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HomeMy WebLinkAboutEHPR-04-2016-23693 (2).TIF v4A co THIS IS NOT A PERMIT Case # EHPR-04-2016-23693 Q :id1 CATAWBA COUNTY HEALTH DEPARTMENT 0 •o •t %" 1/19. PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 sm Environmental Health Plan Review - OSWP o IMPROVEMENT •�• d o. oh Owner CHARLES SHANKLES,3453 PLATEAU RD., NEWTON NC 28658 C:8283206479 NAME TO APPEAR ON PERMIT CHARLES SHANKLES SITE ADDRESS: 3453 PLATEAU RD,NEWTON NC 28658 PIN # 269802670590 NAME of SUBDIVISION: Lot 4 Section/Block PROPERTY SIZE: Square Feet 321,037.20 Acres 7.37 DIRECTIONS: Hwy 10 West, Propst Cross Road, Left on Plateau Rd about 1 mile, House is on the Right beside Fred T Foard High School. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Public Water DESCRIBE WORK: IP to designate repair area for the existing 4 BdRm house. Proposing to put an accessory dwelling on the property 20x30 (1 BdRm,.Kitchen & bath) 'Applied separately for a sperate system. 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, Shed EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: House 73x65, Shed 24x30 NUMBER OF EXISTING BEDROOMS: 4 #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: Acessory Dwelling 20x30 #OF NEW BEDROOMS:: 1 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: E9-chapplication 04/20/2016 1503 Page I of „.:i.)-§A CAhARBA COUNTY Case# EI-IPR-04-2016-23693 /�' h z Public Health Department Subdivision KIt, „cl Environmental Health Division PIN# 269802670590 a4 PO Box 389. 100-A Southwest Blvd. Newton. NC 28658 g 2 s. NAME ON PERMIT: (CHARLES SHANKLES), 3453 PLATEAU RD.. NEWTON NC 28658 ( CHARLES SHANKLES) Site Address: 3453 PLA'T'EAU RD,NEWTON NC 28658 Property Size: S q uare Feet 321,037 20 737 Directions: Hwy 10 West, Propst Cross Road, Left on Plateau Rd about 1 mile, House is on the Right beside Fred T Foard High School. 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 acct ssib(e so that a,complete site evaluation can be performed. Date: Apz.IL7.o `t6 Signature of Applicant orAgenY 77/2 j.------- An Environmental Health Specialist will contact you with-M-5 world g days of application date. If you need further information or assistance please call 828-466-7291 AREA2 FEENAME , ” ` 4;. - ` DATE ' FEE AMOUNT Improvement Permit Fee 04/20/2016 5150.00 ' !,TOTAL FEES 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 04/20/2016 1 5.03 Page 2 of 5 C ATA\ BA THIS IS NOT A PERMIT y" '` �� COUNTY "'°>>,._ CATAWBA COUNTY HEALTH DEPARTMENT N,,,,.. ' Application for Environmental Services Page 1 Improvement Perm Authorization to Construct _ Septic Repair ❑ Septic Malfunction ❑ Septic Expa ion n New Well Permit n Replacement Well _ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) n Application is for New Construction ❑ Existing Facility Property Address 3(1s3 pLJA-c .i ,2S .UeusTON Ai c Subdivision .2gl.sg Lot# Acres Section/Block/Phase Driving Directions to Property 4,,Y r C, w e c -co Psppsrc Roscs4 rsnn, Len PIIATEAU ¢o, t1-PP AMC l n1(Le r NUousc. (s ON R_LGf4T RE5'k OE FoArio 41Gt4 SC14wt- NAME TO APPEAR ON PERMIT? 2rowner ❑ Applicant 1-1 Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name r' Ung i_rs s Not-+KL65 Address 3453 Pt-AreFw .40i ticun r. _Nc 2365-5 Phone Cell Phone( $24) 3w-(,q n Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? 2/Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site S-ncg3LiLr 3iN&L.E PAAmLiowe--1 NC- ; APaaoK '/,ace sgPT, # of Bedrooms *.l. 'f' Structure Dimensions V)3L -_]\ � �� # of Occupants 3 Basement L Yes No Basement Fixtures []'Yes ❑ No SY)rol ..4 X 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 R'No Does the site contain any jurisdictional wetlands? XYes I •No Does the site contain any existing wastewater systems? ❑ Yes ErNo Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes li No 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 n Individual Well n Community Well n Semi-Public Well Of County/City/Township Water Line Is a public water supply available? ** Z'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) V ❑ Accepted ❑ Alternative 12.Conventional ❑ Innovative ❑ Other ❑ Any tesiperi26pciAr CATAWBA 