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HomeMy WebLinkAboutEHPR-07-2016-24399 (2).TIF \\3A •G THIS IS NOT A PERMIT Case # EHPR-07-2016-24399 '`-ILI:� CATAWBA COUNTY HEALTH DEPARTMENT EF"1 P •E1 std'!' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 4ti 842 5M Environmental Health Plan Review - Septic Malfunction 3 i3.11 AUTH CONST - SEPTIC_MALFUNCTION r'' ell 16~I•1: r ,. Owner JAMES& ELIZABETH CHRISTOPHER, 9488 WESTRIDGE DR, HICKORY NC 28601 C:8283278506 NAME TO APPEAR ON PERMIT James & Elizabeth Christopher SITE ADDRESS: 1727 31ST ST NE, HICKORY NC 28601 PIN # 372311552316 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 14,810.40Acres 0.34 DIRECTIONS: Springs Road to Crestmont Development, Right at the Stop light into Crestmont, 1st LER onto 19th Ave &go to the bottom of the hill, Right onto 31st St NE, go to the end of the road, House is on the Right with Remax For Sale sign in yard. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Public Water DESCRIBE WORK: Tank Only Replacement* Required for the sale of the home. 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: 48x40 NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 1 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: 139-elmpplication 07/29/2016 11:36 Page 1 of 8 ���A • CATAWBA COUNTY Case# EHPR-07-2016-24399 /T P+? 'n y Public Health Department Subdivision 4 Thai �I Environmental Health Division PINK 372311552316�' l• PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 1842 "' NAME ON PERMIT: (JAMES& ELIZABETH CHRISTOPHER), 9488 WESTRIDGE DR, HICKORY NC 28601 ( James & Elizabeth Christopher) Site Address: 1727 31ST ST NE, HICKORY NC 28601 Property Size: Square Feet 14,810.40 Acres 0.34 Directions: Springs Road to Crestmont Development, Right at the Stop light into Crestmont, 1st LER onto 19th Ave &go to the bottom of the hill, Right onto 31st St NE, go to the end of the road, House is on the Right with Remax For Sale sign in yard. 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 e aluatioonn can be performed. Date: '7- ' Q - 3' /& Signature of Applicant or Agentc67%y C /,-9, An Environmental Health Specialist will contact you within 5 4orking days of application date. If you need further information or assistance please call 828-466-7291 AREA2 . AI , jlltlls ' nIIJ �illlF " l „ FT!!1ii FEENMEIiluw,iuWgtIlssIIIIINk,: . .,,- ,iD TE:li !r i iEE AMOUNT _._ Authorization to Construct (Repair) Fee 07/29/2016 $150.00 F. gyp; • a l n v": �' ! �11 r ( hTOTAG F ES�hllir narp 1 "94.040�I 1 Ihi(L I iJ,,..4. I $150 OOi lh,1l1llllli�l�It. � { 1'11,-.:_, ! III IIJ,�i uldW,IIIiii+'' flV;141111:1L:11ki::_....cei4u:L liIIIMW '�_Iiiiit IIU 'Ztw uaii-21".. 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-ehapplicalion 07/29/2016 11:37 Page 2 of 8 Catawba County Environmental Health t M-. -‘ `'- ____,,,..L 150 150 4 • • a ° 0 0 .._ ,_. � � 0 ,_ • ,_ ,, I 2 .. 150 f— O 150 1 1 _ II . ill - co tiOI ..., O O ""... "."•- • 15015,. 150 cog N O ' 1111111 32.75 7$1.42 1b7 8 _ 30 Parcel: 372311552316, 1727 31ST ST NE 1in=50ft HICKORY, 28601 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 07/29/2016 CATAWBA THIS IS NOT A PERMIT cooun L ,� LLQ, CATAWBA COUNTY HEALTH DEPARTMENT Application for .nviSonmeeQnnttallSServices Page 1 Improvement Permit❑ Authorizationjjtto Constrbct ❑ Septic Repair❑ Septic Malfunction Lrt 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 1'la 7 31 S4- N E Subdivision 1,j0p12-tx `rye\C .2`SLa) I Lot# Acres ya0C r Section/Block/Phase- Driving Directions to Property ,7i D own ,�p/)s-ri j4 Pvace_ -tai ( ITrnu,t7 b eua..Lcpynm,--t i , i • i.... � f� � _ ... i � ice '__ � ,. v_�. ..r_ . . • A4- .. Qlf t} ue d- 4-0 130 trowi /I I/ -r /lice_ 11 n }v f h-e eAn 4 t), A d. -tic, A,. \21-0-,32- - NAME TO APPEAR ON PERMIT? ner ❑ Applicant ❑ Contractor -/-ha_. AA-;,1 Jut JAL,- Applicant j `L2Applicant Contact Information I a i— SA 1 a S. 9 rt e_, ,n-, nxfa , nthi 544,C1 Name Address Phone Cell Phone a/Owner Contact Information Named ,mss t u W ;fe 1= L. LA 13-e-11,- l3 (? 