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HomeMy WebLinkAboutEHPR-03-2016-23307 (2).TIF $A �� THIS IS NOT APERMIT Case # EHPR-03-2016-23307 rta CATAWBA COUNTY HEALTH DEPARTMENT 0 Ro it 0 0711:tIs PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES "184 SM Environmental Health Plan Review - Septic Malfunction .oo+7o AUTH_CONST- SEPTIC MALFUNCTION o • D .ti . ._.. r ,. Owner CHRIS &ANN STAMEY, 4108 16TH ST NE, HICKORY NC 28601 C:8283I25238 NAME TO APPEAR ON PERMIT Chris & Ann Stamey SITE ADDRESS: 4108 16TH ST NE, HICKORY NC 28601 PIN # 371408999158 NAME of SUBDIVISION: H L FOX PROPERTY Lot# 1 Section/Block A PROPERTY SIZE: Square Feet 23,086.80 Acres 0.53 DIRECTIONS: Hwy 127 North from Downtown towards Bethleham, Right onto Cloninger Mill Rd,At intersection turn Left onto 16th St NE, House is 8th on the Right w/Blue front door. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: Sewage is on the ground* *Sewer line showing on GIS is not available for connection. It is a pressurized force main with limited access. Per Shawn Pennell at City of Hickory they have to apply for septic repair. See attached e-mail. 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? No APPLICATION FOR: \ Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF House EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 59x50 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: I E9-ehappllcauon 03/02/2016 11:56 Page I of 8 �q • CATAWBA COUNTY Case# EHPR-03-2016-23307 Public Health Department Subdivision H L FOX PROPERTY Q int), K Environmental Health Division PINK 371408999158 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 /8.2 . NAME ON PERMIT: (CHRIS&ANN STAMEY),4108 16TH ST NE, HICKORY NC 28601 ( Chris & Ann Stamey) Site Address: 4108 16TH ST NE, HICKORY NC 28601 Property Size: Square Feet 23,086.80 Acres 0.53 Directions: Hwy 127 North from Downtown towards Bethleham, Right onto Cloninger Mill Rd, At intersection turn Left onto 16th St NE, House is 8th on the Right w/Blue front door. 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 a d labeling of all property lines and corners and making the site accessible s hat a complete si evaluation can be performed. Date: O — a—I (o Signature ofApplicant or Agent An Environmental Health Specialist will contact you within 5 working days of applicatio date. If you need further information or assistance please call 828-466-7291 AREA2 I "ifuf'y""" -n' E plj " , "f .>i 2Jifi u 3 "","7 v spg r¢ t. 2}g rerr ^+� E C ,l .' (FEENAME 4 rrkil at't?+a*�`3 v'�s °`+2''":bLyt'p'pq��`t ATE1 "'-chi)'FEEIAMOUNT i+r t.,._....._......_. .1::,..,s r,,,,,:;,�3s:.,„_ F" P- ur,�'u.. w.+4 �._.FSk,�.i at Authorization to Construct(Repair) Fee 03/02/2016 $300.00 r° IOTA L' FEES" ( hL Hm,E np„u$$$$,41.1- `r $34',,.t.. ::•1.a. o\ 34i:�+sal;. SL4�.tft"sityc .. x5,vhFr„a£«' r :,E:..- u 'ad:"3' .!(d ail s'i;;0 $$°4 i-41 '0rlabil$441-ta i$11 a, 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-ehapplication 03/02/2016 11:56 Page 2 of 8 CATAWBA THIS IS NOT A PERMIT COUNTY n CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permit❑ Authorization to Construct H Septic Repair❑ Septic Malfunction Septic Expansion ❑ New Well Permit ❑ Replacement Well n Well Abandonment ❑ Well Repair n Existing System Inspection (Pre-Approval Required) n Application is for New Construction ❑ Existing Facility* S' Property Y Address �f(b (6--L-'51-:S1-: N. Subdivision 14 j CKorj ALL 0 'h4/ Lot# Acres Section/Block/Phase C Driving Directions to Property I a-7 4 A t C i �� nJ Pr /✓ I I RA morn 4nTp ho ,/ se 5 or\ ±Y r;9.}Nfi NAME TO APPEAR ON PERMIT? Pnwner n Applicant ❑ Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name C k S 4 4 5- 7 et Address k4I li 4 /62-b "1--, JU j-E'r_ O rt iL 09.S/6o it Phone / Cell Phone c‘/"1-')/ - 3/ a-S.a 3 5? Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? n Owner ❑ Applicant n Contractor (I' Description of Existing Structures on Site kn Wl\� #of Bedrooms * � x� Structure Dimensions s�it 1c:) # of Occupants 3 Basement Yes n No Basement Fixtures ales n No -r-- 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 C]'So Does the site contain any jurisdictional wetlands? Ef/Yes ❑ No Does the site contain any existing wastewater systems? ❑ Yes E610 is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes Ej) Is the site subject to approval by any other public agency? ❑ Yes ®'No Are there any easements or right of ways on this property? Describe Existing water supply in use n Individual Well ❑ Community Well I I Semi-Public Well By-County/City/Township 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 ❑ Conventional ❑ Innovative ❑ Other RYA; CATAWBA THIS IS NOT A PERMIT cou „. CATAWBA COUNTY HEALTH DEPARTMENT • R 1 Application for Environmental Services Page 2 Proposed Facility Type H Primary Residence H New Residence TI Addition to Residence #of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement ❑ Yes H 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 H No Describe Plumbing Needed H 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 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 n Community Well Abandonment Type ❑ Drilled ❑ Bored n Dug ❑ Unknown Well Repair Requested ❑ Yes H No Describe Calculated Design Flow, Commercial'' 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 • I de �_ Date 3aI Printed Name of Owner or Agent , 3- - / nn v Catawba County Environmental Health • co co 1111 . g r a h 7 flan 0 . • o, a / N I • iv Zt •-,,‘. - h (172) y", � 1723 f �� , 202.35 P 4(170 t' _ '— (9 • 174.39 68.9: rn C> 0 r■ • O i 77:1"-- Parcel: 371408999158, 4108 16TH ST NE 1 in=50ft HICKORY, 28601 4 Sec { bYoo_3 x�/ lA \.b j Iy� Lf� CC• -f6 Ca��n1C�J na ' n Thislma Ireporl pro u*IckA pre 4ofi the Cola ba ounty,Ntospat m ServicegCat�Cnty ha/aT1e substantial)}forts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report 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/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 03/02/2016 Katherine Harris From: Shawn Pennell [spennell @hickorync.gov] Sent: Wednesday, March 02, 2016 11:38 AM To: Katherine Harris Subject: 4108 16th St NE Public sewer to the above mentioned address is not available. They will need to have their septic system repaired. M. Shawn Pennell Utilities Environmental Manager soennell(a hickorvnc.gov City of Hickory, NC (828) 323-7427 www.hicko nc.•ov a Pursuant to North Carolina General Statutes Chapter 132, Public Records, this electronic mail message and any attachments hereto, as well as any electronic mail message(s) that may be sent in response to it may be considered public record and as such are subject to request and review. 1 Parcel Report Page I of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: • Parcel ID: 371408999158 Owner: STAMEY CHRISTOPHER LEWIS Parcel Address: 4108 16TH ST NE Owner2: STAMEY ANN M City: HICKORY, 28601 Address: 4108 16TH ST NE LRK(REID): 64308 Address2: • Deed Book/Page: 1665/0688 City: HICKORY Subdivision: H L FOX PROPERTY State/Zip: NC 28601-8408 Lots/Block: 1/A School Information: Last Sale: $63,000 on 1990-05-01 Plat Book/Page: 5153 School District: COUNTY Legal: LOT 1 1A PL5-53 SANDY RIDGE PL 5-53 Elementary School: SNOW CREEK Calculated Acreage: .530 Middle School: ARNDT Tax Map: 218H 02024 High School: ST STEPHENS Township: HICKORY School Map State Road #: 1401 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: HICKORY County Fire District: ST STEPHENS Zoningl: R-1 Building(s) Value: $96,600 Zoning2: Land Value: $19,200 Zoning3: Assessed Total Value: $115,800 Zoning Overlay: Year Built/Remodeled: 1961/ Small Area: Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: Building Details 2010 Census Block: 3001 WaterShed: 2010 Census Tract: 010302 Voter Precinct: P29 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report 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/report product or the use thereof by any person or entity. ©2015, Catawba County Government, North Carolina. All rights reserved. \6'7\ c/3cN\j-\-\ http://gis.catawbacountync.gov/nomap/parcel_report.php?key=371408999158&typ=P 3/2/2016 71(\5A ---- COUNTY ,4 4 OCA 100A SOUTHWEST BLVD 4 .0 IA NEWTON, NORTH CAROLINA 28658 RECEIPT q���► PHONE: 828.465.8399 U a�- x ,117' Wednesday, March 2, 2016 /842 M sw www.catawbacountync.gov PAYOR: Stamey,Chris& Ann PAYMENTS TRANSACTION NUMBER: TRC-630392-02-03-2016 PAYMENT DATE : 03/02/2016 PAYMENT TYPE: Check 5393 INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-325768 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : S300.00 EHPR-03-2016-23307 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 4108 16TH ST NE, HICKORY NC 28601 Owner CHRIS& ANN STAMEY, 4108 16TH ST NE, HICKORY NC 28601 C:8283125238 ** NO PEOPLESOET ACCOUNT ASSIGNED ** receipt 03/02/2016 1 1:55 Page 1 of I