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HomeMy WebLinkAboutEHPR-06-2016-24035 (2).TIF G THIS IS NOT A PERMIT Case # EHPR-06-2016-24035 � Y,A P CATAWBA COUNTY HEALTH DEPARTMENT' t 0 iB„_ `l PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES • 184 Sn Environmental Health Plan Review - Septic Malfunction o k o' o AUTH CONST- SEPTIC_MALFUNCTION •� -: .: Owner STEVEN SHUMAN, 3953 ENGLEWOOD ST, CLAREMONT NC 28610 11:8282411337 C:8282447197 HOME:8282411337 BARNBURNER30 @AOL.COM NAME TO APPEAR ON PERMIT Steven Shuman SITE ADDRESS: 3953 ENGLEWOOD ST, CLAREMONT NC 28610 PIN # 376004933363 NAME of SUBDIVISION: WOODLAND OAKS Lot tt 7& PT 6 Section/Block H PROPERTY SIZE: Square Feet 47,916.00 Acres 1.1 DIRECTIONS: E NC Hwy 10, Right onto Balls Road, Right onto Love Rd, Left onto Broadway St, Right onto Dover St, Left onto Englewood St, 2nd house on Right. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Community Well DESCRIBE WORK: Sewage is on the ground. -A line was crushed during landscaping. 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 EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 65x35 NUMBER OF EXISTING BEDROOMS: 4 #OF OCCUPANTS: 6 PROPOSED CONSTRUCTION BASEMENT? Yes BASEMENT FIXTURES? No 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 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. Date: 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-ehapplicaGun 06/07/2016 11:55 Page 1 of 7 A�4� \ CATAWBA COUNTY Case# RHPR-06-20 1 6-2403 5 .�m7e1InPy Public Health Department Subdivision WOODLAND OAKS .4 Environmental Health Division PIN# 376004933363 4 PO Box 389. 100-A Southwest Blvd, Newton. NC 28658 /842 NAME ON PERMIT: (STEVEN SHUMAN),3953 ENGLEWOOD ST,CLAREMONT NC 28610 ( Steven Shuman) Site Address: 3953 ENGLEWOOD ST, CLAREMONT NC 28610 Property Size: Square Feet 47,916.00 Acres 1.1 Directions: E NC Hwy 10, Right onto Balls Road, Right onto Love Rd, Left onto Broadway St, Right onto Dover St, Left onto Englewood St, 2nd house on Right 1111 'AME M ��rykj r I .4 , dill -11, 'Nt4A !�)�IIIDATE. I' I sFEE AMOUNT4 Authorization to Construct (Repair) Fee 06/06/2016 $450.00 TOTAk*EES a; l IIIIIIIIlIIIII1161t r' - :.1. "'1 lillIMV I+IDIIN11.4 °15asoroo,�;,y k . I wa +•11hLIWIIllP -«:SIR WW" • . F llflttb i41 FEES ARE NON—REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) F9-chappli eaUon 06/07/2016 11:53 Page 2 of 7 06-06-16; 14:44 ;From: To:8284658276 ; # 2/ 4 CATWB e THIS IS NOT A PERMIT g ra Non couNrr �.� y t �. `CATAWBA COUNTY. HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permit❑ Authorization to Construct ❑ Septic Repair 1711 Septic Malfunction❑ Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility Property Address 3953 E r 61-ree-+ ' Subdivision U W AAA 0 Cicrtrnerj- AUC awe Lot Acres I, )c"'" Section/Block/Phase Driving Directions to Property NAME TO APPEAR ON PERMIT? Owner ❑ Applicant ❑ Contractor Applicant Contact Information Z Name El-tUl+e.,� S�l(Ar✓(o+rl Imh �nr-f'Yl r)C ceip A Address 3cj 3 En5ku4 Cie-rem-10,4 /iJC ZS'610 Phone gam.. .?yl- I3 37 Cell Phone Fr�s- �yc% 7/ 9-7 q\t 