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Home My WebLink AboutRBPR-07-2014-19638.TIFCATAWBA... Environmental Health - Division of Public Health I8 Box 389 —100-A South West Blvd. - Newton North Ca rolina 28658 8 465-8270 — Fax 828 465-8276 '`� ., f, x ` North C�rolin�"`�`, w�.vw.cata�.vbacountvnc.<�cw/envuanmentalhealth/ AUTHORIZATION OF REFUND Date: 8/1/2014 Case #: RBPR-07-2014-19638 Applicant: Deborah Chapman Refund Amount: 590.00 Refund Reason: review not required Authorizing Signature: Received By Staff: Date: It -Lc (acro( the bi ar to a Heahl?ier Cornmcmill, e �OpI CARO��\ 'C It s' Hearn 6 ^-�oe"vava mac" 2 12 ;�'."ytii;°"�9id'.' �� .Li'.,` �.�'F-,t4,k 4a � s4,, u`i �� ',,i,Y,."C z,,•,�,s '"s ,1N' ..,�'�t;;:f..°�:tlas � n, t,.'��zrz�.� r.'I.- ri- ;'� g'C �� F Y3 a„ d: rF n� vCata�ba County North Caroliria�="®fsbursernent Voucher � �<� �ry � 4 '� ss t � r � � 9 , s, ;r�.-..}•o 3.n'!�'��.ns b i�tlim I t "� , r Vendor No Make Payment To: Deborah Chapman 4990 Anderson Mountain Rd Maiden, NC 28650 ,Prepared by Julia English Description Review not required per MC ATTACHMENT Sub -Total Food Tax Sales Tax Total Date 08/01/14 Voucher No(s). Amount 90.00 $ 90.001 I 1 $ 90.00 ' �r'�x �` a ea '' c zM �" �:r s'a. ,.. t ^,— M. ya;., � �,.<_'•;.,. .ta � i �9„`, �v�l -, v.s:” �.s...,`. ,, y ... For Accountingx� a Furcal -Cost Center 'f;; Object , F Project`""1 ; .: Amount ', Use Only 110 580200 663000'' Total The undersigned hereby certifies that the goods or services specified above have been received or performed. Payment has not been previously authorized and this expenditure is a proper charge to the appropriation indicated. The above charge is certified to you for payment. (SIGNATURE - APPROPRIATE OFFICIAL) PAYOR: Chapman, Deborah PAYMENTS CATAWBA COUNTY 100A SOUTHWEST BLVD NEWTON, NORTH CAROLINA 28658 RECEIPT PHONE: 828.465.8399 Friday, August 1, 2014 www.catawbacountync.gov TRANSACTION NUMBER: TRC -361081-01-08-2014 PAYMENT DATE: 08/01/2014 PAYMENT TYPE: DV INVOICE NUMBER FEE NAME FEE AMOUNT 07-14-309241 Improvement Permit (Existing) Fee ($90.00) TOTAL PAYMENTS: RBPR-07-2014-1963 8 ($90.00) CASE TYPE: Residential Building Plan Review WORK CLASS: Swimming Pool SITE ADDRESS: 4990 ANDERSON MOUNTAIN RD, MAIDEN NC 28650 Owner DEBORAH CHAPMAN, 4990 ANDERSON MOUNTAIN RD, MAIDEN NC 28650 C:7043639548 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Contractor CHARLOTTE FIBERGLASS SWIMMING POOLS, 6420 REA RD SUITE 200, CHARLOTTE N( B:7046591708C:7049127340 E9 - receipt 08/01/2014 0838 Page I of 1 To: Deborah Chapman Catawba County Public Health www.catawbacountync.gov/environmentalhealth Environmental Health P.O. Box 389, 100-A South West Blvd., Newton, NC 28658 Phone (828) 465-8270. Fax (828) 465-8276 MEMORANDUM From: Michael Cash, Environmental Health Supervisor Date: August 1, 2014 Subject: Acknowledgement of Responsibility for Proposed Swimming Pool Location at 4990 Anderson Mountain Rd., Maiden, NC 28650; PIN 367603338257 Your signature below formally acknowledges that on the date signed, you have been fully informed of the conditions created by the location of the swimming pool location indicated in the subject line on the property described above, and that you accept full responsibility for the action and potential consequences of the same, as explained to you. Specifically, unless