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HomeMy WebLinkAboutRBPR-07-2016-24361.TIFNovember 9, 2016 Julie Caldwell 3835 Bottom Ln Claremont, NC 28610 Catawba County Public Health www.catawbacoutityiic.gov/environmentalhealth Environmental Health P.O. Box 389, 100-A South West Blvd., Newton, NC 28658 Phone (828) 465-8270. Fax (828) 465-8276 Re: Application for Improvement, Authorization to construct, and well permits for 2159 Clareview Dr, Conover: Flealth Department file number RBPR-07-2016-24361 Dear Nls. Caldwell: The Catawba County Health Department, Environmental Health Division on 8/16/16 evaluated the above referenced property at the site designated on the plat/site plan that accompanied your Il'. According to your application the site is to serve a 3 bedroom house with a design wastewater flow of 360 gallons per day. The evaluation was done in accordance with the laws and rules governing wastewater systems in North Carolina General Statute 130A-333 including related statutes and 'Title 15A, Subchapter 18A, of the North Carolina Administrative Code. Rule .1900 and related rules. Based on the criteria set out in Title 15A, Subchapter 18A, of the North Carolina Administrative Code, Rule .1940 through .1948, the evaluation indicated that the site is UNSUITABLE for a sanitary system of sewage treatment and disposal. Therefore, we must deny your request for an improvement permit. A copy of the site evaluation is enclosed. The site is unsuitable based on the following: Unsuitable soil topography and/or landscape position (Rule .1940) Unsuitable soil characteristics (structure or clay mineralogy) (Rule .1941) X Unsuitable soil wetness condition (Rule .1942) X_ Unsuitable soil depth (Rule .1943) Presence of restrictive horizon (Rule .1944) X Insufficient space for septic system and repair arca (Rule .1945) X Unsuitable for meeting required setbacks (Rule .1950) Other (Rule .1946) These severe soil or site limitations could cause premature system failure, leading to the discharge of untreated sewage on the ground surface, into surface waters, directly to ground water or inside your structure. The site evaluation included consideration of possible site modifications, as well as use of modified, innovative, or alternative systems. however, the Health Department has determined that none of the above options will overcome the severe conditions on this site. A possible option might be a system designed to dispose of sewage to another area of suitable soil or off-site to additional property. For the reasons set out above, the property is currently classified UNSUITABLE, and no improvement "Leading the Way to a Healthier Community" Q�UOtieWIih permit shall be issued for this site in accordance with Rule .1948(c). Note that a site classified as UNSUITABLE may be classified as PROVISIONALLY SUITABLE if written documentation is provided that meets the requirements of Rule .1948(d). A copy of this rule is enclosed. You may hire a consultant to assist you if you wish to try to develop a plan under which your site could be reclassilled as PROVISIONALLY SUITABLE. )'on have a tight to an h?1brnud reriew of this decision. You may request an informal review by the soil scientist or environmental health supervisor at the local health department. You may also request an informal review by the North Carolina Department of I-lealth and Human Services regional soil scientist. A request for informal review must be made in writing to the local health department. You also hire a right too formal appeal of dais decision. 