41-46" Owner Contact Information Name S- ij'wt tT SkUMG.1 I Address ?lc/sa Eni Lweooc./ 54- Cloyed-rani- ✓1/c (9 �6/G Phone g 9$_ t9'/ / 9g? I Cell Phone Kc2f 9 qq 7/Q 7 Contractor Contact Information Name Address Phone I Cell Phone WHO WILL BE THE PRIMARY CONTACT? [Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site S it? k �h+ily home ^_ #of Bedrooms *t Structure (Dimensions / 5-,j F-F #of Occupants 62 Basement [Yes ❑ No Basement Fixtures a Yes glo ( (Ax l ) 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_ 0 Yes ii to Does the site contain any jurisdictional wetlands? &Yes ID No Does the site contain any existing wastewater systems? D Yes LYNo Is any wastewater going to be generated on the site other than domestic sewage? ® Yes IlYNo Is the site subject to approval by any other public agency? C Yes erNo Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well ❑✓'Community Well Li Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? *' ❑ Yes ffeNo 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 06-06-16; 14:44 ;From To:8284658276 U 3/ 4 CATAWBA L 7 A THIS IS NOT A PERMIT COUNTY VV D CATAWBA COUNTY HEALTH DEPARTMENT ...... ...-.7:::--. Application for Environmental Services Page 2 Proposed Facility Type 21/Primary Residence ❑ New Residence ❑ Addition toR� esidence #of New Bedrooms 't Project Description '.,pa-1 r et COI j n ci e,l Ci Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ® Yes ® No Accessory Structures) Describe #of New Bedrooms •t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed U Multi-Family Residence# Units _ #Bedrooms per Unit*j Total# Bedrooms •1' _ Structure Dimensions U 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 ❑ Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown . Well Repair Requested ❑ Yes ❑ No Describe ®.e Calculated Design Flow, Commercial t Additional information may be required to determ ne design flow from certain facilities. This value will be determined during consultation with on-site stall "Any room that will be intended for sleeping at the time of construction or for future consideration should be rioted as a bedroon and counted on all applications.The number of bedrooms will be confirmed by rooms identified on house plans as a bedroom at the ime 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 SCHEDI LE) 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 anc state officials are panted 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 (( Al c"// Date 6-- CD' ! 6 Printed Name of Owner or Agent 5IRIo,� /7` Ji/L1lpmor/7 06-06-16; 14:45 ;From: To:8284658276 # 4/ 4 Catawba County Environmental Health \\ '10 s •\ i;V\ \ \ \ \ d '`_ .z0602 \ \*IP \ \CA4P oo \ \ \ \ C'• \ \ df# Ir. \ ,\ \ \ \� N •\ \ � i • \ \ \ \ 52.00 \ \ \ \le \1 \ `B' \ 1 t 1 \\ Oil \ \ \ if■ \�\ ' ia�X \ 1 \ \ 1 5.00 9 1 �- \ \ 6 1 \ \ \ \ \ \ 1 \ Qp. 1 \ \ \ \ , 1 1 540 • gV Parcel: 376004933363, 3953 ENGLEWOOD ST 1in=5 oft CLAREMONT, 28610 This maplropon product was prepared from the Catawba County.NC Geospatial Information Services. Catawba County hap made substantial effons to ensure the