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HomeMy WebLinkAboutEHPR-07-2016-24258 (2).TIF THIS IS NOT A PERMIT Case# EHPR-07-2016-24258 CATAWBA COUNTY HEALTH DEPARTMENT O ``4• f D v77r" PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 sm Environmental Health Plan Review - Septic Malfunction eo, P ' . AUTH_CONST- SEPTIC_MALFUNCTION o Owner GEORGE CONDEELIS,2051 GARY LN, HICKORY NC 28602 C:828308081I NAME TO APPEAR ON PERMIT George Condeelis SITE ADDRESS: 3989 PLUM ST, CONOVER NC 28613 PIN # 373315627618 NAME of SUBDIVISION: Lot# 1 Section/Block PROPERTY SIZE: Square Feet 15,246-00 Acres 0.35 DIRECTIONS: 140 to Old Hwy 70, Right at light onto Herman Sipe Rd, Right onto Pear St, Left onto Plum St, 5th house on Left. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Water is puddling up on ground. 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: 32x39 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 3 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: 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,o�f all property lines and corners and making the site accessible at a com..ig evaluation can be .erformed. Date: t f 10 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 AREA2 E9-ehapplication 07/11/2016 14:14 Page 1 of 7 4v • CATAWBA COUNTY Case a EFIPR-0 7-2 0 1 6-242 5 8 � �^C� Public Health Department Subdivision 4 —^• . Environmental Health Division IIN# 373315627618 t? PO Box 389, 100-A Southwest Blvd,Newton, NC 28658 78.2 s, NAME ON PERMIT: (GEORGE CONDEELIS),2051 GARY LN, HICKORY NC 28602 ( George Condeelis) Site Address: 3989 PLUM ST, CONOVER NC 28613 Property Size: Square Feet 15,246.00 Acres 0.35 Directions: 140 to Old Hwy 70, Right at light onto Herman Sipe Rd, Right onto Pear St, Left onto Plum St, 5th house on Left. FF NAME'�2 ��41 u �l�lt ,c7 7... iti"t"1',{1m4 ��,:` DATE��I�� t �'I�FEEAMOUNT !„ _' 1��iILrZb,m d;,Jn�nl4 h�,:.au �J ! � u I Authorization to Construct (Repair) Fee 07/11/2016 $300.00 oeBWuliana iaat ILdmma'' �rL9 WJ n. d4in.• ^41f al9'JS:� ' 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) I)-ehopplication 07/11/2016 14:14 Page 2 of 7 CATAWBA TR THIS IS NOT A PERMIT counr �/V I L➢L ]� CATAWBA COUNTY HEALTH DEPARTMENT NertM1 Cotolin Application for Environmental Services Page 1 Improvement Permit ^ Authorization to Construct n Septic Repair❑ Septic Malfunction% Septic Expansion n New Well Permit n Replacement Well n Well Abandonment n Well Repair n Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction n Existing Facility X Property Address 39r rPL ST Subdivision coy, r.4... a l Lot# Acres Section/Block/Phase Driving Directions to Property 4 o TO oLb -k -7 o — Q`%%-ca '4 t wt. c.c. �`� On �c .-e �'Y` NAME TO APPEAR ON PERMIT? ❑ Owner ❑ Applicant n Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name C-covJC �vDet t:S 21 Address a 0 S I G-"7 / Phone 2 g —3 e & ^ °t I I Cell Phone a & — 3 e & — oc // Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? n Owner n Applicant I I Contractor Description of Existing Structures on Site 'S Be d2 I-4-°`s e # of Bedrooms *j' Structure Dimensions /26* s7 jr- #of Occupants 3 Basement ❑ Yes No Basement Fixtures C, Yes ( No 3Z,(3) 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 tNo Does the site contain any jurisdictional wetlands? p Yes Arlo Does the site contain any existing wastewater systems? o Yes )d'CIo Is any wastewater going to be generated on the site other than domestic sewage? ICI Yes Arfslo Is the site subject to approval by any other public agency? ID Yes ltk-NZ Are there any easements or right of ways on this property? Describe Existing water supply in use n Individual Well n Community Well ( Semi-Public Well County/City/Township Water Line Is a public water supply available? ** n 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) \-70 Accepted ❑ Alternative El Conventional ❑ Innovative ❑ Other ❑ Any C AT A ]U A TIIIS IS NOT A PERMIT cousin �0_ 1L_\ CATAWBA COUNTY HEALTH DEPARTMENT �. '— � '„,„„Lc„�,�a„ Application for Environmental Services Page 2 Proposed Facility Type n Primary Residence n New Residence n Addition to Residence # of New Bedrooms *j Project Description Structure Dimensions #of Occupants Basement n Yes ❑ No Basement Fixtures ® Yes n No El Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling n Yes ❑ No Plumbing r Yes No Describe Plumbing Needed Multi-Family Residence#Units #Bedrooms per Unit*t Total#Bedrooms *1' Structure Dimensions ❑ Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift #of Shifts Dining Area (Sq. Ft.) Ti 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 n Semi-Public Well C Community Well Abandonment Type n Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested n Yes ❑ 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 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. 