'fo pursue a formal appeal, you must file a petition for a contested case hearing with the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC 27699-6714. To gel a copy of a petition form, you may write the Office of Administrative Hearings or call the office at (919) 431-3000 or download it from the OAH web site at htto://www.ncoah.com/forms.html . The petition for a contested case hearing must be filed in accordance with the provision of North Carolina General Statutes 130A-24 and 15OB-23 and all other applicable provisions ol'Chapter 150B. N.C. General Statute 130A-335 (g) provides that your hearing would be held in the county where your property is located. Please note: If you wish to pursue a formal appeal, you most file the petition form with the Office of Administrative Hearings WITHIN 30 DAYS OF THE DATE OF THIS LETTER. The date of this letter is November 1, 2016. Meeting the 30 day deadline is critical to your formal appeal. If you file a petition for a contested case hearing with the Office of Administrative Hearings, you are required by law (N.C. General Statute 15013-23) to serve a copy of your petition on the Office of General Counsel, N.C. Department of Health and Human Services, 2001 Mail Service Center, Raleigh, N.C. 27699-200). Leo not serve the petition on yoia- local hecrltli cleparttnent. Sending a copy of your petition to the local health department will not satisfy the legal requirement in N.C. General Statute 15013-23 that you send a copy to the Office of General Counsel, N. C. Department of Health and Human Services. You may call or write the local health department if you need any additional information or assistance. Sincerely, Steven Price, REHS Environmental Health Specialist Enclosures: Site Evaluation Copy of Rule .1948 U.S. Postal Serviee,h� • � � MAIL,,. Ri=�E�[',; Domestic Mail Onl • No Insurance✓era a Provided I[FO,rdelvery m ormet on v sit, _ om,t IIMMM Postage I $ Certified Fee I Return Receipt Fee (Endorsement Requued) Restricted Delivery Fee (Endorsement Required) 0 Total Postage & Fees 1 S'enr ro KIiYK-0%-20.16-24 Siieei, Apr"No.; -----------:1 n lic -CV-aidwel--------------------------------- or PO Box No. clry'siaie,-zfa:a ---------3835 -Bottom. L,n---------------------------- Claremont. NC 28610 IfS9f3rnLrrrkfiwml g.ln .. aftritara a.ngaxmditncal Certified Mail Provides: o A mailing receipt o A unique identifier for your mailpiece c A record of delivery kept by the Postal Service for two years Important Reminders; o Certified Mail may ONLY be combined with First -Class Mail® or Priority Mail® o Certified Mail is not available for any class of international man. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables, please consider Insured or Registered Mail. o For an additional fee, a Return Receipt may be requested toprovide proof of delivery To obtaln Return Receipt service, please complete and attach a Return Receipt (PS Form 3811) to the article and add applicable postage to cover the tee Endorse mailpiece "Return Receipt Requested' To receive a fee waiver for a duplicate return receipt, a USPS® postmark on your Certified Mail receipt is required. n For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent. Advise the clerk or mark the madpiece with the endorsement 'Restricted Delivery' o If a postmark on the Certified Mail receipt is desired, please present the arti. cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed, detach and affix label with postage and mail. IMPORTANT: Save this receipt and present it when making an inquiry. PS Form 3800. August 2006 (Reverse) PSN 7530-02-000-9047 "i'A'' cfidf:ff ■ Complete items 1, 2, and 3. A. Sign tur / ■ Print your name and address on the reverse X 10:1(t&Agent so that we can return the card to you. ( _ Addressee ■ Attach this card to the back of the mailpiece, B. ReFei ved by (Pdrited�Name) C ate f Delivery _ or on the front if space permits. �L� � � C Lq �p� LiJ? I I �— 5')k0 1. Article Addressed to: D. Is delivery address different from item 17 0 Yes If YES, enter delivery