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HomeMy WebLinkAboutEHPR-03-2016-23535 (2).TIF THIS IS NOT A PERMIT Case # EHPR-03-2016-23535 CATAWBA COUNTY HEALTH DEPARTMENT 0 Miof' 0 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ' - iT /842 sM Environmental Ilealth Plan Review - OSWP ,o 't• u d1.o r IMPROVEMENT o-� o ' o 0 ir . r • Applicant REBECCA LOUISE ROSS, 4020 S NC 16 HWY, MAIDEN NC 28650 C:82899443II NAME TO APPEAR ON PERMIT Rebecca Louise Ross SITE ADDRESS: 2699 E NC 10 HWY, CONOVER NC 28613 PIN # 375011750439 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Peet 52,707.60 Acres 1.21 DIRECTIONS: Hwy 10 E, Past Emmanual Church Rd, building will be on Right at Morehead St. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 300 WATER SUPPLY: Private Well DESCRIBE WORK: Change of Use. - Furniture Company to Church 100 seats w/ Kitchen - 300 gallons per day 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: ** NO STRUCTURE SELECTED ** FACILITY TYPE: Church OTHER DESCRIPTION: DESCRIPTION OF Building EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 41x80 NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION 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 accesible so that a complete;ite evaluation can be performed. Date: -3 -1jI - IL, 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 AREA1 E9-ehapplicntion 03/31/2016 15.00 Page I of 4 �eA CATAWBA COUNTY Case tt EHPR-03-2016-23535 Q T Public Health Department Subdivision l Q „r® ^� Environmental Health Division PIN# 37 5011 7 50439 PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 1842 SM. NAME ON PERMIT: ( REBECCA LOUISE ROSS), 4020 S NC 16 HWY, MAIDEN NC 28650 ( Rebecca Louise Ross) Site Address: 2699 E NC 10 HWY, CONOVER NC 28613 Property Size: Square Feet 52,707.60 Acres 1.21 Directions: Hwy 10 E, Past Emmanual Church Rd, building will be on Right at Morehead St. FEENAMF iiux M l kv rH 'V+ 1 PDATEL o FEEAMOUNT4 Improvement Permit Fee 03/31/2016 $150.00 a 14t ' ;TOTAE'FFE$ # P hs !v i"}a:t 4 a1' '.t, Al r i. i :rer$110"00 =,a;1.,h.,Ora r 3.«t'.{.sC x, .,,. 4111,111d5 P,,.,,,_kn,2: "= .t—6.1 st..r _.M;.,:162 ...._..:11 its S,..aa,aa - v_,..,�'. .: 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 icat ion 03/31/2016 15:00 Page 2 o14 CATAWBA THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT �.. �o„h�a,o�;�. Application for Environmental Services Page I Improvement,Permitt Authorization to Construct❑ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion n New Well Permit n Replacement Well n Well Abandonment Well Repair _ Existing System Inspection (Pre-Approval Required) n Application is for New Construction n Existing Facility ❑ Property Address ,24, 9t EA"i' /6 W/i. Subdivision C4MniQR xi %, -27/./3 / Lot# Acres / Section/Block/Phase Driving Directions to Property //u/y /0 .E, ft( ter n/i er? Al C Gn .3nr 1 f,n IFS Au,'//;� /u' // CA/ r;�ht of more head S� J NAME TO APPEAR ON PERMIT? .-Owner ❑ Applicant n Contractor Applicant Contact Information Name e be cc' a 1--13115 e- ZI c5s Address 4,6a0 S N e_ b tivox /%c,L c/e AV' N.0 , 2?1,,s 0 Phone ga2-9qt+ - 4 311 Cell Phone • Owner Contact Information Name /' Address = S _ Phone Cell Phone Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ® Owner n Applicant n Contractor Description of Existing Structures on Site # of Bedrooms *j' 4 Structure Dimensions LI I+ X Fy ) # of Occupants /4Q Basement ❑ Yes No Basement Fixtures n Yes IR 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 ❑'AVo Does the site contain any jurisdictional wetlands? AYes ro Does the site contain any existing wastewater systems? ❑ Yes "No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes Er Is the site subject to approval by any other public agency? ❑ Yes 0-No Are there any easements or right of ways on this property? Describe Existing water supply in use -Individual Well n Community Well n Semi-Public Well �/ ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes g 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) J❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other #{ Any cATAL m THIS IS NOT A PERMIT couNTy CATAWBA COUNTY HEALTH DEPARTMENT • No„„„ ;,, Application for Environmental Services Page 2 Proposed Facility Type n Primary Residence ❑ New Residence n Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes n No n Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions ft of Occupants Accessory Dwelling ❑ Yes No Plumbing n Yes ( I No Describe Plumbing Needed ❑ 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.) n Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts ❑ Other Facility Type Specify ch If Church # of Seats 10O Kiit h n Yes n No If Daycare Specify Occupancy N Application for Well Construction/Abandonment/Repair Proposed Well Type Individual Well n Semi-Public Well ❑ Community Well Abandonment Type n Drilled n Bored n Dug n Unknown Well Repair Requested n Yes n No Describe Calculated Design Flow, Commercial t 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 1 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 t s_ ,46ZGtO9__, Date 3- 31 1p Printed Name of Owner or Agent e be CCq Lou'.S c Ross Catawba County Environmental Health \ •\ *%-'------__ . 