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HomeMy WebLinkAboutEHPR-03-2016-23365 (2).TIF .1/411$A - •� THIS IS NOT A PERMIT Case # EHPR-03-2016-23365 .7i prim 6 H CATAWBA COUNTY HEALTH DEPARTMENT 0 �u. i t 0 .,. .� , PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ...5.• /8 47, sM Environmental Health Plan Review - Septic Malfunction nit of a AUTH_CONST- SEPTIC MALFUNCTION 0 °r As Owner TERESA BURKE, 2459 PINOAK DR, HICKORY NC 28602-9445 C:8286125055 NAME TO APPEAR ON PERMIT TERESA BURKE SITE ADDRESS: 2459 PINOAK DR, HICKORY NC 28602 PIN # 279115544151 NAME of SUBDIVISION: CLEARVIEW ACRES PL 14-28 Lot# 8 Section/Block C PROPERTY SIZE: Square Feet 32,670.00 Acres 0.75 DIRECTIONS: Off 140, exit 123 to 321, Exit 42 onto 127 S-Mtn View, Right at Light w/Hardees onto Fry St, Left onto Hawthorne, Right onto Pinoak, 3rd house on Left. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Community Well DESCRIBE WORK: Unable to flush toilets' Backing up in home. 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, Garage EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: House 91x41, Garage 30x30 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES 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 accessible so that a complete site 'aluatio an be performed. Date: 3 _q -pia/ f+ Signature of Applicant or Agent - --- An Environmental Health Specialist will contact you within 5 working days of application date. If you need further information or assistance please call 828-466-7291 AREA2 P.9-ehapplication 03/09/2016 15:46 Page 1 of 8 (e i CATAWBA COUNTY Case# EHPR-03-20 1 6-23 3 65 fT fin i Public Health Department Subdivision CLEARVIEW ACRES PL 14-28 igatcrAs Environmental Health Division PIN# 279115544151 4 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 /842 s NAME ON PERMIT: (TERESA BURKE), 2459 PINOAK DR, HICKORY NC 28602-9445 ( TERESA BURKE) Site Address: 2459 PINOAK DR, HICKORY NC 28602 Property Size: Square Feet 32,670.00 Acres 0.75 Directions: Off 140, exit 123 to 321, Exit 42 onto 127 S-Mtn View, Right at Light w/Hardees onto Fry St, Left onto Hawthorne, Right onto Pinoak, 3rd house on Left. �r yy v9€n}s z a g -3 ri s 7 ° t`ftl plo r sy,+, t £a;.; r a� x :._". ir1E Is`' FEENAME-; sd`itutiz'a°e rrF;.,udr,�, , 9 na idot DATE it rtEEEAMOUNT�`' Authorization to Construct(Repair) Fee 03/09/2016 $300.00 � 'a d TOTAL"rEEES ri s m`�x k i a au"�p q - Tsiat '°.5300 OO2aa w r 4''g t.._ a .g ,., t 4.r�;.`'x� 'k»Ltca-.»�.�,,.,;.:aaia:,:s:'L:. .�..!..c'^»a3a:.c.°» z.6.Gac.,ts..ua'v_5 -•,ks'G'.;rs.°-'.».,.,`�«4:.:a:. .aas,:�Gat 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 03/09/2016 15:46 Page 2 of 8 CAT AwBA TI-IIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permit n Authorization to Construct n Septic Repair n Septic Malfunction Septic Expansion n New Well Permit❑ Replacement Well ❑ Well Abandonment n Well Repair n Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction n Existing Facility Property Address ,1) y-� 5! -7 P!n o cL/C O? Subdivision /14I (/01' 1 /y. ( )3 66 2 Lot# Acres _ Section/Block/Phase (� Driving Directions to Property P/-1' V 0 / 2 .3 `�SLi- _52-44:74 A Cle2 e [ ! D //� Oi rt e 1ypc P��> �" Lam^ ' '1 /L/� L 6� 0 7U �QACtand CZiGeten�,/,_„,-,,,,I or 0)/V le NAME TO APPEAR ON PERMIT`774 Owner ❑ Applicant n Contractor A t"' e Applicant Contact Information Name Address Phone Cell Phone / Owner Contact Information L Name ---re 'es a pU h±e Address -2 59 2 ;/loofkC i� Y i- ,- ^ (IL_1L_ DXGa>- Phone Cell Phone SIA-6 4.