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Home My WebLink AboutEHPR-03-2016-23364.TIF ApA �G THIS IS NOT APERMIT Case # EHPR-03-2016-23364 cyan CATAWBA COUNTY HEALTH DEPARTMENT 0`e gia o- rev PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES /842 SM Environmental Health Plan Review - Septic Malfunction o"Tr o r nt AUTH_CONST- SEPTIC_MALFUNCTION : . s n o' • 0 s• Applicant PAMELA MORRISON, 1396 BROWN CHAPEL RD, CATAWBA NC 28609 C:7046778948 Owner LITTLE CHARLES FRANKLIN HEIRS (CHASITY SUMMERALL), 1515 WASHINGTON LN, CATAWBA NC 28609 C:7046778905 NAME TO APPEAR ON PERMIT Little Charles Franklin Heirs (Chasity Summerall) SITE ADDRESS: 1396 BROWN CHAPEL RD, CATAWBA NC 28609 PIN # 470001168858 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 16,552.80 Acres 0.38 DIRECTIONS: Hwy 10, Hudson Chapel Rd, Brown Chapel Rd, Brick house on the Left. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Sewage is on the ground.* Last pumped in December. 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 50x35, Bldg 12x12 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 3 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: H9-ehapplication 03/09/2016 14:42 Page 1 of 8 A,' . CATAWBA COUNTY Case t EHPR-03-2016-23364 1 , Public Health Department Subdivision 4 "'1 Environmental Health Division PINk (......09® 470001168858 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 /8.2 sw NAME ON PERMIT: LITTLE CHARLES FRANKLIN HEIRS (CHASITY SUMMERALL), 1515 WASHINGTON LN,CATAWBA N1 28609 Little Charles Franklin Heirs ( Chasity Summerall) Site Address: 1396 BROWN CHAPEL RD, CATAWBA NC 28609 Property Size: Square Feet 16,552.80 Acres 0.38 Directions: Hwy 10, Hudson Chapel Rd, Brown Chapel Rd, Brick house on the 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 identificatio and labeling of all property lines and corners and making the site ac 'bile sot.:t a complete site evaluation can be performed. Date: o-9-/(o Signature of Applicant or Agent idiot,,, f_ ✓ 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 AREA1 *******.***.**.*****....*.**..********..****.****......*....*.**.***....*...**....****....*****.************ {vg ergN�,r ,=:T ccy iti 1 4611 ryr n319l,i 8r t9 a` r m FEENAME''_° 'dl;, it a i t�iv f do to f`rr: ��I'il �D 4.: i',l OBI NAT a ai 1 -.` DATE 1' ,a° FEE AA_MOUNTr ��_ n.S41h,.�:lLld w1 �" Ja'S:.3Ii..ils fit. .P3o-M n('d�'.Il b�.v.J. La.S(.N .MJd Authorization to Construct (Repair) Fee 03/09/2016 $300.00 yo kS `i i TOTAErFEES a+ irl"g*"t rrl{�` '! u ` hx�l` m(.it hhr':' ip w 3"y'w',rp' i$300 00 ! iLFd, �k4 */' A wui tE:rt s��,n`c3.� {metMitakda"„$°' r&`SIZund:Gaiirs't`�._:�'"xrtilGa ir,MET' PG uFaiil3tir,; 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-ehapplication 03/09/2016 14:42 Page 2 of 8 CA'TAWBA THIS IS NOT A PERMIT �cou Tr CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permit n Authorization to Construct n Septic Repair[ Septic Malfunction Septic Expansion ❑ New Well Permit❑ Replacement Well n Well Abandonment n Well Repair n Existing System Inspection (Pre-Approval Required) n 22��jj Application is for New Construction ❑ Existing Facility n� Property Address h.1 �Q EI&Own e (r�7Cl Subdivision La u06a ti� AL9 U-1 Lot # Acres Section/Block/Phase y Driving Directions to Property �r j ( O, +0 In 06.61)r C kW re,( PC I BitoL.0n Cape.( �Lt T trick hno<R, or Ac NAME TO APPEAR ON PERMIT? *Owner n Applicant n Contractor y✓ Applicant Contact Information / ' Name PAYy iMo.( 1aan 7 Address 1,3% bm, on C ha pe( Td Phone 1-01.1-_to 77— 5- (1(4SS Cell Phone Owner Contact IInformation Name ^r 6514 { Sory1me(Cc1 Address Phone v c(05 Cell Phone Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? n Owner Applicant n Contractor Description of Existing Structures on Site F' # of Bedrooms *j- 3 Structure Dimensions # of Occupants Basement ❑Yes ❑ No Basement Fixtures n Yes No (A de -\2 I? The Applicant shall notify the local health department upon submittal of this application4 any of the following apply to the property in question. If the answer to any question is "yes", applicant must attach supporting documentation. ❑ Yes pi Does the site contain any jurisdictional wetlands? !Yes P�'No Does the site contain any existing wastewater systems? Yes 1 No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes 10,No Is the site subject to approval by any other public agency? ❑ Yes No Are there easements or right of ways on this property? Describe Existing water supply in use Individual Well n Community Well n Semi-Public Well n County/City/Township Water Line Is a public water supply available? ** n Yes 'o 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) ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other yAny CATAWBA THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT „a „u Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence n New Residence ❑ Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions #of Occupants Basement n Yes n No Basement Fixtures n Yes ❑ No ❑ Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling n Yes ❑ No Plumbing IT Yes n 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.) n 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 E Community Well Abandonment