0-.t p LZ Address 9 _f gg 0us_i_ei,di.Q p2,' 'e ILl;c-Kur-f /UC ,D_.RLeo I Phone Dg _ 3_ 1- cw So L. Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site ll,,�,4 # of Bedrooms *�' ta Structure Dimensionss�C}^ #of Occupants 0 IXe t Basement [i tYes 5 No Basement Fixtures ® Yes 'R'fVo 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. 10 Yes 0 No Does the site contain any jurisdictional wetlands? ® Yes ® No Does the site contain any existing wastewater systems? 0 Yes ® No Is any wastewater going to be generated on the site other than domestic sewage? El Yes ®No Is the site subject to approval by any other public agency? 0 Yes ®No Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well E Community Well 5 Semi-Public Well Fr County/City/Township Water Line Is a public water supply available? ** IPYYes ❑ 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) 0 Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other B1 Any C ATAwQ A17C� THIS IS NOT A PERMIT couN __ CATAWBA COUNTY HEALTH DEPARTMENT «o.n,� Application for Environmental Services Page 2 Proposed Facility Type D Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *jj Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ® Yes ® No n Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing E Yes n No Describe Plumbing Needed ❑ 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 n Other Facility Type Specify If Church # of Seats Kitchen In Yes n No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type n Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled n Bored ❑ Dug n Unknown Well Repair Requested n Yes n 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. 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 ;(. (L�' z a. i l�e�• A ` i g2��at 16 C!%& >t- i3. c /�V Printed Name of Owner or Agen S p,m N c .r q. F/ ;t•A h t th. 1-3 -' A r`i s*pks-h--, Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 372311552316 Owner: CHRISTOPHER JAMES EUGENE Parcel Address: 1727 31ST ST NE Owner2: CHRISTOPHER ELIZABETH B City: HICKORY, 28601 Address: 9488 WESTRIDGE DR LRK(REID): 54387 Address2: Deed Book/Page: 1568/0672 City: HICKORY Subdivision: State/Zip: NC 28601-9503 Lots/Block: / Last Sale: School Information: School District: COUNTY Plat Book/Page: Legal: 1727 31ST ST NE Elementary School: WEBB A MURRAY Middle School: ARNDT Calculated Acreage: .340 Tax Map: 159H 10004 High School: ST STEPHENS Township: HICKORY School Map State Road #: 1542 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: HICKORY County Fire District: ST STEPHENS Zoning!: R-1 Building(s) Value: $68,300 Zoning2: Land Value: $10,800 Zoning3: Assessed Total Value: $79,100 Zoning Overlay: Year Built/Remodeled: 1959/ 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 #: 3710372300J Building Details 2010 Census Block: 2029 WaterShed: 2010 Census Tract: 010303 Voter Precinct: P28 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 Seryices.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.php7key3723 11552316&typ=P 7/29/2016 p'A Z CATAWBA COUNTY r77Cty \\ IOOA SOUTHWEST BLVD d m_ NEWTON, NORTH CAROLINA 28658 RECEIPT ::<" y PI-IONE: 828.465.8399 lt. Friday, July 29, 2016 1$4www.eatawbacountync.gov PAYOR: Christopher, James& Elizabeth PAYMENTS TRANSACTION NUMBER: TRC-756486-29-07-2016 PAYMENT DATE : 07/29/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 07-16-331040 Authorization to Construct (Repair) $150.00 Fee TOTAL PAYMENTS : $150.00 EHPR-07-2016-24399 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 1727 31ST ST NE, HICKORY NC 28601 Owner JAMES& ELIZABETH CHRISTOPHER, 9488 WESTRIDGE DR, HICKORY NC 28601 C:8283278506 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 07/29/2016 11:36 Page 1 of 1