the proposed new building location complies with the setbacks required by the North Carolina Laws and Rules for Sewage Treatment and Disposal Systems (15A NCAC 18A .1900) as described in your existing permit(s); and since you are declining assistance from Environmental Health to locate your system and/or repair area, the proposed swimming pool location could potentially have an adverse impact your ability to sell, transfer, alter, or improve, the subject property due to its location and possible impact on the existing septic tank system. Further, your ability to repair or replace your existing septic system on this property may also be adversely affected by the swimming pool location. Property Owner Signature: 1�J Q��j Q J��,p� \v �i rr, Date: R— 1—)4 I North Carolina, Catawba CountyN % MCCorkj� I, y—f,I,<4e-n-DR-yCoNe, Notary Public, do hereby certify that �` W b)f(Ah , CA ^ ) i Ylmersonally appeared before me this day and acknowk d t z due execution of the foregoing instrumentA",5 cis V Witness my had rld officia eal, this the I day of June, 2014. �i,icgjAWBA GO��`� Notary Publi My Commission Expires ��fill ��(71(��-�)�'�) "Leading the Way to a Healthier Community" �Z UAIACAR ccredited QZ) R ^Health .� —tlepertmenc> $ USHeal z P Contractor THIS IS NOT A PERMIT Case # RBPR-07-2014-19638 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Swimming Pool IMPROVEMENT �R D CHARLOTTE FIBERGLASS SWIMMING POOLS, 6420 REA RD SUITE 200, CHARLOTTE NC 282 13:7046591708 C:7049127340 Owner DEBORAH CHAPMAN, 4990 ANDERSON MOUNTAIN RD, MAIDEN NC 28650 0:7043639548 NAME TO APPEAR ON PERMIT Deborah Chapman SITE ADDRESS: 4990 ANDERSON MOUNTAIN RD, MAIDEN NC 28650 PIN # 367603338257 NAME of SUBDIVISION: Lot # PT 2 & ADJ Section/Block PROPERTY SIZE: Square Feet 642,074.40 Acres 14.74 DIRECTIONS: Hwy 16S/right on Anderson Mountain Rd/ PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: 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? Yes Are there any easements or right-of-ways on this property? APPLICATION FOR: STRUCTURE TYPE: New Structure ACCESSORY STRUCTURE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF single family home EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 80 x 95 NUMBER OF EXISTING BEDROOMS: 4 # OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 14 x 32 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: 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 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 acceable so that a complete site evaluation can be performed. Date: '7 - 3 Q _ �`f Signature of Applicant or Agent n 1�a0 14 °lei �Ci IY� C�yL 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 ************************************************************************************************************ E9 - chapplication 07/30/2014 16:07 Page 1 of 4 IgA r CATAWBA COUNTY Case # RBPR-07-2014-19638 U� Public Health Department Subdivision ,Environmental Health Division PIN# 367603338257 PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 1842 SM NAME ON PERMIT: ( DEBORAH CHAPMAN), 4990 ANDERSON MOUNTAIN RD, MAIDEN NC 28650 ( Deborah Chapman) Site Address: 4990 ANDERSON MOUNTAIN RD, MAIDEN NC 28650 Property Size: Square Feet 642,074.40 Acres 14.74 Directions: Hwy 16S/right on Anderson Mountain Rd/ MINIMUM SETBACKS FRONT: 80 SIDE: 10 REAR: 10 MAX HEIGHT: FEENAME DATE FEE AMOUNT Improvement Permit (Existing) Fee 07/30/2014 $90.00 $9 :.:TOTAL FEES...,...... 