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HomeMy WebLinkAboutEHPR-05-2016-23830 (2).TIF • THIS IS NOT A PERMIT Case # EI-IPR-05-2016-23830 Q G CATAWBA COUNTY HEALTH DEPARTMENT l "*F' 0 ,heb PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES /842 sM Environmental Health Plan Review - Septic Malfunction :o oo ry AUTH_CONST - SEPTIC_MALFUNCTION • . kilo CI • Applicant BRENDA MARTIN, 1117 GRAHAM ST, CLAREMONT NC 28610 �G C:8288968878 Owner GWENDOLYN CHRISTOPHER, 1117 GRAHAM ST, CLAREMONT NC 28610 C:8288968878 NAME TO APPEAR ON PERMIT Gwendolyn Christopher SITE ADDRESS: 6567 RUSSELL TAYLOR DR, CATAWBA NC 28609 PIN # 379002555029 NAME of SUBDIVISION: Lot ft Section/Block PROPERTY SIZE: Square Feet 476,982.00 Acres 10.95 DIRECTIONS: Hwy 10 E, right on Hudson Chapel Rd, right on Bolton, right on Russell Taylor, 1st brick on left PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: draining slow 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? Yes Property Easements Description: Duke Power Easement APPLICATION FOR: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 38 x 39 NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION BASEMENT? Yes BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: 1.9-ehapplication 05/11/2016 12:01 Page 1 of7 4-1y,es. 6� CATAWBA COUNTY Case# EHPR-05-2016-23830 _ G Public Health Department�'f� p Subdivision 4 `_�® H, Environmental Health Division PIN# �"�e 379002555029 \ -tti PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 842 e, NAME ON PERMIT: (GWENDOLYN CHRISTOPHER), 1117 GRAHAM ST,CLAREMON'I'NC 28610 ( Gwendolyn Christopher) Site Address: 6567 RUSSELL TAYLOR DR, CATAWBA NC 28609 Property Size: Square Feet 476,982.00 Acres 10.95 Directions: Hwy 10 E, right on Hudson Chapel Rd, right on Bolton, right on Russell Taylor, 1st brick on left 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 evaluat.- an be performed. Date: 5 - (0 - (6 Signature of Applicant or Agen fl:A' / .1 i a -ii.!Aril:I An Environmental Health Specialist will contact you within 5 workinedays of application date. If you need further information or assistance please call 828-466-7291 AREA1 r111I trr 'Im ;: Impl ' � l� I : E S�FEENAME 1 l J LDATE4 11FE+AMOUNT3+ Authorization to Construct (Repair) Fee 05/11/2016 $300.00• t }I; TOTA ' . bih� I @ lll�u'I it n (lllll ' B I l[ t h W ll $so oI , „ _ .. t' kl l .1 .•∎• . ti •,, ' .1 , an . � fD ItU . ' ; • 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) F9-ehapplicatinn 05/11/2016 12:00 Page 2 of7 CATAWBA THIS IS NOT A PERMIT _CC TY -R----,-, CATAWBA COUNTY HEALTH DEPARTMENT �h3Cr NQ.,h Ca.cfl S Application for Environmental Services Page 1 Improvement Permit Authorization to Construct❑ Septic Repair ❑ Septic Malfunction Septic Expansion n New Well Permit in Replacement Well ❑ Well Abandonment Well Repair n Existing System Inspection (Pre-Approval Required) ❑ Application iss for New Construction [❑_ Existing Facility Property Address {c{ J 56 9 i \cCb3e/( /��/a e �y�Subdivision Gil rube.-. PVC Lot# Acres t- Seciop/Block/Phase Driving Directions to Property I-1- ) b Izs f-6_45e C(naia__c( rd J ifri e,7 oh/ Ad , —u, tNi ti�&/ fp Pc,sse/( /Ay LK .9(L . f5i b,1 /LA I(Ousc On cP-rf /oe _ Tin SPetk0 - fl e/] 7e< NAME TO APPEAR ON PERMIT? gOwner Applicant n Contractor Applicant Contact Information/ Name I A2Anct._ frkcc R bn Address I I (-7 6e p ldin4 S% G('c e M ort MC decW Phone Cell Phone $C, -- ?i'( - y7a, Owner Contact Information Name GWer\doJ./nN (ARcs-la pf Address f1I7 UAA' N/Qa- 5f cce. ienza✓1-f- l((_ a.5' 6, /0 Phone Cell Phone 1 1 ey 6 - y 7i Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? V Owner ❑✓ Applicant L Contractor Description of Existing Structures on Site ( y32C‘i, 1 #of Bedrooms **t Structure Dimensions l O oo t 5 }-f' #of Occupants Basement ['Yes No Basement Fixtures ❑ Yes 7 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 CiNo Does the site contain any jurisdictional wetlands? [I Yes ❑ No Does the site contain any existing wastewater systems? ❑ Yes C 'No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes Q No