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Home My WebLink AboutEHPR-02-2016-23295.TIF �gA •G THIS IS NOT A PERMIT Case # EHPR-02-2016-23295 .v a CATAWBA COUNTY HEALTH DEPARTMENT oFJ�` 0 L , ,s PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES f�� • 1842 sm Environmental Health Plan Review - Septic Malfunction .o 3• o a? fig ' •r,' AUTH CONST - SEPTIC_MALFUNCTION Contractor LEATHERMAN SEPTIC TANK SVC INC (HARVEY LEATHERMAN), 8420 REEPSVILLE RD RD, LINCOLTON NC 28092 H:8282444409B:7044622 194 HOME:8282444409F:7044622636 Owner PAUL GAITHER, 2637 TIFFANY ST, CONOVER NC 28613 C:8284550481 NAME TO APPEAR ON PERMIT PAUL GAITHER SITE ADDRESS: 2637 TIFFANY ST, CONOVER NC 28613 PIN # 375119624271 NAME of SUBDIVISION: SHAMROCK PARK MAP 3 Lot#6&7&ADJ Section/Block E PROPERTY SIZE: Square Feet 55,321.20 Acres 1.27 DIRECTIONS: Keistler Dairy Road, into Shamrock Park, Left onto Tiffany St, Last lot on the Right PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: Septic is backing up in the house. System is in deep. 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, Bldg EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: House 69x40, Bldg 28x48 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: YES OTHER: INNOVATIVE: ANY: Other described: 69-ehapplication 02/29/2016 16:36 Page 1 of7 e,• CATAWBA COUNTY Case# EHPR-02-2016-23295 e• "tt1 Public Health Department Subdivision SHAMROCK PARK MAP 3 d ,; ,'" Environmental Health Division PIN# 375119624271 N PO Box 389, 100-A Southwest Rlvd,Newton,NC 28658 Ig 2 s.a NAME ON PERMIT: ( PAUL GAITHER), 2637 TIFFANY ST, CONOVER NC 28613 ( PAUL GAITHER) Site Address: 2637 TIFFANY ST, CONOVER NC 28613 Property Size: Square Feet 55,321.20 Acres 1.27 Directions: Keistler Dairy Road, into Shamrock Park, Left onto Tiffany St, Last lot on the Right 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 3. complete site evaluation can be performed. Date:i2 i— IC Signature of Applicant or Agent AV. 44,,M,,yn,-,,,A An Environmental Health Specialist will contact you within 5 wo king days of application date. If you need further information or assistance please call 828-466-7291 AREA2 ro ilia .i err : a mt`-r .n 4 s'rr'' , '€h' i ,,* g . L �FEENAME h Q _Alf;' oat ' � I DATE 3a vi uFEE=AMOUNT N Authorization to Construct(Repair) Fee 02/29/2016 $300.00 2 i'�i t " TOTAL FEES {. ... yr.'�4.py']'.. _.. ; ! httorlveil.., ,,i !!. 2" jY$3OO 00',;': ui .�i,�k�w' -x-aiuE.6 F.?:I 4^ .nr,'u'atu.E.,.I M,,.usa. -'a-as ..aM!1t,Era,.�`..�E` w WitatiligrauZDaide 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) IN-ehapplication 02/29/2016 16:36 Page 2 61'7 CATAWBA THIS IS NOT A PERMIT COUNTY CATAWBA CATAWBA COUNTY HEALTH DEPARTMENT �- a Ne.��..e�,�. Application for Environmental Services Page 1 Improvement Permit H Authorization to Construct H Septic Repair H Septic Malfunction Septic Expansion H New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) n Application is for New Construction ❑ Existing Facility`," �_ Property Address�� Jam/ �� Subdivision ••/ . Lot# Acres Section/Bloch/Phase Driving Directions to Property NAME TO APPEAR ON PERMIT? Owner n Applicant n Contractor Applicant Contact Information ? Name g, (j--124. ' --4" 1 �Lj Address Wvg 0 A -o-t /e / 4Z CLtc�.C�Ju., ,, Phone Agi 70 k _ 43, ,fS y Cell Phone Rte 6 i-)-.9 y-3 Owner Contact Information, C Name /& 9 tii ' Address 63 7 7tn a, j.F,-y,�_,,.e _ 11 c 0-2(C-6/ 3S • Phone Cell Phone Sc-l - £/S S - O S42/ Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? n Owner I Applicant n Contractor Description of Existing Structures on Site _ °_ it[ 2- # of Bedrooms *j c_ Structure Structure Dimensions Affil, #of Occupants_7 Basement n Yes q No Basement Fixtures ❑ Yes±RNo`—"Mac) ??DxC_i 2) The Applicant shall notify the local health department upon submittal of this appliation if any of the following apply to the property in,question. If the answer to any question is "yes", applicant must attach supporting documentation. ❑ Yes CJd No Does the site contain any jurisdictional wetlands? es ❑❑ NNoo Does the site contain any existing wastewater systems? ❑ Yes No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes a< Is the site subject to approval by any other public agency? El Yes .