address below: ❑ No c Ju1k-,Waldwcl 38351uottom Ln Claremont, NC 28610 IIIIIIIII IIIII IIIII III 1111111111 IIIII 1111111 1111111 9590 9403 0368 5163 8849 91 _9_AAirla Numher(Transfer from $erylce label) 7008 1830 0004 6921 9075 PS Form 3811, April 2015 PSN 7530-02-000-9053 3. Service Type ❑ Adult Signature D Adult Signature Restricted Delivery 2a'Certif,ed Mei® ❑ Certlhed Mail Restricted Delivery ❑ Collect on Delivery I Collect on Delivery Restricted Delivery =';ured Mai `.ured Mail Restricted Delivery ert5001 •a'r, ❑ Priority Mall Express® ❑ Registered Mail'"' D Registered Mail ResMctec Delivery ❑ Return Receipt for Merchandise ❑ Signature Confirm onTM ❑ Signature Confirmation Restricted Delivery Domestic Return Receipt UNITED STATES POSTAL SERVICE I I I II I First -Class Mail Postage 6 Fees Paid USPS RBPR 07 2016 24361 Permit No. c -to • Sender: Please print your name, address, and ZIP+4® in this box* Steven Price, REHS Catawba County Environmental Health iiQf9�i119Rex 590 9403 0368 5163 8849 91 iiuiiiiid�wii RECEIVED NOV 17 2016 .A;: „Ur .-v"IVTY _J\!VTF,r'uV1"'FNTAL HEALTH November 1, 2016 Julie Caldwell 3498 Bethany Church Rd Newton, NC 28658 Catawba County Public Health www.catawbacountync.gov/environmentalhealth Environmental Health P.O. Box 389, 100-A South West Blvd., Newton, NC 28658 Phone (828) 465-8270. Fax (828) 465-8276 Re: Application for Improvement, Authorization to construct, and well permits for 2159 Clareview Dr, Conover; Health Department file number RBPR-07-2016-24361 Dear Ms. Caldwell: The Catawba County Health Department, Environmental Health Division on 8/16/16 evaluated the above referenced property at the site designated on the plat/site plan that accompanied your IP. According to your application the site is to serve a 3 bedroom house with a design wastewater flow of 360 gallons per day. The evaluation was done in accordance with the laws and rules governing wastewater systems in North Carolina General Statute 130A-333 including related statutes and Title 15A, Subchapter 18A, of the North Carolina Administrative Code, Rule .1900 and related rules. Based on the criteria set out in Title 15A, Subchapter 18A, of the North Carolina Administrative Code, Rule .1940 through .1948, the evaluation indicated that the site is UNSUITABLE for a sanitary system of sewage treatment and disposal. Therefore, we must deny your request for an improvement permit. A copy of the site evaluation is enclosed. The site is unsuitable based on the following: Unsuitable soil topography and/or landscape position (Rule .1940) Unsuitable soil characteristics (structure or clay mineralogy) (Rule .1941) X Unsuitable soil wetness condition (Rule .1942) X Unsuitable soil depth (Rule .1943) Presence of restrictive horizon (Rule .1944) X Insufficient space for septic system and repair area (Rule .1945) X Unsuitable for meeting required setbacks (Rule .1950) Other (Rule .1946) These severe soil or site limitations could cause premature system failure, leading to the discharge of untreated sewage on the ground surface, into surface waters, directly to ground water or inside your structure. The site evaluation included consideration of possible site modifications, as well as use of modified, innovative, or alternative systems. However, the Health Department has determined that none of the above options will overcome the severe conditions on this site. A possible option might be a system designed to dispose of sewage to another area of suitable soil or off-site to additional property. For the reasons set out above, the property is currently classified UNSUITABLE, and no improvement U �[Pj'�fj�} ['}t �f}j��, 'Leading the Way to a Healthier Community" �Z [P U 4Y/ � W J OptNCAHOV._ UO lth permit shall be issued for this site in accordance with Rule .1948(c). Note that a site classified as UNSUITABLE may be classified as PROVISIONALLY SUITABLE if written documentation is provided that meets the requirements of Rule .1948(d). A copy of this rule is enclosed. You may hire a consultant to assist you if you wish to try to develop a plan under which your site could be reclassified as PROVISIONALLY SUITABLE. You have a fight to an informal review of this decision. You may request an informal review by the soil scientist or environmental health supervisor at the local health department. You may also request an informal review by the North Carolina Department of Health and Human Services regional soil scientist. A request for informal review must be made in writing to the local health department. You also have a right to a formal appeal of this decision. To pursue a formal appeal, you must file a petition for a contested case hearing with the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC 27699-6714. To get a copy of a petition form, you may write the Office of Administrative Hearings or call the office at (919) 431-3000 or download it from the OAH web site at htti)://www.ncoah.com/fomis.html . The petition for a contested case hearing must be filed in accordance with the provision of North Carolina General Statutes 130A-24 and 150B-23 and all other applicable provisions of Chapter 150B. N.C. General Statute 130A-335 (g) provides that your hearing would be held in the county where your property is located. Please note: If you wish to pursue a formal appeal, you must file the petition form with the Office of Administrative Hearings WITHIN 30 DAYS OF THE DATE OF THIS LETTER. The date of this letter is November 1, 2016. Meeting the 30 day deadline is critical to your formal appeal. If you file a petition for a contested case hearing with the Office of Administrative Hearings, you are required by law (N.C. General Statute 15013-23) to serve a copy of your petition on the Office of General Counsel, N.C. Department of Health and Human Services, 2001 Mail Service Center, Raleigh, N.C. 27699-2001. Do not serve the petition on your local health department. Sending a copy of your petition to the local health department will not satisfy the legal requirement in N.C. General Statute 150B-23 that you send a copy to the Office of General Counsel, N. C. Department of Health and Human Services. You may call or write the local health department if you need any additional information or assistance. Sincerely, Steven Price, REHS Environmental Health Specialist Enclosures: Site Evaluation Copy of Rule .1948 QOAm i �� o . m uW�ag `�� B 8'A'MatJ''"E .NJ IrPostage $ i C, Z S S0.)' D Certified Fee •. I '-�% .y Postmark C3 Return Receipt Fee I I �l Herat ^Q^ C3 (Endorsement Required) �v O Restricted Delivery Fee C3 (Endorsement "'AZil d) yam_ J m �O Total Postage & Fees I ,$ rR Sent to KIS 1't<-V /-LII 1 b-G4 5b 1 .:...... .....:Fufic•Catdireft....--...............------•--- rervoea.Na. ......... 34MBethan..•Church-Rd.......... Cary, state, ZIPt•0 Newton. NC 28658 Ir-�ai�rt:,,sT:rT��r.,rmcrrT� �aiarrnn,arortanmxa Certified Mail Provides: o A mailing receipt RECEIVED o A unique identifier for your mailpiece n A record of delivery kept by the Postal Service for two years Important Reminders: � � o � � o ' 6 o Certified Mail may ONLY be combined with First-Claasls Maile or Priority Malls, o Certified Mail is not available to §, `�, o irgp t' bail. o NO INSURANCE COVERAG�h$� RC7dAm5(VtH'Certified Mail. For valuables, please consideEj(4VjR0ifd BNTA&1H EALTH o For an additional fee, a Return Receipt may be requested toprovide proof of tlelivery. To obtain Return Receipt service, please complete and attach a Return Receipt (PS Form 3811) to the article and add applicable postage to cover the fee. Endorse mailpiece "Return