Type E Drilled n Bored ❑ Dug n Unknown Well Repair Requested n 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. f 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. lc Signature of Owner or Agent- /I � O'0c6/� Date 3 7 flp Printed Name of Owner or Agent 'Rim /a L. iOO✓VISOh Catawba County Environmental Health / cif K. y • �1 i - - - - - - - it (151) .14 0 52 (.05) tP 1 z. tom"' O v p .1396 X44 ? n1 eel- N tas $ . • 4 .1390 4 N. `ham Parcel: 470001168858, 1396 BROWN CHAPEL 1 in=50ft RD CATAWBA, 28609 \1\Qi\ i S LnSC CCA 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 03/09/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 470001168858 Owner: LITTLE CHARLES FRANKLIN HEIRS Parcel Address: 1396 BROWN CHAPEL RD Owner2: City: CATAWBA, 28609 Address: 1515 WASHINGTON LN LRK(REID): 14249 Address2: Deed Book/Page: 2061/0558 City: CATAWBA Subdivision: State/Zip: NC 28609-0738 Lots/Block: / Last Sale: School Information: Plat Book/Page: School District: COUNTY Legal: 1396 BROWN CHAPEL RD Elementary School: CATAWBA Middle School: MILL CREEK Calculated Acreage: .380 Tax Map: 013AY 01001 High School: BANDYS Township: CATAWBA School Map State Road #: 1819 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: CATAWBA RURAL Zoningl: R-40 Building(s) Value: $66,300 Zoning2: Land Value: $8,200 Zoning3: Assessed Total Value: $74,500 Zoning Overlay: WP-O Year Built/Remodeled: 1960/ Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710470000J Building Details 2010 Census Block: 1007 WaterShed: WS-IV Protected Area 2010 Census Tract: 011503 Voter Precinct: P21 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. Cl 2015, Catawba County Government, North Carolina. All rights reserved. C Qc cI��I e -\/\,\\■. PP0A-e / http://gis.catawbacountync.gov/nomap/parcel_report.php?key=470001168858&typ=P 3/9/2016 Catawba County Environmental Health • / . 4 ,_ / - (15r) • Au •,,;.. 0 14:0 ,f , �. E ^1 . 4• 1, f ka i i .....--.-- r 4 4+4 r, ' 75 -gaimai pp , (-) 6 F . . .... .rn lk .... ... r S 39 ,I i , sl - • +F .. . ....1.- ..0 - ' '.11,;' 1.:.• it- ,y a14 , ri - SI .. r^C., a. , ic. , „ .,...., .,_ . . • „.., ,.. __ , .. , 0., ., 1-:, h• i nj ,r' i V , , _1 I A Parcel: 470001168858, 1396 BROWN CHAPEL 1 in=50ft RD CATAWBA, 28609,,,,,iv.47,14 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 03/09/2016 Katierilte Harris From: Jonathan Greer Sent: Wednesday, March 09, 2016 10:17 AM To: Katherine Harris Subject: 1396 Brown Chapel Katherine: This property is not required to connect to sewer. They have an existing septic system and can use/repair that system in accordance with Environmental Health rules and regulations. Thanks. Jonathan Greer Utilities& Landfill Project Manager Catawba County Government 100 A South West Blvd Newton, North Carolina 28658 (828)464-6411 1 Ka'herine Harris From: Shawn Pennell [spennell @hickorync.gov] Sent: Wednesday, March 09, 2016 1:21 PM To: Katherine Harris; Kevin Greer Cc: Kimberly Johnson Subject: RE: 1396 Brown Chapel Rd This is a pressurized sewer line. A single family residence cannot connect to this line. M. Shawn Pennell Utilities Environmental Manager spennellhickorync.gov City of Hickory, NC (828) 323-7427 www.hickor nc.•ov Pursuant to North Carolina General Statutes Chapter 132, Public Records, this electronic mail message and any attachments hereto, as well as any electronic mail message(s) that may be sent in response to it may be considered public record and as such are subject to request and review. From: Katherine Harris [mailto:KHarris @CatawbaCountyNC.gov] Sent: Wednesday, March 09, 2016 10:13 AM To: Shawn Pennell <spennell @hickorync.gov>; Kevin Greer<kgreer @hickorync.gov> Subject: 1396 Brown Chapel Rd I have a customer here that is needing a septic repair at the address 1396 Brown Chapel Rd. I am showing a county/hickory co-owned sewer line available. I want to see if they are required to connect or can apply for a repair with us. Please let me know when you can. Thank you, Katherine Harris Administrative Assistant I Environmental Health Catawba County Public Health 100A Southwest Blvd Newton NC 28658 828-465-8270 828-465-8276 fax The information contained in electronic transmissions is confidential and may be subject to protection under the law, including the Health Insurance Portability and Accountability Act(HIPAA).An electronic transmission is intended for the sole use of the individual or entity to whom it is 1 4.4-s?--,A Cp CATAWBA COUNTY �� 100A SOUTHWEST BLVD NEWTON, NORTH CAROLINA 28658 RECEIPT d ' VP� PHONE: 828.465.8399 U vas° it Wednesday, March 9, 2016 'L- 184 su w'vw.catawbacountync.gov PAYOR: Morrison, Pamela PAYMENTS TRANSACTION NUMBER: TRC-634542-09-03-2016 PAYMENT DATE : 03/09/2016 PAYMENT TYPE: Check 3233 INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-326000 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-03-2016-23364 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 1396 BROWN CHAPEL RD, CATAWBA NC 28609 Applicant PAMELA MORRISON, 1396 BROWN CHAPEL RD, CATAWBA NC 28609 C:7046778948 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner LITTLE CHARLES FRANKLIN HEIRS, 1515 WASHINGTON LN, CATAWBA NC 28609 C:7046778905 receipt 03/09/2016 14:42 Page I of 1