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HomeMy WebLinkAboutEHPR-03-2016-23477.TIF $A .� THIS IS NOT A PERMIT Case # EHPR-03-2016-23477 < nn CATA�VBA COUNTY HEALTH DEPARTMENT 0 �� O ` (` 4°� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES F +{{��, 1842 Environmental Health Plan Review - Septic Malfunction '*'�e o _ _.CONST- SEPTIC MALFUNCTION . . ° -- — — 0 r , % r u1 Owner NOAH DANIEL ROBBINS, 3371 34T1-1 AV CT NE, HICKORY NC 28601 H:8282365123 C:8282280733 HOME:8282565123 NAME TO APPEAR ON PERMIT Noah Daniel Robbins SITE ADDRESS: 3371 34TH AV CT NE. HICKORY NC 28601 PIN # 372416845813 NAME of SUBDIVISION: I-1EFNER HEIGHTS Lot# 13-16 Section/Block F PROPERTY SIZE: Square Feet 20,037.60 Acres 0.46 DIRECTIONS: From Springs Rd, Left on Suplher Springs Rd, Left on 34th Ave Ct NE, Brick house 3rd on Right#on mailbox. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: Tank last pumped 3 weeks ago & tank is full. Starting to back up in toilets. 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 30x40, Bldg 15x20 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 5 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 and labeling of all property lines and corners and making the site access le s that letele aluation can be performed. Date: 3-ZA '/G Signature of'Applicant or Agent An Environmental Health Specialist will contact you within 5 work rig days of application date. Ifyou need further information or assistance please call 828-466-7291 AREA2 E9-ehapplirmion 03/28/2016 08:51 Page 1 of 7 4gA CATAPBA COUNTY Case# EHPR-03-2016-23477 .C',. L Public Health Department Subdivision HEFNER HEIGHTS Environmental Health Division PIN;! 372416845813 t!- PO Box 389. 100-A Southwest 131rd, Newton. NC 28658 1842 ,•. NAME ON PERMIT: (NOAH DANIEL ROI313INS), 3371 34114 AV CT NE, HICKORY NC 28601 ( Noah Daniel Robbins) Site Address: 3371 34TH AV CT NE. HICKORY NC 28601 Property Size: Square Feet 20,037.60 ,AC1e, 0.46 Directions: From Springs Rd, Left on Suplhec Springs Rd, Left on 34th Ave Ct NE, Brick house 3rd on Right#on mailbox. I Erik "t _ 3 : ct�x fir, e�?�1: p e'a 'i' 1 i rr 3 6 FEENAMf: i ,I �41,i4 'DATEi�` iamu FEE'AMOUNI' _ r . r3� .., Authorization to Construct (Repair) Fee 03/28/2016 $300.00 1IfL 1() IA1 IILSt ii3t�Il ,aaaii 8fs8tkr '�JIW $30000prl O" .,.. � � . wti w ... .as:f,.b._.. �v ..,... W :::.ides,.�,.-.....a.7.uJE.'°#��..udEu .:.i3n,0.w..»___stb.�:u�i.- .w�,.,3' 3S1T r It FEES ARE NON-REFUNI)ABLE ONCE A SITE VISIT IS MADE OR WORE ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-ehapplication 03/28/2016 08:51 Page 2 of 7 CATA\VBA THIS IS NOT A PERMIT coonTV vy �� CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permit I I Authorization to Construct❑ Septic Repair ❑ Septic Malfunction' Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment_ Well Repair Fl Existing System Inspection (Pre-Approval Required) n Application is for New Construction ❑ Existing Facility X Property Address 3 571 ;y44 4vc et ,46-- Subdivision F- 16t(oe( 2g'6o1 Lot# Acres Section/Block/Phase kDriving Directions to Property FROM SP/1/tJf S /'J) LEFT ant C vI Foie Si°0^1(rr5 LE-Ft 0,4 3tirsi 4€ cf Ale 3Rtct 146. a4 R. s 0A M/Flc BoY NAME TO APPEAR ON PERMIT? %Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name 40411 D f}/J I EL Ro'3[3/mil S ,Address 3371 31141 Avt Cr /JEG- I./lacier 2b6,0/ Phone 5(2 256 S-12 3 Cell Phone sg . 