Receipt Requested'. To receive a fee waiver for a duplicate return receipt, a USPS® postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent. Advise the clerk or mark the mailpiece with the endorsement 'Restricted Delivery' o If a postmark on the Certified Mail receipt is desired, please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed, detach and affix label with postage and mail. IMPORTANT: Save this receipt and present it when making an inquiry. PS Form 3800, August 2006 (Reverse) PSN 7530-024W 9047 CATAWBA (-A7AW13A COUNTY PUBLIC HEALTH t-Imfonmct)tal Heath P() Box 184 Newton, North Carolina 18058 X1:93270201274644 l tiv �t s14 l� �iSt� J Julie Caldwell 3498 Betharni Church Rd Newton, NC NIXIE 274 5E 1 00111/06%16 RETURN TO SENDER No SUCH NUMEER '.!NA3L= TO FORWARD NSN 3C: 23653038989 *0580-09763-03-37 ���:=fir i1�,,111,111111i��iiliii,ll�llf�lllll'1„1„IE�II„f,,,,li�,111„ iWW', 011 1111. W, 111111.1t ■ Complete items 1, 2, and 3. Also complete A. Signature item 4 if Restricted Delivery is desired. X 0 Agent m Print your name and address on the reverse 0 Addressee so that we can return the card to you. B. Received by (Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. I I D. Is delivery address different from dem 19 0 Yes 1. Article Addressed to: If YES, enter delivery address below: 0 No Julie Caldwell 3498 Bethany Church Rd Newton, NC 286;8 2. Article Number (Transfer from service taboo PS Form 3811, July 2013 3. Se ice Type CertPied Mail° 0 Priority Mail Express' 0 Registered 0 Return Receipt for Merchandise 0 Insured Mail 0 Collect on Delivery _ 4. Restricted Delivery? (Extra Fee) 0 Yes 7008 1830 0004-6921-9020 I Domestic Return Receipt CATA"A CATAWBA COUNTY PUBLIC HEALTH 1Or"' Em,ronmartnl Health PO Box 3S9 Newton, North Carolina 2S658 0 N ^', US POSTAGE/) PITNEY BOWES W J C, I✓yo $000.45 2 02 02 IVY a LL 0001313 91273 Julie Caldwell �J 3498 Betham, rhl,rch Rd Newton, NC NZXT. E 274 DE 1081 0011106/16 2AC5e- RETURN TO SENDER NO SUCH N:,M6ER UNABLE TO FORWARD N1:93270201274644 NSN SC: 28658038989 *0948-03575-03-44 -1 '..2.8.65.:.x_ 1C'1't11(t lil1:1111' 1'{{111(„I{Il,.yll"l{'41i• :31 " i•1 rI` .. i, .... _^.. L -w Catawba County Environmental Health a0a, b7- z°IL' z"Jc/ 290.1 0 Parcel: 375116749734, 2159 CLAREVIEW DR CONOVER, 28613 (20 Ca) Cl, 1 in=60ft �r 7 P' 8l' PZ i8o, zctr , This map/report product was prepared from the Catawba County, INC 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 DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF PUBLIC HEALTH, ENVIRONMENTAL HEALTH SECTION Q ��� p7- Zoll - 2 Y 36 / ON-SITE WATER PROTECTION BRANCH SOILISITE EVALUATION for ON-SITE WASTEWATER SYSTEM (Complete all fields in full) Sheet PROPERTY ID #: COUNTY: Catawba OWNER: .� k�,e C'� (�I,,,t�,{ APPLICATION DATE ADDRESS: DATE EVALUATED: _ 8 PROPOSED FACILITY: .3 dr PROPOSED DESIGN FLOW (.1949): g G o PROPERTY SIZE: LOCATION OF SITE: 'Z ISS C PROPERTY RECORDED: WATER SUPPLY: ❑ Private ❑ Public g Well ❑ Spring ❑ Other EVALUATION METHOD: ❑ Au*er Boring 2LPit ❑ Cut TYPE OF WASTEWATER: XSewage ❑ Industrial Process ❑ Mixed P R SOIL MORPHOLOGY OTHER M (.1941) PROFILE FACTORS 1 .1940 L LANDSCAPE HORIZON POSITION/ DEPTH .1942 PROFILE # SLOPE % (]IN.) CLASS b- Li sok c F& St:- 97 0 PS S 2i-37 wf4k GC J� se- y.ct,., ,.. , y0(� 1-14 Al* 3 l 37- qj wS6lc ec. Fe Jr ../ l,ytl DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS (.1946): Available Space (.1945) I,(N SITE CLASSIFICATION (.1948): (4 Al u� EVALUATED BY: �^- ��-- System Type(s) - OTFIER(S) PRESENT: Site LTAR _ COMMENTS: tv H a/� �lK.c ---- dry f(_ -'�- &4.6c-- .1941 .1941 SOIL •1943 .1956 .1944 STRUCTURE/ CONSISTENCE/ WETNESS/ SOIL SAPRO RESTR & LTAR TEX'T'URE MINERALOGY COLOR DEPTH CLASS HORIZ 0-Y G,e S FVe se- /o"34 61 A A14 Ltej Fr v -!o s6� s� lu sE 1 1 10 lg /r4k L F1 S,— lvyrL�/t is -36 hd sL F4 s6 ' dE SCIL ArL, se' / yt� ry-gyp &6k- se- )-I sc I010 7/"ft 2 s� A ­6 k -SG F/ /6 It b- Li sok c F& St:- 97 0 PS S 2i-37 wf4k GC J� se- y.ct,., ,.. , y0(� 1-14 Al* 3 l 37- qj wS6lc ec. Fe Jr ../ l,ytl DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS (.1946): Available Space (.1945) I,(N SITE CLASSIFICATION (.1948): (4 Al u� EVALUATED BY: �^- ��-- System Type(s) - OTFIER(S) PRESENT: Site LTAR _ COMMENTS: tv H a/� �lK.c ---- dry f(_ -'�- &4.6c-- 15A NCAC 18A.1948 STTECLASSIFICATION (a) Sites classified as SUITABLE may be utilized fora ground absorption sewage treatment and disposal system consistent with these Rules. A suitable classification generally indicates soil and site conditions favorable forthe operation ofa ground absorption sewage treatment and disposal system or have slight limitations that are readily overcome by proper designand installation. (b) Sites classified as PROVISIONALLY SUITABLE may be utilized for a ground abs orption sewage treatment and disposal system consistent with these Rules but have moderate limitations. Sites classified Provisionally Suitable require some modifications and careful planning, design, and installation in order for a ground absorption sewage treatment and disposal systemto function satisfactorily. (c) Sites classified UNSUITABLE have severe lunitations for the installation and use of a properly functioning ground absorption sewage treatment and disposal system. An improvement pen -nit shall not be issued for a site whichi classified as UNSUITABLE. However, where a site is UNSUITABLE, it may be reclassified PROVISIONALLY SUITABLE if a special investigation indicates that a modified or alternative system can be installed in accordance with Rules .1956 or .1957 of this Section. (d) A site classified as UNSUITABLE may be used for a ground absorption sewage treatment and disposalsystems pecifically identified in Rules .1955, .1956, or .1957 of this Section or a system approved under Rule .1969 if written documentation, including engineering, hydrogeologic, geologic or soil studies, indicates to the local health department that the proposed system can be expected to function satisfactorily. Such sites shall be reclassified as PROVISIONALLY SUTTABLEifthelocal health department determines that the substantiating data indicate that: (1) a ground absorption system can be installed so that the effluent will be non-pathogenic, non-infectious, non-toxic, and non -hazardous; (2) the effluent will not contaminate groundwater or surface water; and (3) the effluent will not be exposed on the ground surface or be discharged to surface waters where it could come in contact with people, animals, or vectors. The State shall review the substantiating data if requested by the local health department. History Note: Authority G.S. 130A -335(e); Eff. July 1, 1982; Amended Eff. April 1, 1993; January 1, 1990. Applicant Land Owner Owner THIS IS NOTA PERMIT Case # RBPR-07-2016-24361 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Modular IMPROVEMENT - AUTH CONST - NEW WELL *CLAYTON HOMES # 81 /CMH INC (UNLICENSED), 1230 CONOVER BLVD, CONOVER NC 286 6:828-465-3450F:828-464-0261 JWHOLDERaHOTMAIL.COM ROCKY CALDWELL, 9400 US 192, CLERMONT NC 34714 JULIE CALDWELL, 3498 BETHANY CHURCH RD, NEWTON NC 28658 08283341904 Paid By CLAYTON HOMES (BOBBI *LASAGE), PO BOX 132, TAYLORSVILLE NC 28681 C.8282173168 JWHOLDER@HOTMAIL.COM NAME TO APPEAR ON PERMIT Julie Caldwell SITE ADDRESS: 2159 CLAREVIEW DR, CONOVER NC 28613 PIN # 375116749734 NAME of SUBDIVISION: Lot 4 7B Section/Block PROPERTISIZE: Square Feet Acres 2.06 DIRECTIONS: 321 N / to E 20th St to S Mchn Creek Rd / to right onto Emmanual Church Rd / left Keister Rd SE / once on Keister Rd SE left onto Clareview Rd / #2159 at end on left PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY : Private Well DESCRIBE WORK: new modular dwelling 28 x 52 w/ 6x6 front & rear deck 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? No 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? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: STRUCTURE TYPE: FACILITY TYPE: Single Family Residence DESCRIPTION OF vacant EXISTING STRUCTURES ON SITE (IF ANY DIM EXISTING STRUCTURE: New Structure PRIMARY RESIDENCE OTHER DESCRIPTION: NUMBER OF EXISTING BEDROOMS: # OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 28 x 52 w/6x6 front & rear deck # OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Yes Desired system types (Improvement Permit or Authorization to Construct). ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER INNOVATIVE: ANY: Other described. APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO E9 - ehapph„ation 07/25/2016 16 05 Page I of 4 �yzA CATAWBA COUNTY Case a RBPR-07-2016-24361 Public I Iealth Department Subdn ision Environmental Iicalth Division PIN4 375116749734 + PO Bos 389, 100-A Southwest Blvd, Newton. NC 28658 NAME ON PERMIT: (JULIE CALDWELL), 3498 BETHANY CHURCH RD, NEWTON NC 28658 (Julie Caldwell) Site Address: 2159 CLAREVIEW DR, CONOVER NC 28613 Property Size: Square Feet Acres 2 06 Directions: 321 N / to E 20th St to S Mclin Creek Rd / to right onto Emmanual Church Rd / left Keister Rd SE / once on Keister Rd SE left onto Clareview Rd / #2159 at end on left 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 an e{m�, all property lines and corners and making the site acres le so he a co i plate site evaluation can be performed Date: Signature of Applicant or Agent An Environmental Health Specialist will contact you within 5 working days of appliate. If you need further infonnation or assistance please call 828-466-7291 AREA2 FEENAME FEE AMOUNT Improvement Permit Fee _DATE 07/25/2016 $150.00 Well Permit & Inspection Fee 07/25/2016 $300.00 Authorization to Construct Fee (New/Expansion) 07/25/2016 $150.00 Fee TOTAL FEES 5600.00 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 - ehapplrcatmn 07/25/2016 16 05 Page 2 of 4 CATAV j� j� Tans IS NOT A PERMIT 0 (� j �cov�rt 1 r ��` A CATAWBA COUNTY HEALTH DEPARTMENT Application for Uhvironmental Services Page 1 Improvement Permit Authorization to Const vcX Septic Repair El Septic Malfunction ❑ Septic Expansion b New Well Permit Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre -Approval Required) ❑ Applicatiap Is for %v nstruction (` Existing Facility ❑ PropertyAddrers._C25 LII tI-'(,ii D9. ///Subdivision �Aar r3- Lot # Acres Section/Block/Phase Driving erty t:ons to Trop l��'�° F• ?r�tC I� .t� ' 1 7D NA.?VEE'fO APPE?AR ON PERNIIT? (k0 ner ❑ Applicant ❑ Contractor- ^A Applicant Contact Information 'Name -[avf7V,1 ANV-10-255 #R1 Address � I JNI).l 03 Phone Owner Contact Information Name 6Q (_►! �AUjc-/ Ad � 10 Adress (f $ ( �t S Phone Contractor Contact Information Name f Address Phone WI'IO WILL, BE THE PRIMARY CONTACT? ❑ Owner Description of Existing Structures on Site _ # of Bedrooms *f Structure Dimensions Basement ❑ Yes ❑ No Basement Fixtures Q Yes � b215`30� CellPhone Cell Phone, 33e{ 1 gpt_f Cell Phone [Applicant 1�IM ❑ Contractor ii of Occupants The Applicant shall notiA, the local health department upon submittal of this application if any of the following apply to the property in question. l l'the answer to any question is "yes", applicant must attach supporting documentation. 11 Yes No Does the site contain any jurisdictional wetlands'? 