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HomeMy WebLinkAboutEHPR-07-2016-24259 (2).TIF SAY A O THIS IS NOT A PERMIT Case # EHPR-07-2016-24259 . r CATAWBA COUNTY HEALTH DEPARTMENT D r!o t U PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ti' J 84;Am Environmental Health Plan Review - Septic Malfunction po • C" y f� AUTH_CONST- SEPTIC_MALFUNCTION Contractor COOL PARK PUMPING INC (KELLY ISENHOUR), 1535 VICTORIAN HILLS CIR, CONOVER NC B:8282562926 C:8282171596 Owner AMY MCCLAIN, 6247 N NC 16 HWY, CONOVER NC 28613 C:8282448660 NAME TO APPEAR ON PERMIT Amy McClain SITE ADDRESS: 6247 N NC 16 HWY,CONOVER NC 28613 PIN # 375513141508 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 151,588.80 Acres 3.48 DIRECTIONS: Travel Hwy 16 North towards Taylorsville, Pass Springs Rd on the Left, GO Past a blue wearhouse on the Right, the next house on the Left, Red Brick house. PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Tank was pumped & she was advised that the drain field is no longer working. 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: ** NO STRUCTURE SELECTED ** FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF House, Bldg EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: House 67x36, Bldg 27x18 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION 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: 09-ehappl;caw mi 07/11/20 t6 IS:IS Page 1 of 7 Its CATAWBA COUNTY Case# EHPR-07-2016-24259 .`t A.u9� Public Health Department Subdivision 2 r���,�; Environmental Health Division PIN# 375513141508 kV.. PO Box 389. 100-A Southwest Blvd, Newton.NC 28658 1842 NAME ON PERMIT: (AMY MCCLAIN), 6247 N NC 16 HWY, CONOVER NC 28613 ( Amy McClain) Site Address: 6247 N NC 16 HWY, CONOVER NC 28613 Property Size: Square Feet 151,588.80 Acres 3.48 Directions: Travel Hwy 16 North towards Taylorsville, Pass Springs Rd on the Left, GO Past a blue wearhouse on the Right,the next house on the Left, Red Brick house. 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: r■-11-1(p Signature of Applicant or Agent Qrcn.. C(l, CIA.:. 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 lu1„ 7nr - . r I0n r.- .- - , ..i °l ftl �ul 0 11 II " hl .p 111"1' : FEENAME lig1 ` .,; fl'FE E'1,111711T01:7 MOUNT Authorization to Construct (Repair) Fee 07/11/2016 S300.00 11417:1 �' ai I Itr {N I tl il. IIt`IiNfll,G to 1��$p�i� Ii6°TOTALtFEES :! Mp a 111!:11 4„�f Iptflr t rf r!'(,; I�lifllifl, 5300 00 ,a Ldt�ll:"u�wfi�L'dut� ad.tAatluJ..JY' _....'uixL�+t u.'ImiIJ(Wui'u!IPnW,tllbllluL,ill,h.W ulw1.:1F.....rJ1,L'ku .�a_.,»i+i 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-ehappl i cation 07/11/2016 15:18 Page 2 of 7 ,,��``tt T�\ T�\ THIS IS NOT A PERMIT �1.�� CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permit❑ Authorization to Construct❑ Septic Repair❑ Septic Malfunction Septic Expansion E New Well Permit n Replacement Well ❑ Well Abandonment IT Well Repair Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility] Property Address (cQt}1-1 IJ lJC l Subdivision $ Lot# Acres Section/Block/Phase Driving Directions to Property Tf *o&JC A(Th Tck∎o s\);1le c e SS Syr∎ngs 'cd -fin' •o • • 1- _G b\u• �c ^�� .�_ cl_ht. ;k's -4,- • ho 1 on -4\- Ie4k ft1 NAME TO APPEAR ON PERMIT? XOwner U Applicant n Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name c\i,‘„i Address (� .yr1 C` l Phone Cell Phone (2,a$- t}- g(Ain Contrac sr Co to forma 'u • Name r_ 10 '∎ IC VVJ.