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HomeMy WebLinkAboutEHPR-03-2016-23388 (2).TIF $ THIS IS NOT A PERMIT Case # EHPR-03-2016-23388 �, CATAWBA COUNTY HEALTH DEPARTMENT O N. ,o r•* Cl �" PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES :I gl Ig�2 sM Environmental Health Plan Review - Septic Malfunction o • -*o f AUTH CONST- SEPTIC_MALFUNCTION d CI �o f " `M Owner NANCY STEWART, 1317 CHANCELLOR OR, CLAREMONT NC 28610 H:8284611119 C:8284640032 HOM E:8284611119 NAME TO APPEAR ON PERMIT Nancy Stewart SITE ADDRESS: 1317 CHANCELLOR DR, CLAREMONT NC 28610 PIN # 376010268472 NAME of SUBDIVISION: SHERWOOD LANES Lot# 7 Section/Block PROPERTY SIZE: Square Feet 20,473.20 Acres 0.47 DIRECTIONS: Hwy 10 East toward Catawba, go past cubbard express, 1st paved road passed store on Right, Last house on right (has pool) PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: *Water on the ground. Lines are failing 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, Pool EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: House 78x45 NUMBER OF EXISTING BEDROOMS: 4 #OF OCCUPANTS: 1 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: 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 necessa inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identificatirn / �f at property lines and corners and making the site ac.- sib - so that a comp ete site 643 •anon can be performed. Date: Y !o Signature of Applicant or Age it�� . ._i 0 2 An Environmental Health Specialist will contact you within 5 worki r• says of application date. If you need further information or assistance please call 828-466-7291 AREA1 ************************************************************************************************************ E9-ehapplication 03/14/2016 11:17 Page I of 8 ��e• CATAWBA COUNTY Case# EHPR-03-2016-23388 .Q' dtt z Public Health Department Subdivision SHERWOOD LANES Q © 'C Environmental llealth Division PIN# 376010268472 PO Box 389, 100-A Southwest Blvd,Newton, NC 28658 '84 N NAME ON PERMIT: (NANCY STEWART), 1317 CHANCELLOR DR, CLAREMONT NC 28610 ( Nancy Stewart) Site Address: 1317 CHANCELLOR DR, CLAREMONT NC 28610 Property Size: Square Feet 20,473.20 Acres 0.47 Directions: Hwy 10 East toward Catawba, go past cubbard express, 1st paved road passed store on Right, Last house on right (has pool) .,; ;x, ^'is m. . ' *�E J 3 ��pro�a r 75 to l,i.. , ynr i fx r:ri "FEENAME s .ri "' tc t�!1., 1 4hr J DATE* 1 :FEE1°AMOUNT"Li 3tt . �a.rd � 1. Lr ?At ti Authorization to Construct (Repair) Fee 03/14/2016 $450.00 4P1M " TOTAL FEES ' rlSPI Rq° jinnir"a`I s M �' i Nkir'IR $45U"00' �2 a {� �, h t i b 1 � 4 a L{IJkt�kt� $ .. n .� �a�e�I M .2"` b..ie4 ae„u'0d ikfi°ai mtt!r=-tktillritantiThai 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-chappl ication 03/14/2016 11:17 Page 2 of 8 CATAWBA THIS IS NOT A PERMIT COUNTY „ .-- .`„�r� CATAWBA COUNTY HEALTH DEPARTMENT ` ,s�,>- _ „ „a Application for Environmental Services Page 1 Improvement Permit❑ Authorization to Construct❑ Septic Repair n Septic Malfunction [ . Septic Expansion n New Well Permit ❑ Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is.for New Construction ❑ Existing Facility Property Address / ' // �/C/t/f CP�/o �r L.)k Subdivision (Y14 )e-7ft 'ni/ It C Lot# Acres / / L SectionB1oc hale Drivi v Directions to Property /`� /4 1 0C- 74 G+-7R r�� /- T'9 w-B f} / 6'-a 13/a.if LGe-,0,- .9-.^ 2 L,L-,p r/r (a - Co 11 -rq I n El ) j ',Pf9 U d Id /� Riga-- (Li%/X'p //nr yZ7e, 69s' 1-/ w�„ 0.21 „„Etatit / NAME TO APPEAR ON PERMIT?, Owner ❑ Applicant El c� - Applicant Contact Information Name _ Address Phone Cell Phone Owner Contact Information tName ,7/j-/7 e e ,- S 7`e i..2n t- 7` '�" Address /3 / ? (�/1 /9-/7 c' e //, r c--,1) X_ eZA /Let»-cgn `1-1G c>73' Z, / d Phone 7&s- C4 PD5a -Fra.,= p..S',.? tit) ell Phone , G4 /_/// g Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? :1 Owner ❑ Applicant n Contractor Description of Existing Structures on Site fric411 Mal # of Bedrooms**f Structure Dimensions '/bX LIS #of Occupants / Basement IR Yes No Basement Fixture Yes ❑ No TThe 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 I&No Does the site contain any jurisdictional wetlands? 