0.00 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 07/30/2014 16:07 Pale 2 of ,AAW A THIS IS NOT A PERMIT Ct}U T,Y CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permit d 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 ❑ Existing Facility ❑ Property Address '� cl�� RdER5p� m-TtJ . PSSGSI. Subdivision M Gad n9 C (o5 O Lot # Acres __G�P rO)C 1-5 Section/Block/Phase Driving Directions to Property 1- (,J� l ---sou-r4, (7b W\ G vo E P,3oR r✓\oarn-L ar. 2Oukl Q_0 �0 E0�5 G n r-sP.c44\_ OF QllJ_e6Cr\ N-vTN c� (�G57- fACAdEAI C R.O�5 5 LAA_[Z9.5 E C-r-ra'J a pQ ( Ox I/ter- r�r• i� (�R [. e F� . s�oN� Enr� c�K�Co NAME TO APPEAR ON PERMIT? L Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name ` F80P.G-4 `VAR PrY1A(0 Address /,►-qc�() An11 254N wr(J . RQ QA-- KNQ�d&\). NM Phone a - /• - �l l I I Cell Phone' 1 Q 4, _ 3 W - 4 5 4k Owner Contact Information Name f� ry r--, PP -10V Address Phone Cell Phone Contractor Contact Information Name 1�6�R1 ►-r� Fr`s�2 G -!ASS 5u)�n m,` Address + ao (E Q p a • n) TL /aCD l" �+A-2 (C)r� DU C P-;:). X1'7 Phone 'IQ Lt- , 5 Q ^ I �� Cell Phone WHO WILL BE THE PRIMARY CONTACT? [Owner ❑ Applicant Agicontractor Des cription of ting Structures on Site .�-m # of Bedrooms # of Occupants fi '4Structure Dimensions p a Basement ❑ Yes61�o` Basement Fixtures C1 Yes 0 No The App ant shall notify the to - p . . 't "up .. _.. ubmit a- ... ,: _pp_,_...._._-.., any: ..._::_._._ _._ .. "..._.__ . _. he � cal health de artment u ons tal of this a hcation >f of the following apply to the property in question. If the answer to any question is "yes", applicant must attach supporting documentation. 3� Yes Does the site contain any jurisdictional wetlands? 0/6s U N Does the site contain any existing wastewater systems? 0 Yes - o Is any wastewater going to be generated on the site other than domestic sewage? 0" Yes ICS No Is the site subject to approval by any other public agency? Q/fes U No Are there any easements or right of ways on this property? Describe Existing water supply in use �� WW Individual Well _ ] Communit Well+ ] Semi -Public Well .. .......�: ❑ tY ❑ ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes ❑ No If applying for an Im Improvement Permit or Author p Authorization to Construct, Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) 0 Accepted 13 Alternative ❑ Conventional 0 Innovative ❑ Other 11 Any CATAWBA THIS IS NOT A PERMIT COUNTY_ -- � --- CATAWBA COUNTY HEALTH DEPARTMENT NT y_ Application for Enviromnental Services Page 2 6Ta� Cmotno'+G Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions # of Occupants ,,.. -.Yes . NoBasementBas�m�ntro Fixtures _ Yes No ,.�....,..:.�_:..,_�.� f Basement ❑ [ Accessory Structure(s) DescribeUAf-u-Stx),nnf'r 1 A+ X 3 a # of New Bedrooms *T if applicable Structure Dimeksions # of Occupants a Accessory Dwelling [—]Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ e #Bedro a._mily Residenc# Umts Multi- oms per Unit*t Total # Bedrooms Structure Dimensions U Food . Ser vice... -Speccif"—f"y Ty,T—y..pe......,_-.._ .......".._...__"" ... .._...,..._ . s..�_. _�.._ ,:....:..: �:__.._ ....._.. _ = ,�...�...... ,.. . # Seats Floor Space -Entire Food Service Facility (Sq Ft) # Employees per Shift # of Shifts Dining Area (Sq. Ft.) .