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HomeMy WebLinkAboutEHPR-08-2016-24471 (2).TIF IgA �G THIS IS NOTA PERMIT Case # EHPR-08-2016-24471 `-T 2 CATAWBA COUNTY HEALTH DEPARTMENT 6 1L] 40"' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES '17ti 1842 sM Environmental Health Plan Review - Septic Malfunction o. • o • o X AUTH_CONST- SEPTIC MALFUNCTION y ' o. . o • Owner RONALD& BRANDY MERCER, 2451 EMMANUEL CHURCH RD, CONOVER NC 28613 C:8284558318 NAME TO APPEAR ON PERMIT Ronald & Brandy Mercer SITE ADDRESS: 2451 EMMANUEL CHURCH RD, CONOVER NC 28613 PIN # 375118404900 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 22,215.60 Acres 0.51 DIRECTIONS: Left from Hwy 10 East, Left onto Emmanuel Church Rd, 2nd house on the Left past the Pure Gas Station. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: Failed septic inspection. Issues with drain field. 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, 2 Bldgs EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: House 64x35, 2 Bldgs: 12x12, 12x20 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,an labeling of all property lines and corners and making the site acce slblle so that acompl site evaluation�,� � can be performed. Date: . 1p Signature of Applicant or Agent �" ' lyLL- ("� 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 +*hitt t*iii,t hitt t i*t*itttttt tt ttit******t**t**itttt*************i*ttt******t*•*******tt*******t*t*****ttt lig-ehapplicat inn 08/08/2016 16:54 Page 1 of 7 „oA • CATAWBA COUNTY Case# EI-IPR-08-2016-24471 .7-74.111 c- Public Health Department Subdivision < :��`v�®; Environmental Health Division PIN# 375118404900 PO Box 389. 100-A Southwest Blvd.Newton. NC 28658 /842 o NAME ON PERMIT: (RONALD R. BRANDY MERCER), 2451 EMMANUEL CHURCH RD, CONOVER NC 28613 ( Ronald & Brandy Mercer) Site Address: 2451 EMMANUEL CHURCH RD, CONOVER NC 28613 Property Size: Square Feet 22215.60 Acres 0.51 Directions: Left from Hwy 10 East, Left onto Emmanuel Church Rd, 2nd house on the Left past the Pure Gas Station. J FEE • ht� ����I k �NAMEtla �I� , Jki • IjIUI } J9IJ'DATEL; All FEE ATNIOTI Authorization to Construct(Repair) Fee 08/08/2016 $300.00 I I'( 1��,r 'iuylp� 5300 00 ��� X1111�TOTALiFEES� i�.,� iu Bron n�ul ���ti�t�� i n, 5k 1e1+ ,'tr nn H 'a4t'I�YilGiet . �iilSillll,lilltl0..,. ”6llN„WWWL�Ihuli�il6L'I➢tllfWl!Illlq!CW;WCIL'4I6JLL'�WI11�1�i11;NI A :IIuL aLL,!u IIIlhc.,fWtttW6 m2ll.11lII Ii.::'li 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-ehapplicatinn 08/08/2016 16:54 Page 2 of 7 CATAWBAMIS IS NOT A PERMIT coutil � CATAWBA COUNTY HEALTH DEPARTMENT Page 1 '-44-4.--7 ,,—;:7:7--..i, Application for Environmental Services Improvement Permit U Authorization to Construct n Septic Repair Septic Malfunction Septic Expansion n New Well Permit I I Replacement Well ❑ Well Abandonment _ Well Repair n Existing System Inspection (Pre-Approval Required) ❑ Application is for New Connstruuctioo n Existing Facility 1 Property Address 41/9Cri7j i wP-/ C4, ?d Subdivision (O p 0 ve r 1j6 a- K 61 3 Lot# Acres HE ((t� ' I Section/Block/Phase 4 Driving Directions to Property jt4 'tro✓i tot Vnc hcluse 0M- The 104 Pas+ • 44, - (, Ai _ -fes , • NAME TO APPEAR ON PERMIT? "Owner ❑ Applicant _ Contractor Applicant Contact Information Name Address Phone I Cell Phone Owner Contact Information Name 0_ c-c x c_Cr Address 2 t L rma�-1.vej QXt ?c-`Z_ �CA�Ove✓ NC 2?LPI S Phone ( %28. 4-SS s3is I Cell Phone Contractor Contact Information Name Address Phone I Cell Phone WHO WILL BE THE PRIMARY CONTACT?% Owner 1 S Applicant ❑ Contractor Description of Existing Structures on Site kitouS e _ 4- 2 (:o c -x `j s 1 b1?.. i 17 x?.O #of Bedrooms *'p t3 Structure Dimensions_ e #of Occupants Basement Yes No Basement Fixtures a Yes A 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. CI Yes Vivo Does the site contain any jurisdictional wetlands? C Yes 1 1No Does the site contain any existing wastewater systems? O Yes No Is any wastewater going to be generated on the site other than domestic sewage? 