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 97 1 1/ / -6 // Printed Name of Owner or Agent J Catawba County Environmental Health y�ER1 Pt 'p, .32 y"r1 \\%:\ 111.98 g0 \ A0 0 \ '1.75 1 1\14.-i .... 1 cP 20.93 -- 163.04 » 0�' o cG C.3 • N� • A J J N • 95.310 83.57 0 100.E 0 100.00 �gig75.22 O a 17 • N m • .. 147.61 i Parcel: 373315627618, 3989 PLUM ST 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 07/11/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 373315627618 Owner: CONDEELIS GEORGE C • Parcel Address: 3989 PLUM ST Owner2: null City: CONOVER, 28613 Address: PO BOX 1081 LRK(REID): 900694 Address2: null Deed Book/Page: 3243/0479 City: HICKORY Subdivision: null State/Zip: NC 28603-1081 Lots/Block: 1/ null Last Sale: $108,000 on 2013-06-20 School Information: School District: NEWTON CONOVER Plat Book/Page: 38/58 Legal: LOT 1 CARLIN AC PLAT 38-58 Elementary School: SHUFORD Middle School: NEWTON CONOVER Calculated Acreage: .350 High School: NEWTON CONOVER Tax Map: null School Map Township: CLINES State Road #: 3010 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: CONOVER RURAL Zoning1: R-20 Building(s) Value: $106,600 Zoning2: null Land Value: $11,000 Zoning3: null Assessed Total Value: $117,600 Zoning Overlay: null Year Built/Remodeled: 1996/null Small Area: ST STEPHENS/OXFORD 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: 2000 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.catawbacou ntync.gov/nomap/parcel_report.php?key=373315627618&typ=P 7/11/2016 ril - CATAWBA COUNTY IMALTH DEPAR MEN Telephone (704) 465-82 TDD (704) 46S-8200 5 8 3 Improve Permit /Authorization to Construct(/Repair Permit_Oper PermitSystt�em�j-Type J kD Owner/Agent ���_�.�..1�.../ a i.- -! 1 i-'P Phone av tQ 1O 1/ Address AffI. L - s=/ SubdivisionC 1 G/c�1-0-_- Section/Block/Phase ca. Lot# to Si e.�;- '' yy Directions a»��A aL ti a i A 4„ .a �.. Facility: House f/ Mobile Home Business Other: Tax Map # ;;Ae;04/7/ ,/)-d — hu�z Multi-family Other Zoning Approval # 7 je . . # Bedrooms 3# Seats # Employees Application Rate it GPD Flow 34-0 Not Tub or Spa yes/no Special Fixtures 100% Repair Area tri o Basement yes3 Basement Plumbing yes/no Water Supply: Private Well , Public__ Type of System: Trench Bed�,c Pump A Pump/Panel . Panel LPP Other `* Tank• Size: Septic Tank Size `( O g� Pump Tank Size Nitrification Field: Total Square Feet ref° Depth of Stone Bed Size Trench Width 3/ Total Length of All Trenches l�Cp�,..2 Number of Trenches 9 �` •Individual Trench Lengthidf!%1 r�,� 75.)?/3)/3�`3 /e on Center Maximum Trench Depth r/ �l Distance of Nearest Well Of AL *DO NOT INSTALL WHEN WET* 91 Topocc % Slope Texture p Structure (2W/13 / Clay Min - -. a 1._ --L_ - - - - Soil Wetness Atif " e '• Soil Depth - , , " < I p-.1 Restric Hoz at ,; " 0,3/4 Available space ed4 noL, Overall Class SO U ,,r Comments /j�/ t7 I(� I �/ -- E o a) . trtit4 ( . ‘a. a L **NO GUARANTEE CR 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 rom date issued and is not transferable. Permit Date �—/--5 Owner/Agent," ,, AA. �.�, 1' Sanitarian `j, c-ei -> Installed By g�� �l 3IP Date `-(o --ry fu unitarian e aA _ .57 -Ji White-Office Blue-Building Inspection Operation Permit Yellow-OwnerlAgent Green-Building Inspection Authorization to Construct CATAWBA COUNTY r- g S IOOA SOUTHWEST BLVD RECEIPT NEWTON, NORTH CAROLINA 28658 r�:rmrmt "a e ►� /,C, PHONE: 828.465.8399 U 'vds� Monday, July 11, 2016 1842 sn1 www.catawbacountync.gov PAYOR: Condeelis,George PAYMENTS TRANSACTION NUMBER: TRC-728837-11-07-2016 PAYMENT DATE : 07/11/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 07-16-330297 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-07-2016-2425 8 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 3989 PLUM ST, CONOVER NC 28613 Owner GEORGE CONDEELIS, 2051 GARY LN, HICKORY NC 28602 C:828308081 I ** NO PEOPLESOPT ACCOUNT ASSIGNED ** receipt 07/11/2016 14:13 Page 1 of I