1 ,.. } } (3 0 } •3 EHC10HWY (245) 7) 930 -- °" f 1 . i t 205) 935 A70 C.13 ON f to m f w N� t f f 1a t , A 130 93.52 '�'Ir'+' (330) Parcel: 375011750439, 2699 E NC 10 HWY 1in=50ft 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 03/31/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 375011750439 Owner: P & G BUILDERS LLC Parcel Address: 2699 E NC 10 HWY Owner2: null City: CONOVER, 28613 Address: 112 RUBY LANE LRK(REID): 34794 Address2: null Deed Book/Page: 3185/1027 City: MAIDEN Subdivision: null State/Zip: NC 28650-9602 Lots/Block: null/ null Last Sale: $99,000 on 2008-08-29 School Information: School District: COUNTY Plat Book/Page: Elementary School: CATAWBA Legal: 2699 E NC 10 HWY Calculated Acreage: 1.210 Middle School: RIVER BEND Tax Map: 062N 02007B High School: BUNKER HILL Township: NEWTON School Map State Road #: null 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: $32,000 Zoning2: null Land Value: $16,200 Zoning3: null Assessed Total Value: $48,200 Zoning Overlay: WP-O Year Built/Remodeled: 1960/null Small Area: BALLS CREEK Current Tax Bill Split Zoning Districts: null/null Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 37103750003 Building Details 2010 Census Block: 3004 WaterShed: WS-IV Protected Area 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. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=375011750439&typ=P 3/31/2016 • ' •CATAWBA COUNTY HEALTH DEPARTMENT Telephone: (704) 465-8270 TDD: (704/), 465-8200 Improve. Permit Authorization to Construct Repair Permit Oper. Permit/\System Type Owner/Agent U.)6-ijtlac GQN -'� Phone y6/II- Li ysc Co Address Q.O . 3 < (oil Subdivision &Jew It^-= *QC Section/Block/Phase Lot# Lot Size Directions: 10 6 O`e..l ruGI4-1 3.QcW--c (3e` Y?....• 6k tt(4 Ly i=7SYOG A/'lhe Facility: House Mobile Home Business 1-X\ t . Other: Tax Map # Multi-family Other . Zoning Approval # # Bedrooms # Seats # Employees 3 . Application Rate GPD Flow Hot Tub or Spa yes/no Special Fixtures . 100% Repair Arep.-VEZ7kio Basement yes/no Basement Plumbing yes/no Water Supply: Private Well Public Type of System: Trench Bed /" Pump Pump/Panel Panel LPP Other Tank Size: Septic Tank Size 4;2Cf57-rx✓'G Pump Tank iT Nitrification Field: Total Square Feet 400 Depth of Stond fl— - Bed Size (0 )C 4d Trench Width Total Length of All Trenches Number of Trenches Individual Trench Length / / / / Feet on Center Maximum Trench Depth Distance of Nearest Well *DO NOT INSTALL WHEN WET* Topo % Slope Texture Lail V t.r 0 r Tri . Structure d, I- C Clay Min. - ._ —_ • — .�,, C MST-t .� Soil Wetness " �'\. ' Soil Depth / Restric. Hoz. at " ��p.,!) Available space yes/no Overall Class S PS U Comments: '..-\---. 1„,1--,---- . to y ". **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** • *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility. An Authorization to Construct is valid for (5) five years porn date issued and is not transferable. Permit Date G1 S 0 - /n,7, :s1 U Sanitarian ai 7277, 4� Installed By /r �. Dater--9 GSanitarie 4✓ , �lT%• _1. White-Office Yellow-Owner/Agent • O O .1 O O p N > n J O O N -* - - CO N • O „co- 0 ,� .n. Z T v 0 } .j � ✓� . N n- ., -, ,e'er,, • -< ' 'O • rr N __ 3 .} , I Fur l'1 o 1 ,� 1 I) ''4. § CA xi I • t. ,f C tl. ,- m e_ jy ,.h ■ ..,+, uuii r. :-�5�-. . .m,.. 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I 2: 2.3. •O 8 C � J -. ro O '`a O O ro 3 '< 0 4 Li CATAWBA COUNTY t Ci IOOA SOUTHWEST BLVD d NEWTON, NORTH CAROLINA 28658 RECEIPT ri U i PHONE: 828.465.8399 Wily Thursday, March 31, 2016 i8 4 2 sM www.catawbacountync.gov PAYOR: Ross,Rebecca Louise PAYMENTS TRANSACTION NUMBER: TRC-64728 1-3 1-03-201 6 PAYMENT DATE : 03/31/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-326716 Improvement Permit Fee $150.00 TOTAL PAYMENTS : S150.00 EHPR-03-2016-23535 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 2699 E NC 10 H WY, CONOVER NC 28613 Applicant REBECCA LOUISE ROSS, 4020 S NC 16 HWY, MAIDEN NC 28650 C:828994431 I ** NO PEOPLESOFTACCOUNTASSIGNED ** receipt 03/31/2016 15:00 Page 1 oft