0 Yes No Does the site contain any existing wastewater systems? Q Yes o Is any wastewater going to be generated on the site other than domestic sewage? XYes o Is the site subject to approval by any other public agency? a Yes Na Are there any easements or right of ways on this property? Describe Existrg pp } ' r❑n County/Citv(Townshi tcr viduat Well El Corn munity Well ❑ Semi -Public Well p Line Is a public water supply available? ** ❑ Yes )eNo If applying for an Improvement Permit or Authorization to Construct, Please Indicate Desired Systens Type($): (systems can be ranked in order of your preference) 0 Accepted 0 alternative 0 Conventional 0 Innovative 0 Other � Any ,fit AWBTHIS IS NOTA YERIvI1'f CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page % Proposed Facility Type p 1( ❑ Primary Residence )� New Residence ❑ Addition to Residence # of New Bedrooms *j' 3_-_ Project Description, , / R n ��cZ �_J U✓`o Structure Dimensions�I,i_ -- # of Occupants 3 Basement ❑ Yes Z] No Basement Fixtures 0. Yes P�No ❑ Accessory Structure(s) Describe # of New Bedrooms *j' if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed [—I' 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 During 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 Cons ruction/Abandonment/Repair Proposed Well Type Individual Well ❑ Semi -Public Well E]Community Well Abandonment Type Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ No Describe Calculated Design Flow, Commercial f 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 firture 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. ** ]fNo, a well permit must be issued with the Authorization to Construct. SYSTEM REDESIGN AND/OR RE, TRIP 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 idend 6cation 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 VZ1410 Printed Name of Owner or Agent G.� Parcel Report Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 375116749734 Owner: CALDWELL ROCKY L Parcel Address: 2159 CLAREVIEW DR Owner2: City: CONOVER, 28613 Address: 9400 US 192 LRK(REID): 38490 Address2: Deed Book/Page: 3280/0350 City: CLERMONT Subdivision: State/Zip: FL 34714-0000 Lots/Block: 7B/ Agricultural District: Parcel Report Data Descriptions School Information: Last Sale: Assessment Report School District: COUNTY Plat Book/Page: 25/137 Elementary School: CLAREMONT Legal: LOT 76 PLAT 25-137 Middle School: RIVER BEND Calculated Acreage: 2.060 High School: BUNKER HILL Tax Map: 074N 01010F School Map Township: NEWTON State Road #: Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: CLAREMONT County Fire District: CLAREMONT RURAL Zoningl: R-2 Buildings) Value: $0 Zoning2: Land Value: $15,700 Zoning3: Assessed Total Value: $15,700 Zoning Overlay: Year Built/Remodeled: / Small Area: Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710375100J Building Details 2010 Census Block: 1039 Watershed: WS -IV Protected Area 2010 Census Tract: 011401 Voter Precinct: P22 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report Page 1 of 1 This map/repos product was prepared from the Catawba County, INC 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 veM,cahon of any data contained on this map/report product by the user. The County of Catawba, ds 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 anse from this map/repos product or the use thereof by any person or entity © 2016, Catawbp County Government, North C LOX o arolina. All rights reserved. http://gis.catawbacountync.gov/nomaplparcel_report.php?key=375116749734&typ=P 7/22/2016 Catawba County Environmental Health 290.1 _ Std J 9� a 383.2 65. - Parcel: 375116749734, 2159 CLAREVIEW DR CONOVER, 28613 120 1 in=60ft This map/report product was prepared from the Catawba County, NC Geospallal 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 .,, N 290.1 _ Std J 9� a 383.2 65. - Parcel: 375116749734, 2159 CLAREVIEW DR CONOVER, 28613 120 1 in=60ft This map/report product was prepared from the Catawba County, NC Geospallal 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