-_�..-.� .�_.: �_..:..., .....,_...,�. F1 Business Specific Type of BusinessRetail 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 Constructton/Abandonmen ' 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 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. f 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 comers and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent k� Q AD AGS � Date Printed Name of Owner or Agent } Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geospat,al lnfonnation 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: 3676-03-33-8257 inch = 80 feet 331 t52� C 00 d' N � �CIO -7-1-1 C/ - -11-03 81, L: J r.-- 98, 90 4994 8. 1 9111'�-Pit 1� Prepared for: Plat 4�6-37 ®3-79. , 6 rn 1\ --A—i5 14.74'A THIS IS NOT A LEGAL DOCUMENTS 2 5 7 Date Saved: 7/29/201 xm Plo .24 CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID:. 3676-03-33-8257 Name: CHAPMAN MICHAEL Name2: CHAPMAN DEBORAH Address: 4990 ANDERSON MOUNTAIN RD Address2: City: MAIDEN State: NC Zip: 28650-9262 Account: Calc Acreage: 14.74 Tax Map: 012 K 02007 LRK: 12607 Deed Book: 2825 Deed Page: 1086 Subdivision Name: Subdivision Block: Lots: PT 2 & ADJ Plat Book: 48 Plat Page: 17 Building Number: 4990 Street Name: ANDERSON MOUNTAIN RD Site Zip: 28650 Township: CALDWELL Fire Dist: BANDYS City/Tax: State Road: 1857 Total Bldgs Value: $461,100 Land Value: $73,900 Total Value: $535,000 Year Built: 2007 Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 128 Watershed: Watershed Split: NO Voter Precinct: P9 E911 District: COUNTY Zoning: R-40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): Split Zoning Dist(2): School District: COUNTY Elementary School: TUTTLE Middle School: MAIDEN High School: MAIDEN School Split: NO P&Z Case Number: Census Tract 2010: 011600 Census Block 2010: 3017 Small Area Plan: BALLS CREEK Agricultural District: Printed: Wednesday, July 30, 2014 03:23 PM —�. CATAWBA COUNTY Case # WLS2007-00447 Nblic Haddi Depahment EnvirommitalHealthDivision Subdivision PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Sect/BLJPh/L.ot # P12&A (828) 465-8270 FAX (828) 465-8276 TDD (82S) 465-8200 PIN4 367603338257 Applicant/Owner: MIKE & DEBBIE CHAPMAN Site Address: 4994 ANDERSON MOUNTAIN RD MAIDEN NC Property Size: SF 31.43 ACRES Directions: 16S / RT ANDERSON MOUNTAIN RD/PASS EAST MAIDEN RD/ APPROX ON 1/20N RIGHT/ JUST PAST DRIVE WAY Catawba Countv Health Department Operation Permit System Code System Type: 3�} Description: t 2 n 01(.2 Types V and VI systems expire in 5 years. (In accordance with Table Va) Owner must contact health department 6 months prior to exiration for permit renewal. PERMIT CONDITIONS: 1. Performance: System shall perform in accordance with Rule .1961. II. Monitoring: As required by Rule. 1961. 111. Maintenance: As required by Rule . 1961. Other: Subsurface system operator required? YesNo y If yes, see attached sheet for additional operation conditions, maintenance and reporting. IV. Operation: This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and All cq ditions of thg Improvement Permit and Construction Authorization. p I 1, ; V1 H a Q Lkmay /v -z -07 System Installer Installation uale prutEeci 5tat6 �erit Date of Operation Permit Issurance Form F r: \T i Hewn rk\Fa rrn s V lY(Sa tea. rn t l CATAWBA COIJN,rY &ali-wi :/Lnvironrnental