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HomeMy WebLinkAboutEHPR-07-2016-24353 (2).TIF s��� • THIS IS NOTA PERMIT Case # EHPR-07-2016-24353 hT Q Ga CATAWBA COUNTY HEALTH DEPARTMENT'11171 � i f :9. PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES :i t 1842 sM Environmental Health Plan Review - Septic Malfunction D x � � AUTH_CONST - SEPTIC MALFUNCTION o � . {.o • Applicant JERRY STANLEY, 3006 JACK WHITENER RD, NEWTON NC 28658 C:8286124286 Land Owner BETH MCCASLIN, 3006 JACK WHITENER RD, NEWTON NC 28658 C:8285143025 NAME TO APPEAR ON PERMIT Jerry Stanley SITE ADDRESS: 3006 JACK WHITENER RD, NEWTON NC 28658 PIN # 364815530472 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Peet 582,832.80 Acres 13.38 DIRECTIONS: Hwy 321 Business, Left onto Prison Camp Rd, Right onto Jack Whitener Rd & go about 1 mile&the home is on the Left. House#is on the mailbox. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Tank is Collapsing & ground water is going into the tank & filling it up quickly. The drain field also does not seem to be draining properly. 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 I House, Out buildings EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: House 46x69 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 5 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: 09-ehapplicatinn 07/22/2016 15:58 Page 1 of 7 A,ysA • CATAWBA COUNTY Case# EHPR-07-2016-24353 ! n Public Health Department Subdivision !Pig Environmental Health Division PIN/i 364815530472 Al' PO Bos 389, 100-A Southwest Blvd,Newton. NC 28658 1842 et NAME ON PERMIT: (JERRY STANLEY), 3006 JACK WHITENER RD, NEWTON NC 28658 ( Jerry Stanley) Site Address: 3006 JACK WHITENER RD, NEWTON NC 28658 Property Size: Square Feet 582,832.80 Acres 13.38 Directions: Hwy 321 Business, Left onto Prison Camp Rd, Right onto Jack Whitener Rd &go about 1 mile&the home is on the Left. House#is on the 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 that a complete site evaluation can be performed. Date: 71 ,202. /!r Signature of Applicant or Agent �/ An Environmental Health Specialist will contact you within worki g da. ofidpplication date. If you need further information or assistance please call 828-466-7291 AREA1 M l I �'l1 ; E. ATLFEENV; �lLIr;1' ;.s11',11wlr � .EDA dLJFEIM i Authorization to Construct (Repair) Fee 07/22/2016 $300.00 gill ��(�i�F"y. TOTAL-FEES 6b�1''i� �1ti )lihillil���l�lii 1iiI1i : 114111'" $300 00 . "i tin to nnn„ JiIllI i r .ill — ae! FEES ARE NON—REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-ehapplication 07/22/2016 15:58 Page 2 of 7 CATAWBA -MIS IS NOT A PERMIT counry V V 1J CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permit❑ Authorization to Construct cg., Septic Repair ❑ Septic Malfunction Septic Expansion Li New Well Permit❑ Replacement Well [ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility Property Address 30560 Jo1HC it. el4,r 1U Subdivision ,(,' - 2r6 C Lot# Acres j ^3er Section/Block/Phase Driving Directions to Property / g u3T vte 5 f�,`,Sdn cat.), 04 tact/4-- h /,sCl- 4 +,-N K,Z I 6-2, 43 Ser 4.A.4.e.,,,22,--i- g-0 ¢f ,7'/ /2., to i rtl1t� Harp =5 t-hi 1P-1.+- „�� NAME TO APPEAR ON PERMIT? ❑ Owner in plicant ❑ Contractor Applicant Contact Information Name Jerry S61 �/ Address r i�IO TGGtG,t2. 4.,,,,4,,,- tee /vet,fre„v, .,OC ,2?G Phone Cell Phone Z?? - 642 . q (p Owner Contact Information Name C pp 't”) /ACC-g61-)/>1 Address P � . c !( /C J%1, .1 P/ KCL/ 71)c.A'Sl AAc, ?aScr Phone Cell Phone g -, --/[f- , ?-c Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Ownert_{'Applicant ❑ Contractor Description of Existing Structuresnon Site . Z . # of Bedrooms *t 9. Structure Dimensions 'Ybd 2$ Pt #of Occupants Basement ❑ Yes 12---No Basement Fixtures a Yes ® No 4coX The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in uestion. If the answer to any question is "yes", applicant must attach supporting documentation. D Yes o. Does the site contain any jurisdictional wetlands? i XYes 44% Does the site contain any existing wastewater systems? C Yes C'No= Is any wastewater going to be generated on the site other than domestic sewage? ® Yes SNo Is the site subject to approval by any other public agency? C Yes Z3 No Are there any easements or right of ways on this property? Describe Existing water supply in use A'Individual Well U Community Well n Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** Er 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// 0 Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other laIC cATAN m A THIS IS NOT A PERMIT • COUNTY CATAWBA COUNTY HEALTH DEPARTMENT s „a„„,a,o„;a ' Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ® Yes ® No I Accessory Structure(s) Describe #of New Bedrooms *t if applicable_ Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing E Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence#Units #Bedrooms per Unit*t 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.) _ ❑ 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 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 niay 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 corners and making the site accessible so that a complete site evaluation can be performed. Ce Signature of Owner or Agent �/Ci. Date (7, 22 Printed Name of Owner or A nt�e_rry y S1/4..n/y(/ Catawba County Environmental Health /,/o✓ o .4,./.,--- we-1-c O © cGG u/pav J !ty C C:::: le, C • ego (so, • \g's L-N,.JACk iith, E 131 RIT ,4NN \ A ... (3,„ fJ/ Bg gg° r Parcel: 364815530472, 3006 JACK WHITENER 1in=80ft RD NEWTON, 28658 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 maptreport 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 07/22/2016 d Catawba County Environmental Health \ \\_r___,,___-%1/4-'-------------- g35 7• sie , istrill .