- < c_c Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? --; ( Owner ❑ Applicant n Contractor Description of Existing Structures on Site K o vt, __q i c... -< # of Bedrooms *1- 3 Structure Dimensions • X #of Occupants Basement ❑ Yes 2-No Basement Fixtures ❑ Yes •CVO v� � The Applicant shall notify the local health department upon submittal of this appation if any of the following apply to 7 the property in question. If the answer to any question is "yes", applicant must attach supporting documentation. ❑ Yes;-01xo Does the site contain any jurisdictional wetlands? -0 No Does the site contain any existing wastewater systems? ❑ Yes —O"No is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes Ed`xIo Is the site subject to approval by any other public agency? ❑ Yes o Are there any easements or right of ways on this property? Describe Existing water supply in use n Individual Well -Co nunity Well ❑ Semi-Public Well ❑ County/City/Township Water Line 1s 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 ita Any cATAYY BA THIS IS NOT A PERMIT c0 UNIX CATAWBA COUNTY HEALTH DEPARTMENT «o,,�,e Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence n Addition to Residence #of New Bedrooms *j Project Description Structure Dimensions # of Occupants Basement ❑ Yes n No Basement Fixtures ❑ Yes n No ❑ Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling n Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed n 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 n Yes n No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type n Individual Well n Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug n Unknown Well Repair Requested n 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 2.‘— Printed Name of Owner or Agent 751^ eS it U rke Catawba County Environmental Health J 021 .1 'a o ° p \ ° r O p O j --- --...X 9 O ° ,1115°° i ZD 000 w 3 a, 02 45 S 3 8 ca 11531 w,,,,. 22 22°'°() °. rri ° N cr 7 --- --- \ - -\- 3Q00 -- - ° ° 02448, 6 ° ...- 5 ° ° . ° y ° U ° S 4 - 1120 00 - 3 Parcel: 279115544151, 2459 PINOAK DR 1in=50ft HICKORY, 28602 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. Coovriaht 2014 Catawba County NC N 1 V L V . Q O C N_ O O 0 0 Q 0' > T. a al 4- Q O Cu w 0 G 3 .8 } N N S 3 i ti V e5 w 0- m 0 • z` �i c IAA "%..c.i: -0 TU ti. ti x m C ro a I. a 1° V c` `1 VS x C 0 Ce _ •�1 1 ' 4' al C Lai u+ 0 f--.,,• 01 p [ •5 Q r1 \ u Y �S -C m O N 2 = N N O j Z - + c) i- D a Q Q C� -'�- e 0 w. 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Q,,C . z > Z:�1 ,) .a 0 `' o a .. i Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 279115544151 Owner: BURKE TERESA ELAINE Parcel Address: 2459 PINOAK DR Owner2: City: HICKORY, 28602 Address: 2459 PINOAK DR LRK(REID): 48343 Address2: Deed Book/Page: 1559/0847 City: HICKORY Subdivision: CLEARVIEW ACRES PL 14-28 State/Zip: NC 28602-9445 Lots/Block: 8/C Last Sale: $62,000 on 1988-05-01 School Information: School District: COUNTY Plat Book/Page: 14/28 Legal: Elementary School: MOUNTAIN VIEW Middle School: JACOBS FORK Calculated Acreage: .750 Tax Map: 133H 06019 High School: FRED T FOARD Township: HICKORY School Map State Road #: 1215 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: MOUNTAIN VIEW Zoningl: R-20 Building(s) Value: $106,500 Zoning2: Land Value: $19,700 Zoning3: Assessed Total Value: $126,200 Zoning Overlay: Year Built/Remodeled: 1971/2010 Small Area: MOUNTAIN VIEW Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710279100J Building Details 2010 Census Block: 2039 WaterShed: 2010 Census Tract: 011101 Voter Precinct: P24 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 Co my Government, North Carolina. All rights reserved. I) WON- a)-*ji) nniponi t 1 t L Nkk 6\c,cli :), http://gis.catawbacountync.gov/nomap/parcel_report.php?key=279 1 1 5 5441 5 1&typ=P 3/9/2016 BA CATAWBA COUNTY �� IOOA SOUTHWEST BLVD NEWTON, NORTH CAROLINA 28658 RECEIPT PV►�<i PHONE: 828 465.8399 v ,\ °asp Wednesday, March 9, 2016 \$42 SM www.catawbacountync.gov PAYOR: BURKE,TERESA PAYMENTS TRANSACTION NUMBER: TRC-634618-09-03-2016 PAYMENT DATE : 03/09/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-326002 Authorization to Construct (Repair) S300.00 Fee TOTAL PAYMENTS : 5300.00 EHPR-03-2016-23365 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 2459 PINOAK DR, HICKORY NC 28602 Owner TERESA BURKE, 2459 PINOAK DR, HICKORY NC 28602-9445 C:8286125055 **NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 03/09/2016 15:45 Page 1 of 1