Loading...
HomeMy WebLinkAboutEHPR-05-2016-23869 (2).TIF 13A • THIS IS NOT A PERMIT Case # EHPR-05-2016-23869 : � CATAWBA COUNTY HEALTH DEPARTMENT 0 sy o i 0 � PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES :1•e i 1842 Environmental Health Plan Review - Septic Malfunction to el AUTH_CONST- SEPTIC_MALFUNCTION •0 t4 ox Applicant HAROLD DALBEY (HAROLD DALBEY), 1517 STEEPLE ST, CONOVER NC 28613 C:8284660820 Owner CHERYL EMERSON, 1293 LANDSDOWNE DR, CONOVER NC 28613 NAME TO APPEAR ON PERMIT CHERYL EMERSON SITE ADDRESS: 1293 LANDSDOWNE DR, CONOVER NC 28613 PIN # 373319711131 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 94,089.60 Acres 2.16 — DIRECTIONS: Take Old Hwy 70 , First Right after Jack in the Box, follow to Landsdowne Dr, Go 3-4 Blocks, House will be on the Right 2 story house wI#on mailbox. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 600 WATER SUPPLY: Community Well DESCRIBE WORK: Tank Only Replacement* Septic inspection for sale of home determined that there was a crack in the tank. 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 61x63, Garage 24x24 NUMBER OF EXISTING BEDROOMS: 5 #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: E9-chapplicaGnn 05/16/2016 09:49 Pagel of 7 -ts CATAWBA COUNTY Case# EHPR-05-2016-23869 .4-Lin- Public Health Department Subdivision 4 IR 0, Environmental Health Division PIN# 373319711131 'Wt- p0 Box 389. 100-A Southwest Blvd,Newton, NC 28658 1842 ,x NAME ON PERMIT: (CHERYL EMERSON), 1293 LANDSDOWNE DR, CONOVER NC 28613 ( CHERYL EMERSON) Site Address: 1293 LANDSDOWNE DR, CONOVER NC 28613 Property Size: Square Feet 94,089.60 Acres 2.16 Directions: Take Old Hwy 70 , First Right after Jack in the Box, follow to Landsdowne Dr, Go 3-4 Blocks, House will be on the Right 2 story house w/#on mailbox. 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 thatA complete site evaluation can be performed. Date: ✓l'lid 1(o,Z LL Signature of Applicant or Agent `--A' 4✓-P t An Environmental Health Specialist will contact you within 5 working days of a-lication date. If you need further information or assistance please call 828-466-7291 AREA2 •�JIFEENAI EEr[y �TCLIJ u uihl lipiloiin W].,17l t'tt t !iliilli{�IIIi�11DATEru��rl��' �i FEE AMOU1NTt Authorization to Construct(Repair) Fee 05/16/2016 $150.00 lip ,'' I E,,roTA.eF> Es-p';h�uG"fli��(P�IiPIiilililulit i��i9a(iliililt111�111ililh"�' �ttitii:itOi}lui'" 9Ilj$15o1oo1iiiii iliit 1 i.4 l.du hib..-:aliontErevioitiviimutimenilu.,n q,yPglilllllallLliiiii _ilmG3 i ingit .tali IJI miilligth lui. 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 05/16/2016 09:49 Page 2 of 7 CATAWBA THIS IS NOT A PERMIT COUNTY ; CATAWBA COUNTY HEALTH DEPARTMENT N ; & Application for Environmental Services Page 1 Improvement Permit n Authorization to Construct U Septic Repair _ Septic Malfunction Septic Expansion New Well Permit❑ Replacement Well ❑ Well Abandonment[ Well Repair ❑ Existing System Inspection (Pre-Approval Required) [ Application is for New\\Construction Li Existing Facility ,Property Address i 2`13 LAnJbvi ctANC' S�(L Subdivision (((��� OO1+0Je2 , NC ZSLe\3 Lot# Acres \Section/Block/Phase , Driving Directions to Property 1€VE St-•I (aL hvi ( ')a ) "n & FQSr R\t=\' a FVt ,T PC - )1.-.1 TS Z,DX At-> Fotu:w -o La..ii otaNE 2 , (U0 3-4 S ac- ,, 1-43use (ZsTmz,h ou 23Cal: NAME TO APPEAR ON PERMIT? ❑ Owner g Applicant ❑ Contractor Applicant Contact Information Name tt(N'ZcL., C. bALV3E4 Address i5i'q Sit?LL ST N Cc).. o ERn)C_ Phone 825 1 y(,(o-O ,Zo Cell Phone ,J.