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HomeMy WebLinkAboutEHPR-03-2016-23316 (2).TIF THIS IS NOT A PERMIT Case # EHPR-03-201 6-233 1 6 ,„�� ti CATAWBA COUNTY HEALTH DEPARTMENT U n:r •n °"°` PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES `# ' � � 1842 sM Environmental Health Plan Review - Septic Malfunction - n_• AUTH_CONST- SEPTIC_MALFUNCTION f c r _r Applicant JEDADIAH CHATMAN, 1340 NORMANDY ST, CONOVER NC 28613 H:8285828303 C:8282340464 HOME:8285828303 NAME TO APPEAR ON PERMIT Jedadiah Chatman SITE ADDRESS: 1340 NORMANDY ST, CONOVER NC 28613 PIN # 375010358310 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 47,480.40 Acres 1.09 DIRECTIONS: Hwy 10 E, left on Normandy St, sharp turn back to right, 4th on right PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: Septic tank not draining into drainfield 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 EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 38x 54 NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 4 PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? 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 1 am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so ata com lete site evaluation can be performed. Date: .3- �- j (7 Signature of Applicant or Agent ���1 An Environmental Health Specialist will contact you 106n-5-Working days of application date. If you need further information or assist nce please call 828-466-7291 AREA2 G9-ehapplicaton 03/03/2016 11:46 Page 1 of 7 a, • CATAWBA COUNTY Case# EHPR-03-2016-23316 Public Health Department Subdivision , # H Environmental Health Division PIN# 375010358310 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 18.2 sM NAME ON PERMIT: (JEDADIAH CHATMAN), 1340 NORMANDY ST, CONOVER NC 28613 ( Jedadiah Chatman) Site Address: 1340 NORMANDY ST, CONOVER NC 28613 Property Size: Square Feet 47,480.40 Acres 1.09 Directions: Hwy 10 E, left on Normandy St, sharp turn back to right, 4th on right Pro s aw_ ' w EFEENAMEis t 4s s* , 3 ` w AaUATE �tl e.FEEAMOUNT Authorization to Construct (Repair) Fee 03/03/2016 $300.00 rr it S' , v r u.I ai7a n TOTAF FEES 4tdjtst''d-asa 3;- •,{i"'F �t�tl i5 °fix st xu Psi��h '`'$30000' � i ,�� E t a 15 t i .a t}�.#�.;a x d:.,,,..,.. Va€.:.a'�"t nxaihr t,m.x.,,..M.,Plr+ 4sk z r,diilg ggi-t. a33'x'ti sa ti. 'a.INF 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 03/03/2016 11:46 Page 2 of 7 CATAWBA THIS IS NOT A PERMIT ou CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permit Cl Authorization to Construct❑ Septic Repair VSeptic Malfunction �(J Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment❑ , \ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ ,1Application is for` New Construction ❑ Existing Facility g Property Address I4b kjec-fc'urA\( ¶2?"r ar Subdivision Sits si C. ' � • Lot# Acres 1 . o cl Section tlock/'base Driving Directions to Property Si srl' . _ ' I' _ t4 I tT PJR . a) la. r4! .` t & )Iii W . . 9 . Le ma ( i• °!d *11 rfIBI c S.r n• • �i (0 ct U (bpp TO • "EA O ' E Owner I/ Applan on ct Applicant Contact.Information Name T-1t 1 l\\ 'r(. P .. O 1 ��'cW ] to c�4- 4 11 /LAl-, �c. -ha A Address Y 34.m Nor L'cetec, /VC, z Pi0Iy Phone Rak - 55a- 83b 3 3 Cell Phone Bz1 - 2_<3LJ _ 0110-1 Owner C nttac�t Information �, , Name (��, 1 �� R �, a\ c\- U , JeeLc\1ak N. CAc.4Man Address \3 \ b3c- cif( l 'cce_e: ('ocxyle i IU C . 2p10 l�� Phone �at ' Scra - SS30 3 Cell Phone Ca 2C - Z3q/ _N f0L Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site a Ws-eon keM4 39 ec( # of Bedrooms *j 2. Structure Dimensions Iola Sq• �� ' #of'Occupants '1 Basement ❑ Yes 1%1,No Basement Fixtures ® Yes xr 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 '$No Does the site contain any jurisdictional wetlands? 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 62)No Is the site subject to approval by any other public agency? El Yes i'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 ❑ Innovative ❑ Other 94\Any CATAWBA THIS IS NOT A PERMIT ,COUNTY CATAWBA COUNTY HEALTH DEPARTMENT c, Application for Environmental Services Page 2 41.\ posed Facility npe Primary ry Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *I' .-,.