accuracy of location and Iabellns information contained on Ihla map or data On It report.Coluwba County promotes and recommends the indopendcni verification of any data contained on this map/report product by he user.The County of Catawba,its employees.agents,and personnel,disclaim,and shell not Do hold liable for any and all damages,loss or liability,whether direct,indirect or censoquontlal which arises or m]y arise from this map/report product or the use thereof by any person or entity, Copyright 2014 Catawba County NC 06/06/2016 Catawba County Environmental Health 3 v �di1 1 \ 000yc \ \ \ \ \ \‘'r pP \ \ \ \ \ W,' .J 52.00 \ \ \ \ \ \ \ \ ti \ \ \ 1 \ \ 35.00 \ \ \ \ 69 1 \ \ \pp \ \\ \ ......__ \ \ \ \ CP$ 1 \ \ \\ \ \ g \ \ \mop 1 \ \ \ \ \ 1 1 015° , :5• 1 26 fl 5q. Al Parcel: 376004933363, 3953 ENGLEWOOD ST 1in=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 06/06/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 376004933363 Owner: SHUMAN STEVEN H Parcel Address: 3953 ENGLEWOOD ST Owner2: SHUMAN JOY A City: CLAREMONT, 28610 Address: 3953 ENGLEWOOD ST LRK(REID): 22902 Address2: null Deed Book/Page: 2798/1604 City: CLAREMONT Subdivision: WOODLAND OAKS State/Zip: NC 28610-8213 Lots/Block: 7 & PT 6/ H Last Sale: $169,900 on 2006-11-30 School Information: Plat Book/Page: 16/285 School District: COUNTY Legal: LOT 7 & PT 6 7H + PT 6 PL 16-285 PL Elementary School: BALLS CREEK Middle School: MILL CREEK 16-285 Calculated Acreage: 1.100 High School: BANDYS Tax Map: 022CY 05007 School Map Township: CATAWBA State Road #: 2651 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: BANDYS Zoningl: R-20 Building(s) Value: $124,300 Zoning2: null Land Value: $20,300 Zoning3: null Assessed Total Value: $144,600 Zoning Overlay: WP-O Year Built/Remodeled: 1985/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 #: 37103760003 Building Details 2010 Census Block: 3004 WaterShed: WS-IV Protected Area 2010 Census Tract: 011402 Voter Precinct: P1 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=376004933363&typ=P 6/6/2016 CATAWBA COUNTALTH DEPARTMENT NEWTON, NORTH CAROLINA COMPLETION PERMIT FOR SEPTIC TANKS PERMIT N° 00001 ( DATE :. / 7 __ OWNER /-� F'] euza. .d&- ADDRESS �r�� �// BUILDING rrrOOONTRACTORp 4 . SUBDIVISION lik-0441. �2 LOCATION ll0 1( 7 ' LOT # 7 LOT SIZE / BLOCK OR SECTION HOUSE (D/MOBILE HOME ( ) BUSINESS ( ) OTHER ( ) FHA-VA LOAN ( ) SEPTIC TANK: (SIZE /C900 GALS) WATER SUPPLY :: / NO. BEDROOMS NO FIXTURES INDIVIDUAL T PUBLIC V GARBAGE DISPOSAL UNIT :YES (-770 ( ) IF WELL, TYPE : BORED DRILLED DUG AUTO WASHING MACHINE : YES ( ) NO ( ) DISTANCE FROM SEPTIC TANK OR NEAREST NITRIFICATION FIELD: 07.0 SQ.FT. POLLUTION: FT. 1) NUMBER OF LINES 0 SEPTIC TANR INSTAL�jEDD BY: 2) LENGTH TD W DT ■ N S CR. y� C)// PERMIT FEE $ L( U at a) BED STEM ( CERTIFI E 0 COMPI.EiION _ _. b) TRENCH SYSTEM ( ) _. 3) DEPTH OF STONE IN LINES l�L _ REMARKS . ADEQUATE FALL (GRADE) ON: 1) BUILD NG (HOUSE) SEWER LINE : YES ( ( ) l- '7_.