- lie \,. .‘a. Illibir _ _ , di. -11 ---a11:1. ..,, 41/ ,, i, _ r-----..... . • h rosprillio\iiiHirsiThV .....%.‘S m a itirs'' air 1/4"CCP CD SI\s\?\ , isli i "------,....,48, FilliNN 193 4 pcicYs ' ie,/„////::::: EryFR R0 6,,, ,....s- _ --a--- - ,,,‘„ AIL _...." Parcel: 364815530472, 3006 JACK WHITENER 1in=200ft RD NEWTON, 28658 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 07/22/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 364815530472 Owner: COULTER BETH MCCASLIN Parcel Address: 3006 JACK WHITENER RD Owner2: City: NEWTON, 28658 Address: 3006 JACK WHITENER RD LRK(REID): 29646 Address2: Deed Book/Page: 1659/0473 City: NEWTON Subdivision: State/Zip: NC 28658-9375 Lots/Block: / Last Sale: $50,000 on 1990-03-01 School Information: School District: COUNTY Plat Book/Page: Elementary School: MAIDEN Legal: 3006 JACK WHITENER RD1882 Calculated Acreage: 13.380 Middle School: MAIDEN Tax Map: 043N 02025A High School: MAIDEN Township: NEWTON School Map State Road #: 1882 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: MAIDEN RURAL Zoningl: R-40 Building(s) Value: $72,200 Zoning2: Land Value: $79,200 Zoning3: Assessed Total Value: $151,400 Zoning Overlay: FPM-O Year Built/Remodeled: 1920/1995 Small Area: BALLS CREEK Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710364800J Building Details 2010 Census Block: 1047 WaterShed: 2010 Census Tract: 011601 Voter Precinct: P20 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/nornap/parcel_report.php?key=364815530472&typ=P 7/22/2016 12'. ;oa - CATAWBA COUNTY HEAL ]ci3ARTMENT N° 1 6 7 5 5 Telephone: (828) 465-8270 TDD: (828)465-8200 Imp. Print. Intl-. to Cox Rpr. Print. Opr. Print. Sys. Type Well Prmt. X. Well Rpr. Prm Owner/Agent 1j.0-..._ Phone y ,Q,- COLO •Address '30a .that... (, 0-... amt Subdivision Section/Block/Phase Lot# Lot Size 99 Directions: 221 " 0 IfIS (a-�, ' '• Q ,w�c. 1,41,1,-L. �'>m O Facility: House 7 Mobile Home Business Multi-family . Other: Tax Map Pin Number 361 ` . - "01 Other . Zoning Approval #Bedrooms ' #Seats #Employees . Application Rate GPD Flow Hot Tub or Spa yes/no Special Fixtures Basement yes/no . 100% Repair A a yes/no Basement Plumbing yes/no Water Supply. Private Well Public Semi-Public_ **************iii***********************************************************************************************t********** Type of System: Trench Bed Pump Pump/Pan•1 Piet LPP Other Septic Tank Size Pump Tank Size Nit tfication F : Total Square Feet Depth of Stone Bed Size Trench Width Total ength of Alenches Number of Trenches Trench Length / / / / / Feet on Center Maum Trench Depth Distance of Nearest Well *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* *************************************************************************************************************************** Topo % Slope Texture Structure Clay Min. Soil Wetness " Soil Depth " Restric. Hoz. at " Available space yes/no TN — Overall Class S_PS.U- _ _ ,meq/ _—. _ -. — - - . _ _ .. -- Comments: � ,(�f�t�"�'" ,tet /1 O / C' 1 �' - `��I•- A�_1,/ Q0 Zit Oo 0 • cen L�� I.? VVVyyy I I CA ,t 601. -s • A: !b • I kW � _J ett* Filter Required Riser required when jade, Gjlytk a 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) five 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 known possible sources of contamination. No volume of water is guaranteed at any site bi a Health Department. �) Permit Date e • a,` c'( EHS ` Y nte->_. 17.1- Owner/Agent /� Owner/A ent ' n✓1'[' g � ��e�i1l�..- Septic Tank I Ile Q y417 Date EHS Well lnstalled_By, .,� C Well Grout Approval Date/p w_99. Well Head Approval Date P•to Sample QofJl¢ra�ted �G ' / �/ n J� Date of Results ' -T/• Results a e,�:r / It{�li - EHS �,O� .r(L l l Lt.1 ityr ..____ k rf2 White-Office Bllue-Building Inspection I.eration Perm' Yellow-Owner/Agent Green-Buil i I p ction tho za: Construct ,, p'A p CATAWBA COUNTY IOOA SOUTHWEST BLVD n' 2 NEWTON, NORTH CAROLINA 28658 RECEIPT Q 'ilea►ey PHONE: 828.465.8399 U j,vdp C Friday, July 22, 2016 1$[}2 set www.catawbacountync.gov PAYOR: Stanley, Jerry PAYMENTS TRANSACTION NUMBER: TRC-746309-22-07-2016 PAYMENT DATE : 07/22/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 07-16-330820 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-07-20 1 6-24353 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 3006 JACK WHITENER RD, NEWTON NC 28658 Applicant JERRY STANLEY, 3006 JACK WHITENER RD, NEWTON NC 28658 C:8286124286 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Land Owner BETH MCCASLIN, 3006 JACK WHITENER RD, NEWTON NC 28658 C:8285143025 • receipt 07/22/2016 15:55 Page 1 of I