Sewage [ ] Industrial Process Sheet: Property ID: Lot #: Fite #-. AppID: Applicant: Date Evaluated: Property Size: Property Recorded: [ ] Spring [ ] Other [ ] Cut [ ] Mixed P R 0 SOIL MORPHOLOGY b F .1941 PROFILE FACTORS 1 .1940 .' .1942 L Landscape Horizon .1941 1941 Soil .1943_ .1956 .1944 Profile E Position/ Depth Structure/ Consistence Wetnesst soil: Sapro . Rests Class # Slope% :. (IN.) Texture Mineralogy Color Depth (IN.) Class Hodz & LTAR 1 L, 6% I 0-10 cl,sbk fr,ss,sp 10-48 I sc,sbk fi,ss,sp 48 0.25 2 I 0-24 cl,sbk fr,ss,sp 24-48 I sc,sbk fr,ss,sp 48 0.3 3 I 0-16 cl,sbk fr,ss,sp 16-48 c,sbk fi,ss,sp 48 0.25 Description Initial System Repair System Other Factors (.1946): (Available Space (.1945) s s Soil Evaluation By: Robbie Phelos ISystem Type(s) 25% 25% Others Present: ISite LTAR 0.25 0.25 Site Classification (.1948): PS Site Evaluation By: Others Present: COMMENTS: Landscaoe Position Group Texture R -Ridge I S -Sand SS -Shoulder Slope LS -Loamy Sand LS -Linear Slope SS -Slightly Sticky FS -Foot Slope II SL -Sandy Loam NS -Nose Slope L -Loam HS -Head Slope NP -Non -Plastic CC -Concave Slope III SI -Silt CV -Convex Slope SICL-Silty Clay T -Terrace Loam FP -Flood Plain CL -Clay Loam SCL-Sandy Clay Loam IV SC -Sandy Clay SIC -Silty Clay C -Clay Consistence Consistence Moist Wet VFR-Very Friable NS -Non -Sticky FR -Friable SS -Slightly Sticky FI -Firm S -Sticky VFI-Very Firm VS -Very Sticky EFI-Extremely Firm NP -Non -Plastic 0.6-0.3 SP -Slightly Plastic P -Plastic VP -Very Plastic Sheet: FILE #: .1955 LTAR Structure 1.2-0.8 SG -Single Grain M -Massive CR -Crumb 0.8-0.6 GR -Granular SBK-Subangular Blocky ABK-Angular Blocky 0.6-0.3 PL -Platy PR -Prismatic 0.4 - 0.1 Mineraloak SEXP-Slightly Expansive EXP -Expansive Sketch of Soil Evaluation Locations 1