7BA THIS IS NOT A PERMIT COUNTY VV 1? CATAWBA COUNTY HEALTH DEPARTMENT .o,„--;,»i Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence n Addition to Residence #of New Bedrooms *t Project Description Structure Dimensions #of Occupants Basement C Yes ❑ No Basement Fixtures ❑ Yes ❑ No XAccessory Structure(s) Describe 511Q c".4. j )} # of New Bedrooms *� if applicable 1 Structure Dimensions 'GU (12 # of Occupants )'t_ Accessory Dwelling IX Y s ❑ No Plumbing 7Yes ❑ No Describe Plumbing Needed )( i `VQn; 120;1-t-) 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 n Other Facility Type Specify If Church# of Seats Kitchen ❑ Yes ❑No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type I Individual Well Li Semi-Public Well n Community Well Abandonment Type n Drilled n Bored ❑ Dug ❑ Unknown Well Repair Requested Yes n 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. j 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 Pennits 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 1 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 4P2i L za t le Printed Name of Owner or Agent C -SNZtzS Si-(A.+)Lt_eS Catawba County Environmental Health .\\ ,,,,, �`.. e_,.... >S w 967) A 1s> <1. 1)&G 040 it .„) i / .. --1":„,,,..,:i".:2) ti 1030 • v 3a N, • ( l • /111Irrior 4p. \ // ✓ �� �J ,r _ i / tiooa gg5\ ,,, / I Parcel: 269802670590, 3453 PLATEAU RD 1 in=150ft NEWTON, 28658 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 04/18/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 269802670590 Owner: SHANKLES CHARLES ALLEN Parcel Address: 3453 PLATEAU RD Owner2: SHANKLES JEAN MACE City: NEWTON, 28658 Address: 3453 PLATEAU RD LRK(REID): 4689 Address2: null Deed Book/Page: 1916/1391 City: NEWTON Subdivision: State/Zip: NC 28658-8809 Lots/Block: / Last Sale: $155,000 on 1995-01-01 School Information: Plat Book/Page: School District: COUNTY Legal: 3453 PLATEAU RD Elementary School: BANOAK Calculated Acreage: 7.370 Middle School: JACOBS FORK Tax Map: 005 J 01005 High School: FRED T FOARD Township: JACOBS FORK School Map State Road #: 2036 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: PROPST Zoningl: R-40 Building(s) Value: $177,700 Zoning2: Land Value: $41,700 Zoning3: Assessed Total Value: $219,400 Zoning Overlay: Year Built/Remodeled: 1894/1980 Small Area: PLATEAU 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 #: 3710269800J Building Details 2010 Census Block: 3009 WaterShed: null 2010 Census Tract: 011802 Voter Precinct: P3 Agricultural District: Proximity 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 269802670590&typ=P 4/20/2016 Telephone: (704) 465-8270 TDD: (794)' 465-8200 Improve. Permit/ Authorization to Construct Repair Permit/ I•Oper. Pe[r`mit y2stem Type _ • Owner/Agent (i ‘K _S Iw+✓ K( (..0 5 Phone LG',R,<R:J 7%g Address ,i4S-.j pC>,7C/-✓ • "'eel Subdivision ig1'vC° Section/_B..ock/Phase Lot#. Lot Size cr. /+Y Directions: /r dJ CD ? Z/d-4in1 /� La w..r • rT l r:-, — , r O,-7 ,cc%n-/ .1513 P/4/Z-—t 2.1 Facility: House ' Mobile Home Business : Other: Tax Map # ' . Multi-family Other . Zoning Approval # # Bedrooms # Seats # Employees . Application Rate GPD Flow Hot Tub or Spa yes/no•Special Fixtures . 100% Repair Area yes/no ' 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 1y/9rp✓C Pump Tank Size "I x Nitrification Field: Total Square Feet /,f//z) Depth of Stone / Z. Bed Size AI X41 Trench Width Total Length of All Trenches Number of Trenches Individual Trench Length / / /_/ Feet on Center Maximum Trench Depth_ Distance of Nearest Well *DO NOTe INSTALL WHEN WET* Topo % Slope • 57,'N ~ t" Texture • . Structure •. m%1 H&j Clay Min. -• Soil Wetness / t4VJ oil Soil Depth " /) Restric. Hoz. at " . i I}{/A7` �r,.ry/✓& Available space yes/no I E Y ' Overall Class S PS -u • Comments: nJi 1.. LCII0 • . • • **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 CCfrom date issued and is not transferable. Permit Date /7- ZG/�/ wner/A nt 1 •,g 1 A--xr . ' . I 0 Sanitarian t /IC�, r -Adpidpit . Ins a-fled By jZ'Z !Z /a Date J-t95. '9 Sanitari=.n �� y/Z ' - White-Office Blue-Building Inspection Operation Permit Yellow-Owner/Agent Green-Building Inspection Alit,,--:------ - a^r:rnx 6"'c t