-co Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well n Community Well ❑ Semi-Pub is Well E C-ounty/City/Township Water Line Is a public water supply available? ** Yes n 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 eference) 7' ❑ Accepted ❑ Alternative ® Conventional ❑ Innovative ❑ Other ❑ Any CATAWBA THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT • „0„„,,—;;;;--,,,, Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence H New Residence n Addition to Residence # of New Bedrooms *f Project Description Structure Dimensions # of Occupants Basement E Yes n No Basement Fixtures ❑ Yes ❑ No ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence# Units #Bedrooms per Unit*t Total # Bedrooms *f Structure Dimensions H 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 n Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type n Individual Well n Semi-Public Well n Community Well Abandonment Type n Drilled ❑ Bored n Dug n 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 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 de/44.4.)-0/ cf j e7 ti� Date el 9 Printed Name of Owner or Agent /lft/z Lie/ 2 e, 7h e/? p7fill Catawba County Environmental Health \ \ h \\113, 3 .c Q 118 L. PI lik TIFFANY ST tmamirsommou 117.20 120 e_____m _ - v$45 Co I e1625 al 158.85 l 30 1 , lii i Lo r I 0 Ams a a 0 I 144.Q, .. .. 120 120 a IN7, oo 4. rE r r. a MIR . 113.33 Parcel: 375119624271, 2637 TIFFANY ST 1 in=60ft 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 02/29/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 375119624271 Owner: GAITHER PAUL E JR Parcel Address: 2637 TIFFANY ST Owner2: GAITHER BETH H City: CONOVER, 28613 Address: 2637 TIFFANY ST LRK(REID): 39821 Address2: Deed Book/Page: 3131/0194 City: CONOVER Subdivision: SHAMROCK PARK MAP 3 State/Zip: NC 28613-9115 Lots/Block: 6 & 7 & ADJ/ E Last Sale: $64,500 on 1988-12-01 School Information: Plat Book/Page: 14/42 School District: COUNTY Legal: LOT 6&7 ADJ SHAMROCK BLOCK E PL Elementary School: CLAREMONT 14-42 Middle School: RIVER BEND Calculated Acreage: 1.270 High School: BUNKER HILL Tax Map: 079N 06006 School Map Township: NEWTON State Road #: 1991 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: CLAREMONT RURAL Zoningl: R-20 Building(s) Value: $146,800 Zoning2: Land Value: $20,900 Zoning3: Assessed Total Value: $167,700 Zoning Overlay: WP-O Year Built/Remodeled: 1970/ Small Area: CATAWBA 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: 1048 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 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. a 2015, Catawba County Government, No h Carolina. All rights reserved. bQR1 S 5/. Ke■ Necp \� , • ' e- 4—QYCArCj, em \sc\k\ s).), onCr\ei5 \IN, 'is HR--Ct nark_ http://gis.catawbacountync.gov/nomap/parcel_report.php?key=375 1 1 9624271&typ=P 2/29/2016 sa CATAWBA COUNTY r' r•-f Case 0 � r 0 IMPV-01-2013-034231 ®� � Public Health Department $ 5`[[ r Subdivision SHAMROCK PARK MAP 3 4 :w Y' Environmental Health Division .3: •� -• 'T�'+ ��'} I'INti 375119624271 N... PO Box 389, 100-A Southwest Blvd, Newton,NC 28658 •.9 • t�i A LOTS 6 &7 &ADJ Ay}}S .-11. S G ° I• •j : R6Pk -01 -)013 -)&73q NAME ON PERMIT: PAUL GAITHER, 2637 TIFFANY ST, CONOVER NC 28613 Site Address: 2637 TIFFANY ST, CONOVER NC 28613 Property Size: Square Feet 55,321.20 Acres 1.27 Directions: KEISLER DAIRY RD/ INTO SHAMROCK PARK ON SHANNON DR/ RT TIFFANY Improvement Permit • INITIAL SYSTEM EXISTING Facility: Primary Residence - house Permit Category: Other Bedrooms 3 WATER SUPPLY: Public Water Basement? No Basement Plumbing? No INITIAL SYSTEM SPECIFICATIONS Permit Valid: Expires In Five Years: _X_ No Expiration: Projected Daily Flow 360 g.p.d Proposed Wastewater System: CONVENTIONAL Type: IIA -CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Permit Conditions: REPAIR SYSTEM SPECIFICATIONS Repair System Required? Required Proposed Wastewater System: 25% REDUCTION Type: IHG -OTHER NON-CONY TRENCH SYSTEMS Landscaping or other site alterations that potentially divert groundwater or surface water toward the septic system, or prevent proper drainage away from the septic system, including the direction of gutter flows or foundation drains, is not approved, and may result in failure to approve the initial system installation, or the suspension/revocation of existing permits. The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the applicant/property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are met. This Improvement Permit is subject to revocation if the site plan,plat or the intended use changes,or if site conditions are altered. The Improvement Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina 'Laws and Rules for Sewage Treatment and Disposal Systems' (15A NCAC I 8A .1900). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for any given period of time. Megen McBride 01/24/2013 AUTHORIZED STATE AGENT APPROVAL DATE Permit Expiration Date: 01/24/2018 No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department. E9-ehpernm 01/28/2013 10:25 Page I of 3 • i P -&Q D1-2013-1473 263-i Tgaill SI. C6noieV *EXIS+Iri`\ SPr+'c $r/ek. was U;s lli -('�he'i0hiv5 11Z3'13 lqov.IvieV hccyco ike CGh` �C.. r YS to i I �7ni Vii J I J tEXIS+1n3 cycfcih rvta4 �e ur0ey5;zF�l b' cut1en-L- Si Zinc? ST'^hikTdS -iv+ a 3 LP�{Yooh hoot-. d. e, ackl4∎0 , will 41 ivcreos( serrlic -110P,1 014 c, -Fuli 3 6ed?mr. refit Aver has fie.` des Jmird . t` M I uCure5 14.""4 Imo. 5'4 .4-rofk. 1irI fC .c,7 4.}eWt5 4 a5 'I, -6-att^ WPlls_ 4` ha\ �rile, Jade, Ct OC _.f; i\ oJeV ((p-}ic or ✓ o ar&1 . • i10,11 u$e5 ?, blic-• WcAcr. (?o' za• Rhea) Exuting erorsed Sioloye 80,1 I % o4d'fiu. c, lTank J Jf , Oa K -ta /'a cA "J�^ tot85. 3 . d�,n d � 14 J i -30' Da v. o.Y � 1^IS. Izo' IIZ�• Ti nySI I0-L0, DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES • Shed of DIVISION OF ENVIRONMENTAL HEALTH PROPERTY ID#: .ON•SITE WASIEWATERSECTION COUNTY: SOIL/SITE EVALUATION / 1 for ON-Si•LE WASTEWATER SYSTEM p„ruff OWNER: Pad GAI ]�.C✓ APPLICATION DATE 1-N-13 r-Or12-01-9 013-1113, ADDRESS: DATE EVALUATED: I— 27•(3 PROPOSED FACILITY: OP,ASED DESIGN FLAW(.I949): 31.0 . PROPERTY fl 1 2-7 at re4 LOCATION OF SITE: 2(x31 Gnu{ S • C A'1Qg/k PROPERTY'R CORDED: WATER SUPPLY: D Private Public [1 Well 0 Spring 0 Other EVALUATIONN.EIHOD: I Auger Boring 0 Pit 0 Cut TYPE OF WASTEWATER: Sewage O Industrial Process O 1.3 u ; SOILRfOnnO?O( V AS R (1841} ,.IRO „ , FACTORS L t9w p- ' s. : CASE.; �CiN .Y9AL.: _ 9.9f1 SD1L_ 1943 tP.g , 3946 ' i XOSITlQ11( DF,FTIi. sTgti URE+ OH$1SX'£Ni",Fl tY£`PN;;S'SJ SOdL SaP$t7 ' $IIt P1tCrFJL}:: SLOP Y . T TT11Rl ltcnelu':>ocr c ijRa . Dee3x CLA,SS . 1{t9Fi1G:. 15-39 /du, S 6 cr.55,S7xe 1 C�lii{ reob, (ov�dr.-i o ev dtr) 3� • — (� • •ll i 03 2 3 4 DESCRIPTioR I INITIAL SVDTEM I REPAIR SYSTEM OTHER FACT ORS(.1946): A',Bablr Space(.1945) 195 SITE CLASSIFICATION(.194E): Syatm Typ_(r) -T77' EVALUATED BY: J'IPF0' I L £ 5 OTAER(S)PRESENT: . • . Site LIAR 0,3 COMMENTS: Co CATAWBA COUNTY FQ' $-3 Ca 100ASOUTHWESTBLVD NEWTON, NORTH CAROLINA 28658 RECEIPT PHONE: 828.465.8399 CJ 17e- '� Monday, February 29, 2016 /842 sm www.catawbacountync.gov PAYOR: LEATHERMAN SEPTIC TANK SVC INC LEATHERMAN SEPTIC TANK SVC INC(Leathennan, Harvey) PAYMENTS TRANSACTION NUMBER: TRC-629551-29-02-2016 PAYMENT DATE : 02/29/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 02-16-325707 Authorization to Construct(Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-02-2016-23295 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 2637 TIFFANY ST,CONOVER NC 28613 Owner PAUL GAITHER. 2637 TIFFANY ST,CONOVER NC 28613 C:828455048I Contractor LEATHERMAN SEPTIC TANK SVC INC, 8420 REEPSVILLE RD RD, LINCOLTON NC 28092 H:82824444096:7044622194F:7044622636 ACCOUNT: 50131 receipt 02/29/2016 16:35 Page 1 of I