0 Yeso Is the site subject to approval by any other public agency? O Yes No Are there any easements or right of ways on this property? Describe Existin ' ater supply in use III Individual Well IE Community Well ❑ Semi-Public W [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 0 Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other Any 2A ,���r y iS THIS IS NOT A PERMIT c.cxmz, CATAWBA COUNTY HEALTH DEPARTMENT NAii `--';„ „ Application for Environmental Services Page 2 Proposed Facility Type j I Primary Residence New Residence n Addition to Residence # of New Bedrooms 't Project Description Structure Dimensions # of Occupants Basement ❑Yes No Basement Fixtures ri Yes a No I IAccesson Structure(s) Describe #of New Bedrooms *I- if applicable Structure Dimensions #of Occupants Accessory Dwelling n Yes n No Plumbing n Yes ❑ No Describe Plumbing Needed C Multi-Family Residence#Units #Bedrooms per Unit*j' Total#Bedrooms *1- Structure Dimensions I I Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift #of Shifts Dining Area(Sq. Ft.) I I 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 H Semi-Public Well LJ Community Well Abandonment Type ❑ Drilled Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes H No Describe Calculated Design Flow, Commercial j' 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.f� Signature of Owner or Agent f Wh(� _ r. Date cS .S . t t p Printed Name of Owner or Agent Pp(�Ylrt.\/ C . rneYC{f7 Catawba County Environmental Health Z ( i ( l (195) I 4 Fy"M. ( • FC cy&RcyRo 1 x8351 (100) Jt a or ANI, ^ (cps) iG V .s o ` 1.58 4.' 131.67 a �► o � W 76.16 125.41 , 79.36 125.39 C. •2.64 60.1 Val. If Si.52 '1 Parcel: 375118404900, 2451 EMMANUEL lin=50ft CHURCH RD 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 08/08/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 375118404900 Owner: MERCER RONALD B Parcel Address: 2451 EMMANUEL CHURCH RD Owner2: MERCER BRANDY C City: CONOVER, 28613 Address: 2451 EMMANUEL CHURCH RD LRK(REID): 38585 Address2: Deed Book/Page: 2587/0392 City: CONOVER Subdivision: State/Zip: NC 28613-9133 Lots/Block: / Last Sale: $95,500 on 2004-06-22 School Information: School District: COUNTY Plat Book/Page: Legal: 2451 EMANUEL CHURCH RD Elementary School: CLAREMONT Middle School: RIVERRBENDBEND Calculated Acreage: .510 Tax Map: 074N 02011 F High School: BUNKER HILL School Map Township: NEWTON State Road it: 1732 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: CONOVER County Fire District: CLAREMONT RURAL Zoningl: R-20 Building(s) Value: $83,400 Zoning2: Land Value: $10,300 Zoning3: Assessed Total Value: $93,700 Zoning Overlay: Year Built/Remodeled: 1966/ 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: 1004 WaterShed: WS-IV Protected Area 2010 Census Tract: 011300 Voter Precinct: P22 Agricultural District: 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. UnC be\010 n' GC:ft, tet http://gis.catawbacountync.gov/nomap/parcel_report.php?key=375118404900&typ=P 8/8/2016 KKBA CATAWBA COUNTY �" � IOOA SOUTHWEST BLVD y Y NEWTON,NORTH CAROLINA 28658 RECEIPT H e�►e' PHONE: 828.465.8399 V ��, Arai). C Monday, August 8, 2016 1842 SM www.catawbacountync.gov PAYOR: Mercer, Ronald& Brandy PAYMENTS TRANSACTION NUMBER: TRC-772861-08-08-2016 PAYMENT DATE : 08/08/2016 PAYMENT TYPE: Check 2091 INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-331368 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : S300.00 El- PR-08-2016-24471 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 2451 EMMANUEL CHURCH RD, CONOVER NC 28613 Owner RONALD& BRANDY MERCER, 2451 EMMANUEL CHURCH RD, CONOVER NC 28613 C:8284558318 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 08/08/2016 16:53 Page 1 of I