14 Yes ONo Does the site contain any existing wastewater systems? ❑ Yes `tI No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes ISPNo Is the site subject to approval by any other public agency? ❑ Yes eli No Are there any easements or right of ways on this property? Describe Existing water supply in use [RI'Individual Well ❑ Community Well ❑ Semi-Public Wells) ❑ County/City/Township Water Line Is a public water supply available? ** _-gi Yes ❑ No If applying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s): Vsystems can be ranked in order of your preference) ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other lAny CATAWBA THIS IS NOT A PERMIT cou�ry CATAWBA COUNTY HEALTH DEPARTMENT North Camllna\ Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence I I Addition to Residence #of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement ❑ Yes No Basement Fixtures ❑ Yes El No ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling E Yes n No Plumbing ❑ Yes n No Describe Plumbing Needed ❑ Multi-Family Residence#Units #Bedrooms per Unit*j 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 ❑ 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 n Drilled n Bored [ Dug n Unknown Well Repair Requested ❑ Yes El 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 Aget 17'1- 4 Date // Printed Name of Owner or Agent /111 CT K-S7 eLipi, A� Catawba County Environmental Health Il ft ca 0 Is o z a n= YN m A o v a ls' 6a i. le CY 0 60 0 v en \\I .m. N • Parcel: 376010268472, 1317 CHANCELLOR DR 1 in=50ft CLAREMONT, 28610 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 03/14/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 376010268472 Owner: STEWART NANCY GANTT Parcel Address: 1317 CHANCELLOR DR Owner2: City: CLAREMONT, 28610 Address: 1317 CHANCELLOR DR LRK(REID): 24384 Address2: Deed Book/Page: 1043/0972 City: CLAREMONT Subdivision: SHERWOOD LANES State/Zip: NC 28610-9510 Lots/Block: 71 School Information: Last Sale: Plat Book/Page: 14/153 School District: COUNTY Legal: LOT 7 7 PL 14-153 SHERWOOD PL 14- Elementary School: CATAWBA Middle School: RIVER BEND 153 Calculated Acreage: .470 High School: BUNKER HILL Tax Map: 025CY 05007 School Map Township: CATAWBA State Road #: 2622 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: CLAREMONT RURAL Zoningl: R-20 Building(s) Value: $149,400 Zoning2: Land Value: $10,800 Zoning3: Assessed Total Value: $160,200 Zoning Overlay: WP-O Year Built/Remodeled: 1973/1998 Small Area: BALLS CREEK Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710376000J Building Details 2010 Census Block: 2032 WaterShed: WS-IV Protected Area 2010 Census Tract: 011402 Voter Precinct: P5 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared Item 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 Cou Government, North Carolina. All rights reserved. ( .ceincYdi 4 0 pr t M^Otr utx t 0Snculr�� http://gis.catawbacountync.gov/nomap/parcel_report.php?key=376010268472&typ=P 3/14/2016 �A C( CATAWBA COUNTY 100A SOUTHWEST BLVD RECEIPT NEWTON,NORTH CAROLINA 28658 d r�lk PHONE: 828.465.8399 Monday, March 14, 2016 \ )/84'2, sM www.catawbacountync.gov PAYOR: Stewart,Nancy PAYMENTS TRANSACTION NUMBER: TRC-637214-14-03-2016 PAYMENT DATE : 03/14/2016 PAYMENT TYPE: Check 3403 INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-326117 Authorization to Construct (Repair) $450.00 Fee TOTAL PAYMENTS : S450.00 EHPR-03-2016-23388 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 1317 CHANCELLOR DR,CLAREMONT NC 28610 Owner NANCY STEWART, 1317 CHANCELLOR DR, CLAREMONT NC 28610 H:828461 1 1 1 9 C:8284640032 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 03/14/2016 11:17 Page 1 of 1