Is the site subject to approval by any other public agency? /1h� k�j7,-e,, rr iJ Yes 0/No Are there any easements or right of ways on this property? Describe I)F;pt PbLue//avn .r Existing water supply in use [7 Individual Well I i Community Well ❑ Semi-Public Well El 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 ❑ Any Cy A T iij L 7B A TIIIS IS NOT A PERMIT OUNTY CATAWBA COUNTY HEALTH DEPARTMENT N, Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence H New Residence n Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement _ Yes n No Basement Fixtures ❑ Yes ❑ NO I I Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes n No Plumbing n Yes n No Describe Plumbing Needed I I Multi-Family Residence#Units #Bedrooms per Unit*t Total #Bedrooms *j Structure Dimensions H 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 If Church# of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type —I Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type n Drilled n Bored n Dug [ Unknown Well Repair Requested n 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. 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. r- Signature of Owner or Age i -tar-L .� A - p�D to 5 - �� I i ( r- Printed Name of Owner or Agent v (�/e r1 CI z /1/4.) tom/ D (Y j 11 (iclopr 1 eec Catawba County Environmental Health 15.35 ay - — - — — — — 54740— — 104.37 19Ag3 �y1P�1'�R°R 21�� RVSSO D � tkril - AP`s` rep' 12881 (443) 128.68 Orr • Parcel: 379002555029, 6567 RUSSELL TAYLOR 1 in=60ft DR CATAWBA, 28609 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 maplreport 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 05/11/2016 Catawba County Environmental Health J' SVcrC 15.35 1—v.:0-,-,..0-,,,,-p - lt r 0 as r `tiatil !SIVA ° i 4,011141f # I. 0 .0„, i ,!I:JD ' ‘ IZ50 410111Adie len 11111 'Pr ' -41111Prillir _ 1. pfrr ‘.4 lijaiiii)401?, . ,11, . rillitill / N Jj/ ., itliV/ .apii/ . s.,7%....7______„... , ,v,____,.,- , .tte„." , . 4 rat, i ( Parcel: 379002555029, 6567 RUSSELL TAYLOR 1in=200ft DR CATAWBA, 28609 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 05/11/2016 Parcel Report Page 1 of 1 • Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 379002555029 Owner: CHRISTOPHER GWENDOLYN Parcel Address: 6567 RUSSELL TAYLOR DR DECKER City: CATAWBA, 28609 Owner2: null LRK(REID): 17065 Address: 2148 SEAGLETOWN RD Deed Book/Page: 0962/0039 Address2: null Subdivision: null City: VALE Lots/Block: null/null State/Zip: NC 28168-7709 Last Sale: Plat Book/Page: School Information: School District: COUNTY Legal: P/L ROW = 1.08 AC Elementary School: CATAWBA Calculated Acreage: 10.950 Middle School: MILL CREEK Tax Map: 016 Y 01023 Township: CATAWBA High School: BANDYS State Road #: null School Map TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: CATAWBA RURAL Zoningl: R-40 Building(s) Value: $59,300 Zoning2: null Land Value: $54,900 Zoning3: null Assessed Total Value: $114,200 Zoning Overlay: DWMH-O,WP-O Year Built/Remodeled: 1957/null Small Area: SHERRILLS FORD 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 #: 3710379000J Building Details 2010 Census Block: 1005 Watershed: WS-IV Protected Area 2010 Census Tract: 011503 Voter Precinct: P21 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. N ?et 11‘; I- Fhb it http://gis.catawbacountync.gov/nomap/parcel_report.php?key=379002555029&typ=P 5/11/2016 ' Co CATAWBA COUNTY S 100A SOUTHWEST BLVD NEWTON, NORTH CAROLINA 28658 RECEIPT U lotV1bV r PHONE: 828.465.8399 ri-' Wednesday, May 11, 2016 • \842 set www.catawbacountync.gov PAYOR: Christopher,Gwendolyn PAYMENTS TRANSACTION NUMBER: TRC-670719-11-05-2016 PAYMENT DATE : 05/11/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 05-16-328226 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-05-2016-23830 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 6567 RUSSELL TAYLOR DR, CATAWBA NC 28609 Applicant BRENDA MARTIN, 1117 GRAHAM ST, CLAREMONT NC 28610 C:8288968878 Owner GWENDOLYN CHRISTOPHER, 1117 GRAHAM ST, CLAREMONT NC 28610 C:8288968878 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 05/I1/2016 11:59 Page 1 of 1