22 - 07 3 3 Contractor Contact Information Name License # Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? IXOwner I I Applicant ❑ Contractor Description of Existing Structures on Site --(3U)g # of Bedrooms *j' 3 Structure Dimensions Ao 3r7 X90 # of Occupants S Basement ❑ Yes F---No Basement Fixtures ❑ Yes RiVo 101 �> l20 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. ❑ Yes Ergo Does the site contain any jurisdictional wetlands? )Yes o Does the site contain any existing wastewater systems? ❑ Yes k2-No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes in-co Is the site subject to approval by any other public agency? ❑ Yes o Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well fl Jommunity Well El Semi-Public Well 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) ID Accepted ❑ Alternative lit/Conventional ❑ Innovative ❑ Other ❑ Any C gTAwBA THIS IS NOT A PERMIT counr7 , CATAWBA COUNTY HEALTH DEPARTMENT No;;„—j-.7;,;?...:,‘ Application for Environmental Services Page 2 Proposed Facility Type n Primary Residence ❑ New Residence n Addition to Residence it of New Bedrooms *t 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 n Yes ❑ No Plumbing n Yes n No Describe Plumbing Needed ❑ Multi-Family Residence# Units #Bedrooms per Unit*t Total #Bedrooms *t Structure Dimensions n Food Service Specify Type Al 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 ❑ Yes n No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type n Individual Well n Semi-Public Well ❑ Community Well Abandonment Type n 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. 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 corners and making the site accessible so that a complete site evaluation can be performed. AS Signature of Owner or Agent 1, 77r1,a4"--- Date 31 FC- /5 Printed Name of Owner or Agent //Q4+( 1�AAIIeL €tyJ&ws Catawba County Environmental Health / - - i l _- / F / / a::i- / `� y / f l \ / f r \ \ -'' "� O / a \ --- ( s-*'1(51'.1 ,, - '''':-:4:-.: --. _.--, ,,,. I. l \ / 2CP \ A \ \ \ \ .- \ \ \ Parcel: 372416845813, 3371 34TH AV CT NE 1in=5011 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 03/28/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 372416845813 Owner: ROBBINS NOAH DANIEL Parcel Address: 3371 34TH AV CT NE Owner2: ROBBINS STEFANIE KYE City: HICKORY, 28601 Address: 3371 34TH AVE CT NE LRK(REID): 50118 Address2: null Deed Book/Page: 3264/0919 City: HICKORY Subdivision: HEFNER HEIGHTS State/Zip: NC 28601-7775 Lots/Block: 13-16/ F Last Sale: $73,000 on 2006-10-16 School Information: Plat Book/Page: 9/106 School District: COUNTY Legal: LOTS 13-16 BLOCK F PLAT 9-106 Elementary School: SNOW CREEK Calculated Acreage: .460 Middle School: ARNDT Tax Map: 1411 10001 High School: ST STEPHENS Township: CLINES School Map State Road #: 1614 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: ST STEPHENS Zoningl: R-20 Building(s) Value: $76,300 Zoning2: null Land Value: $11,800 Zoning3: null Assessed Total Value: $88,100 Zoning Overlay: null Year Built/Remodeled: 1961/null Small Area: ST STEPHENS/OXFORD Current Tax Bill Split Zoning Districts: null/null Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710372400J Building Details 2010 Census Block: 2018 Watershed: null 2010 Census Tract: 010301 Voter Precinct: P29 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 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. rI,h 73 I ►� Otto �� �i-6( a'\9 -,kcb oc\cfbe \NCAex N (30r�� 5 0/10471- \Oc ___) ili.0\160(0 A ittp://gis.catawbacounty nc.gov/nomap/parcel_report.php?kcy=372416845813&typ=P 3/28/2016 gC p CATAWBA COUNTY IOOA SOUTHWEST 13LVD 4 ;