liudth Division PJ Box 389, 100-A Southwest Blvd, Nekton, NC 25655 �q;. � (525) 465-4270 FAX (x28) 465-5276 "CDD (528) 465-5200 Case 4 Subdivision SectBUPh/L.ot # PIN# WLS2007-00447 PT2 &A 367603338257 Applicant/Owner MIKE & DEBBIE CHAPNL4N Poste 56 Site Address: 4994 ANDERSON MOUNTAIN RD MAIDEN NC Property Size: SF 31.43 ACRES Directions: 16S / RT ANDERSON MOUNTAIN RD / PASS EAST MAIDEN RD/ APPROX ON 1/2 ON RIGHT/ JUST PAST DRIVE WAY Improvement Permit Permit Valid For: Five years No Expiration Facility (Residential): House House X Mobile Home Multi -Family Bedrooms 4 New? /�' Addition? Projected Daily Flow �0 9 -p -d Water Supply Private Well? Public? Semi -Public? Basement: N Basement Plumbing: N HotTub/Spat: Y Special Fixtures (explain): Proposed Wastewater System- ��'� /0� Type: Proposed Repair: ,;2o Permit Conditions: Owner or Legal Represenp9ive Signature: Date: Authorized State Agent:` CJ Date: 4-A -0% The issuance of this permit by the Health Department d . macs of taarantee 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 Pernut 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 it change in ownership of the property. This pernut was issued in compliance with the pro0sion_s of the North Carolina 'Laws and Rules for Sewate Treatment mul Disposal Svstemts' (ISA NCAC ISA .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. Authorization to Construct Wastewater System (Required for Building Permit) * See site plan and additional attachments ( ) Proposed Wastewater System: ,2570 Type: �.� Wastewater Flower g.p.d New 11_ Repair , Expansion Soil LTAR9 ..35- g.p.d./ft2 Type of Facility: ' / Ay- J-hn_L_e_ Basement: N Basement Plumbing: N HotTub/Spa: Y Special Fixtures (explain): —L-1-1.1-91- y1L,.1 1 Wastewater Svstem Requirements Tank Size: Septic Tank %DOO Drainfield: Total Area: %a '�; C,_-) Trench Width .'Z1 It Distribution: Distribution Box Additional Specifications: ,X- ,2y 1, gal Pump Tank — gal Grease Trap gal sq it Total Length: it Maximum Trench Dept tF� 02q iW�- Minimum Soil Cover b Minimum Trench Seperation %� it SerialnDistribution A_ Pressure Manifold LPP Other I II A . Authorized State Agent: Permit Expiration Date- 3 �2- 1 have read and accept the specifications and all conditions of this permit as indicated. Owner or Legal Representative Signature: v r:\Tidernark� nnaVa7_Caau✓w Date: _�_,/3 'D 7 Date: `f 14,9 fid? I Form B CA"rAW13A COIJINTv /•�' \ Public Health Depaitiinent (ase # WLS2007-00447 L'.nvirotunental Health Division Subdivision Pu Box 389, 100-A Southwest Blvd, Newton, NC 23655 Sect/13L/Ph/Lot # M&A PfN# --� / (828) 465-8270 FAX (828) 465-8276 TDD (828) 465-8200 "= 367603338257 Applicant/Owner MIKE & DEBBIE CHAPMAN Site Address: 4994 ANDERSON MOUNTAIN RD MAIDEN NC Property S SF 31.4 ACRES Directions: 16S / RT ANDERSON MOUNTAIN RD / PASS EAST MAIDEN RD/ APPROX ON 1/2 ON RIGHT/ JUST PAST DRIVE WAY Jil Improvement Permit Authorization To Construct 10 Db ;w/- ; , e, u 5 /Do Scale SITE PLAN ® Well Permit System components represent approximate contours only. The contractor must flag the system prior to beginning the installation to ensure that proper grade is maintained. Do not install system under wet conditions. This permit is subject of revocation if the site plan or site conditions are altered. uthori State Ag U Date Form C .: �r,eena,rntonn,vwzsan�..,,,