„.. Owner Contact Information 7\ Name CH£Q‘iC- 'tmEZSonj Address 3uFrat_D , MEti - OR Phone a-- Cell Phone BaS-s81 - 3111 Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner 10 Applicant ❑ Contractor Description of Existing Structures on Site , , 0=r L / _ # of Bedrooms *t 5 Structure Dimensions Lab( ( p3 # of Occupants f— SALE Basement El Yes y No Basement Fixtures n Yes N-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 2 No Does the site contain any jurisdictional wetlands? $Yes FA No Does the site contain any existing wastewater systems? ❑ Yes ll No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes 2 No Is the site subject to approval by any other public agency? ❑ Yes 2 No Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well K Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? **yf 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) RePt_ACE cry"CAceS \ /O Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other sena_ wiC ❑ Any C A rTAv BA THIS IS NOT A PERMIT COUNTY ac=' CATAWBA COUNTY HEALTH DEPARTMENT „o„„�o,o Application for Environmental Services Page 2 Proposed Facility Type H Primary Residence H New Residence Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions #of Occupants Basement H Yes I I No Basement Fixtures ❑ Yes _No ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes H No Plumbing Yes No Describe Plumbing Needed 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.) H 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 H Individual Well [ Semi-Public Well H Community Well Abandonment Type n Drilled [ Bored _ Dug H Unknown Well Repair Requested Yes H 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. I- 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 RETRH'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 -7424'4-6) Date 5 /1 to to Printed Name of Owner or Agent 1y ARou\ E. R a3 t Catawba County Environmental Health 100 99_96 ro 112.35 . ,,r. • . . . .... . . . . . ... . . . mospoi—E DR L 356A8 • !loon Q4 V . 0 s • to ID —99 iiii;:r J^y V 8 c56.59 _._ - 99.00 71.00 rV a Parcel: 373319711131, 1293 LANDSDOWNE DR 1in=60ft CONOVER, 28613 i No\-- S Or L ato Of SepfiCJ . 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 riot 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 05/16/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 37331 9711 1 31 Owner: EMERSON CHERYL Parcel Address: 1293 LANDSDOWNE DR Owner2: null City: CONOVER, 28613 Address: 1293 LANDSDOWNE DR LRK(REID): 67198 Address2: null Deed Book/Page: 2810/1254 City: CONOVER Subdivision: null State/Zip: NC 28613-8921 Lots/Block: null/ null Last Sale: School Information: School District: NEWTON CONOVER Plat Book/Page: Legal: 1293 LANDSDOWN DR Elementary School: SHUFORD Calculated Acreage: 2.160 Middle School: NEWTON CONOVER Tax Map: 3106 01001 High School: NEWTON CONOVER Township: CLINES School Map State Road #: 2244 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: CONOVER County Fire District: CONOVER RURAL Zoningl: R-20 Building(s) Value: $121,800 Zoning2: null Land Value: $29,100 Zoning3: null Assessed Total Value: $150,900 Zoning Overlay: null Year Built/Remodeled: 1966/null Small Area: null 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 #: 3710373300J