-55' 2) NITR ZCAT'�ION LINES : DATE INSTALLED: YES NO ( ) • SEPTIC TANK LAYOUT 1 . • . . al. -, .. Z I 6 . H • r I l • . NEALT4I DEPARTMENT COPY • � r �� (f ---""r----7==‘'-- -'`-, APIp j i , � CATAWBA • .16, H • DEPARTMENT ' ,//r- `� .] IMPRO,V,EEMEN^,i PERWWT FOR SEPTIC TAT !1 / Permit No 1 9,`� 8 'rP NA. 2 OWNER. : . ` ,-- C e .JVQ/L//KQ j.. .. :DATE• 's.. -S ADDRESS OF OWNER .. .. . PHONE NAIL OF CONTRACTOR - :. - ADDRESS - / L EL it - Qty 1� D SUBDIVISION !!'/Z!(rp I9s,Qy . LOT'ENO.. .SECTION OR BLOCK /7 LOT SIZE, FHA, yVA LO Septic Tank .Contractor must follow all HOUSE ( -' .MOBILE HOME ( ) BUSINESS ( ) OTHE_R. ( ) Details, of this permit ,(layout). NO BEDROOMS .;p t3) NO FIXTURES (� - '.SEPTIC TANK LAYOUT GARBAGE DISPOSAL UNIT , YES ( ) NO• ( ) - - _ l PLUMBING UNDER BASEMENT FLOOR: YES ,( ) NO;'( ) - SIZE OF TANK 10 0 :LIQUID GALLONS - - - NITRIFICATION FIELDc ! C - 1. Number of lines i7- ` 2. Length and width of lines: : f, ^-� a' - .. :.Bed 'System 1c 7^ ft. /0 i. , - � b.. Trench System ft 9;,,. ^: 3. Total Depth of stone inches v _ 'GROUNDWATER INTERCEPTOR DRAIN: . (IF REQUIRED) . =WATER SUPPLY- PRIVATE -. ABLIC -(:A--2..,7 ----------7.--:- ` f- -\ =`x- - — - I- OWNER NOTIFIED TO CHECK ZONING?' Y NO ( ) 1 - OWNER AGREES WITH .LAYOUT:' YES )- NO ( YY OWNER AGREES WITH SPECIAL INSTRUCTIONS: Y£ BO ( ) I , ;� OWNER OP. CONTRACTOR SIGNATURk, r+ . _ - - 15� PERMIT FEE $ Ltd'(.0 e •v ----s• PERMIT VOID AFTER 36. MONTHS , I AL APPROVAL OF THIS SEPTIC TANK SYSTEJBY IMMPROVE:`IENT. FERMI ISSU BY - _ E HEALTH DEPARTMENT SHALL INDICATE THAT THE SYSTEM HAS BEEN CONSTRUCTED ACCORDING TO SANITA_RI•. •�•• THE STANDARDS SET FORTH IN THE•CATAWBA COUNTY ' SEWAGE DISPOSAL REGULATIONS, BUT IN NO WAY HEALTH DEPT. COPY SHALL BE TAKEN AS A GUARANTEE THAT THE SYSTEM . WILL FUNCTION.SATISF,ACTORILY"FQR'.ANY.GIVEN 7M SOIL CLASSIFICATION: SUITABLE (' ) ;PROVISIONALLY. SUITABLE O �itY3. ITASLE O SI-TE FACTORS: - - - 1. SLOPE (%) - S - PS- -.`U 7. SOIL PERMEABILITY 'S - PS - U 2. SOIL TEXTURE (12-48 'IN.) .. - S - PS U - UNDER 60 MIN. - OVER 60 MIN:. SANDY, LOAMY, CLAYEY 8,. OTHER S - PS - U 3: SOIL STRUCTURE (12-48. IN.) S - PS - U , .. (SPECIFY). 4. SOIL DEPTH (IN.) - S- - PS - U 9. SOIL •SERIES: 5: RESTRICTIVE, HORIZONS (IN• ) S - PS U A- .CECIL ( ') B. HIth\SSEE ( ) (IMPERVIOUS STRATA, ROCK) - ' C. MADISON ( ) D. APPLING ( ) SOIL DRAINAGE - GROUNDWATER S - PS U E: PACOLET ( ) F. FLOOD PLAIN ( ) (EXTERNAL - ,INTERNAL) 1 G. 2-1CLAY SOILtL.-OTHER-SPECIFY' ilk AL,Al ./ / i `-.r • ' CATAWBA COUNTY • t� G 100ENOUTH CAROLINA BLVD RECEIPT }��r p � NEWTON,NORTH CAROLINA 28658 eape PHONE: 828.465.8399 v .apo� Tuesday, June 7, 2016 /842 SM www.catawbacountync.gov PAYOR: Shuman, Steven PAYMENTS TRANSACTION NUMBER: TRC-687277-07-06-2016 PAYMENT DATE: 06/07/2016 PAYMENT TYPE: Credit Card payment by phone INVOICE NUMBER FEE NAME FEE AMOUNT 06-16-329141 Authorization to Construct (Repair) $450.00 Fee TOTAL PAYMENTS : $450.00 EHPR-06-2016-24035 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 3953 ENGLEWOOD ST, CLAREMONT NC 28610 Owner STEVEN SHUMAN,3953 ENGLEWOOD ST, CLAREMONT NC 28610 H:8282411337C:8282447197 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 06(07(2016 11.50 Page 1 of 1