■ _ Address Phone Cell Phone z s 1 ] r' o WHO WILL BE THE PRIMARY CONTACT? Owner E. Applicant SContractor Description of Existing Structures on Site hw3t 4- bu;14; # of Bedrooms *1' ' Structure Dimensions #of Occupants I Basement drYes ❑ No Basement Fixtures 'Yes Cl 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. D Yes CeNo Does the site contain any jurisdictional wetlands? ` Yeso Does the site contain any existing wastewater systems? C Yes PiNo Is any wastewater going to be generated on the site other than domestic sewage? Ci Yes 10/No Is the site subject to approval by any other public agency? Yes C7No Are there any easements or right of ways on this property? Describe Existing water supply in use Individual Well ❑ Community Well ❑ Semi-Public Well ❑ 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) v ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other Any cATA A THIS IS NOT A PERMIT couNry . — CATAWI3A COUNTY HEALTH DEPARTMENT • ,,e Application for Environmental Services Page 2 Proposed Facility Type I Primary Residence ❑ New Residence [ Addition to Residence # of New Bedrooms *1. Project Description Structure Dimensions # of Occupants Basement n Yes ❑ No Basement Fixtures ® Yes C2 No n Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑ Yes n No Plumbing (— Yes n No Describe Plumbing Needed 1 Multi-Family Residence#Units #Bedrooms per Unit*j 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.) 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 ❑ Individual Well In Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled n Bored ❑ Dug • • n Unknown • Well Repair Requested Ti 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. 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 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 comers and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent areTh f(Vc 04.tut Date -1-1\- I ly Printed Name of Owner or Agent lA ' M c (,\0.J ■ Catawba County Environmental Health 264.09 _ _ - - - J - x l „So co y 1 i I, _ _ - - ;� 4• lis; 58.09 '‘ C\ \\\ , 1 Parcel: 37551 31 41 508, 6247 N NC 16 HWY 1in=100ft 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: 375513141508 Owner: MCCLAIN AMY LYNN Parcel Address: 6247 N NC 16 HWY Owner2: null City: CONOVER, 28613 Address: 6235 NORTH NC HIGHWAY 16 LRK(REID): 42585 Address2: null Deed Book/Page: 2697/2000 City: CONOVER Subdivision: null State/Zip: NC 28613-7411 Lots/Block: null/ null Last Sale: School Information: School District: COUNTY Plat Book/Page: Elementary School: OXFORD Legal: 6247 N NC 16 HWY Calculated Acreage: 3.480 Middle School: RIVER BEND Tax Map: 0900 00078 High School: BUNKER HILL Township: CLINES School Map State Road #: 16 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: OXFORD Zoningl: R-20 Building(s) Value: $98,000 Zoning2: null Land Value: $26,600 Zoning3: null Assessed Total Value: $124,600 Zoning Overlay: null Year Built/Remodeled: 1964/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 #: 3710375500J Building Details 2010 Census Block: 1013 WaterShed: null 2010 Census Tract: 010201 Voter Precinct: P33 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=375513141508&typ=P 7/11/2016 p'A C' CATAWBA COUNTY I00A SOUTHWEST BLVD O Q '.y "!ti NEWTON,NORTH CAROLINA 28658 RECEIPT __iVe , PHONE: 828.465.8399 U vas-%' Monday, July 11, 2016 �84 I Z zm ++'ww.catawbacomuync.gov PAYOR: McClain, Amy PAYMENTS TRANSACTION NUMBER: TRC-729051-11-07-2016 PAYMENT DATE : 07/11/2016 PAYMENT TYPE: Check 6563 INVOICE NUMBER FEE NAME FEE AMOUNT 07-16-330305 Authorization to Construct(Repair) 5300.00 Fee TOTAL PAYMENTS : 5300.00 EHPR-07-2016-24259 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 6247 N NC 16 1-IWY, CONOVER NC 28613 Owner AMY MCCLAIN, 6247 N NC 16 HWY, CONOVER NC 28613 C:8282448660 ** NO PEOPLESOFI'ACCOUNT ASSIGNED ** Contractor COOL PARK PUMPING INC, 1535 VICTORIAN HILLS CIR, CONOVER NC 28613 B:8282562926C:8282171596 receipt 07/11/2016 15:18 Page 1 of I