Building Details 2010 Census Block: 2019 WaterShed: null 2010 Census Tract: 010202 Voter Precinct: P7 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=37331971 1 13 1&typ=P 5/16/2016 30 fl ' �CATAWBA COUNTY HEALTH DE' A. '• I MENT N° 554 ' Teleph ne (828)465-8270�T1 (828)465.11 �/ 7/f� Imp Print. Auth. to C st. Rpr Print. Opr Print. '�(/Sys Type t ell Print. Well Rpr Print. Owner/Age t �, a ! - o,.. ( Phone Li6�G�s�� Address I 93 Lc,-IAra s Do'-he. 0( - Subdivision Section/Block/Phase Lot# Lot Size- Directions Man S , Pe (A . L7( o,„I-s o ,_ ne . (Irk j j Se O h T Facility• House 7. Mobile Home Business Mulii-family Other Tax Map or Pin Number $ 133/5 ]//) 3 ) Other Zoning Approval# #Bedrooms S #Seats #Employees Application Rate -3 5 . GPD Flow yt' Hot Tub.or Spa yes/tbSpecial Fixtures Basement yes!(to 100% Repair Area es o Basement Plumbing yes/ Water Supply• P • ate Well X- Public Semi-Public. ********************1”4*************************************#*****************#***************#****************4*********** Type of System. Trench \ Be Pump Pump/Panel Panel LPP Other . 1° Septic Tank Size FYI Pump Tank Size — Nitrification Field. 'total Squire Feet I?.DO Depth of Stone I ,, Bed Size " ) f tS Trench Width _Total Length of All Trenches - Number of Trenches Trench Length / / / / / Feet on Center Maximum T inch Depth- 'Z Distance of Nearest Well 6 5 *DO NOT INSTALL SEPTIC WHEN WET* •*WELL RECORD REQUIRED AT COMPLETION* ********************************************************************** *************************************************** Topo 1 r - % Slope Texture Y Structure -•Clay Min. n I •`1 Soil Wetness 1 Soil Depth i " - Restric Hoz at 4. " r P I \ `q Available space V�a no I .1- i _Overall Class S 0U _ �__ �I I •Comments 'k I ov s e '----.m ra I Qs,/. I _ I I.) 15 . Filter Required al - Riser required whe - L•tn,'1 tS J °L•• tank is more than 6 - inches deep. **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) live years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. The siting of the well by the Health Department staff is to provide protection from know •,ssible sou •s of contamination. No volume of water is guarant-.•d at ap siit�y the Health Department. Permit Date a—__` - EHS A .. _ Owner/A,=!fl��L ✓s Septic Tank Installed'iy I re i f•-- Date ° ' EHS aj.�7�. �• .e• Well Installed By WI.1 Cr. t • pproval Date Well Head Approval Date Date Sample Collected Date of Results Results EHS White-Office Blue-Building Inspection Operation Permit Yellow Owner/Agent Green Building Inspection Authorization to Construct y14'A Cc CATAWBA COUNTY t I QUA SOUTHWEST BLVD LT ;i a^I,E i U rt NEWTON,NORTH CAROLINA 28658 RECEIPT l< m a nr-vo H' PHONE: 828.465.8399 C,J '�� Lidw ''C Monday, May 16, 2016 /842 sM www.catawbacountync.gov PAYOR: HAROLD DALBEY HAROLD DALBEY(DALBEY, HAROLD) PAYMENTS TRANSACTION NUMBER: TRC-673542-16-05-2016 PAYMENT DATE : 05/16/2016 PAYMENT TYPE: Check 2233 INVOICE NUMBER FEE NAME FEE AMOUNT 05-16-328386 Authorization to Construct (Repair) $150.00 Fee TOTAL PAYMENTS : S150.00 EHPR-05-2016-23869 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 1293 LANDSDOWNE DR,CONOVER NC 28613 Applicant HAROLD DALBEY, 1517 STEEPLE ST, CONOVER NC 28613 C:8284660820 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner CHERYL EMERSON, 1293 LANDSDOWNE DR, CONOVER NC 28613 receipt 05/16/2016 09.49 Page 1 of 1