=2 ------- Project Description t)e,--.nee _ - „ Structure Dimensions talo Si F4-. - #of Occupants 4 Basement ❑ Yes *No Basement Fixtures ® Yes 0 No Iyi Accessory Structure(s) Describe # of New Bedrooms *t if applicable _Q_ Structure Dimensions —{s—rt #of Occupants _P- Accessory Dwelling ❑ Yes T. No Plumbing ❑ Yes ELNo Describe Plumbing Needed U Multi-Family Residence#Units #Bedrooms per Unit*t Total # Bedrooms *1' Structure Dimensions U 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 Calculated Design Flow, Commercial f 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 he performed. Signature of Owner or Agendrvi/71 ; Zr /./ Date 3 -5-1 Printed Name of Owner or Agent fA1 tit 1..S/1t 'A • Catawba County Environmental Health I\.) i 0 b \C\ )s to (31.4) a Qp 'be W�y 4 All( 01340 0 �� yaei 0 1332 4aa oi .h a ti� ti Parcel: 375010358310, 1340 NORMANDY ST 1 in=60ft CONOVER, 28613 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. Copyright 2014 Catawba County NC 03/03/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 375010358310 Owner: MARTINEZ AMANDA PAULETTE Parcel Address: 1340 NORMANDY ST Owner2: City: CONOVER, 28613 Address: 1340 NORMANDY STREET LRK(REID): 34171 Address2: Deed Book/Page: 3159/1802 City: CONOVER Subdivision: State/Zip: NC 28613-8305 Lots/Block: / Last Sale: $88,500 on 2012-11-29 School Information: School District: COUNTY Plat Book/Page: Elementary School: BALLS CREEK Legal: OFF HWY 10 Calculated Acreage: 1.090 Middle School: MILL CREEK High School: BANDYS Tax Map: 060N 01040A School Map Township: NEWTON State Road It: 1733 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: NEWTON RURAL Zoningl: R-20 Building(s) Value: $56,000 Zoning2: Land Value: $14,700 Zoning3: Assessed Total Value: $70,700 Zoning Overlay: Year Built/Remodeled: 1958/ Small Area: CATAWBA Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710375000J Building Details 2010 Census Block: 2001 WaterShed: 2010 Census Tract: 011300 Voter Precinct: P22 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. ©2016, Catawba County Government, North Carolina. AM rights reserved. http://gis.catawbacountync.gov/nomap/parcelreport.php?key=3 7501 03 5 83 1 0&typ=P 3/3/2016 CATAWBA-LINCOLN-ALEXANDER DISTRICT HEALTH DEPARTMENT . • HICKORY, N. C—NEWTON, N. C.—LINCOLNTON, N. C.—TAYLORSVILLE, N. C. Phones 2883 393 Regent 5-5521 3101 PERMIT TO INSTALL SEPTIC TANK L? PERMIT NO it PERMIT DATE lb-) ti Owner ...... 1)/ -t: , Address Tenant Address C Installed by --Ct ?"--c Address Location of Property d 4,t,„ x=f, Lyate,,, _6/1-7,4 Kind of tank Size l2ce-/ Length of trench / 6 NOTIFY HEALTH DEPARTMENT AT LEAST EIGHT HOURS BEFORE TANK IS TO BE INSPECTED Final Inspection 19 t57.- Approved ( L.)/ Disapproved ( ) Remarks First five feet of line from outlet should be of cast iron soil pipe. \ (d E cs ii Sanitarian. Sketch of tank and line showing dis- tance from dwelling and well on subject property and on adjoining property. • 0 \e/ „kJ, CATAWBA COUNTY ki �� IOOA SOUTHWEST BLVD s ... NEWTON, NORTH CAROLINA 28658 RECEIPT , Yip• PHONE: 828.465.8399 Uap, Thursday, March 3, 2016 1$[}2 sm www.catawbacountync.gov PAYOR Chatman, Jedadiah PAYMENTS TRANSACTION NUMBER: TRC-630955-03-03-2016 PAYMENT DATE : 03/03/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-325810 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-03-2016-23316 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 1340 NORMANDY ST, CONOVER NC 28613 Applicant JEDADIAH CHATMAN, 1340 NORMANDY ST, CONOVER NC 28613 H:8285828303 C:8282340464 **NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 03/03/2016 11:46 Page I of 1 #2k CATAWBA COUNTY (Lt,..t l�� ION, SOUTHWEST LIN BLVD RECEIPT 11 NEWTON, NORTH CAROLINA 28658 ds�>a PHONE: 828.465.8399 V p e0, Thursday, March 3, 2016 is 42 sm www.catawbacountync.gov PAYOR: Chatman, Jedadiah PAYMENTS TRANSACTION NUMBER: TRC-630955-03-03-2016 PAYMENT DATE : 03/03/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-325810 Authorization to Construct(Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-03-2016-23316 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 1340 NORMANDY ST,CONOVER NC 28613 Applicant JEDADIAH CHATMAN, 1340 NORMANDY ST, CONOVER NC 28613 14:8285828303C:8282340464 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 03/03/2016 11.46 Page I of I