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HomeMy WebLinkAboutEHPR-03-2016-23536.TIF • �,y,A sG THIS IS NOT A PERMIT Case # EHPR-03-2016-23536 an Q - p CATAWBA COUNTY HEALTH DEPARTMENT O .El PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES _ �_{ 1842 sM Environmental Health Plan Review - OSWP a a i�o IMPROVEMENT �, Applicant JIM ESTES, PO BOX 376, TERRELL NC 28682-0376 4' C:7046410325 Land Owner S&M PROPERTIES OF DAVIE, LLC, PO BOX 587,COOLEEMEE NC 27014 Paid By GEMINI HOMES OF THE CAROLINAS INC, PO BOX 367, TERRELL NC 28682 NAME TO APPEAR ON PERMIT JIM ESTES SITE ADDRESS: 1410 BROWN CHAPEL RD, CATAWBA NC 28609 PIN # 470001178019 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 30,492.00 Acres 0.7 DIRECTIONS: Hudson Chapel Rd, Right on Brown Chapel, cross bridge to top of hill. On Left before Washington Lane PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP for Purchase* 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? No 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: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF Vacant Land EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 40x40 #OF NEW BEDROOMS:: 3 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: FY-ehapplical ion 03/31/2016 15:12 Page 1 of 4 a CATAWBA COUNTY Case# EHPR-03-2016-23536 Q j.� L Public Health Department Subdivision 4 . ` Environmental Health Division 'c 11N# 470001178019 PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 B42, „ NAME ON PERMIT: (JIM ESTES), PO BOX 376, TERRELL NC 28682-0376 ( JIM ESTES) Site Address: 1410 BROWN CHAPEL RD, CATAWBA NC 28609 Property Size: Square Feet 30,492.00 Acres 0.7 Directions: Hudson Chapel Rd, Right on Brown Chapel, cross bridge to top of hill. On Left before Washington Lane 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 cor e • thorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and if- serstand that I am solely responsible for the proper identification§nd labeling of all property lines and corners and making the site accessibl-E .•- r• • - .to evaluation can be performed. Date: ,5 — 3) — /(� Signature of Applicant or Agent f An Environmental Health Specialist will contact you witli ll5 we 'tng says of application date. If you need further information or assistanc�s lease call 828-466-7291 AREA1 tp l/w a 't F lr 9 m!7p i I prakrr""d.. i �'"a" ' ri pi Oft, ` a t :: FEENAMEl Irrt 14v I r[,v ohmic DATE t ?Ea0 =FEE AMOUNT;fF Improvement Permit Fee 03/31/2016 $150.00 rt Y 514 TOTAL"FEEw' i tr r.f,a re . ,/ pt`' :` frt 12ln h 5150 00. FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) H9-chappl icaiion 03/31/2016 15:12 Page 2 of 4 cATA ]B® THIS IS NOT A PERMIT COUNTY 1v a:` A CATAWBA COUNTY HEALTH DEPARTMENT - -na '° a" „--,� Application for Environmental Services Page 1 Improvement Pcrmit1< Authorization to Construct n Septic Repair n Septic Malfunction ❑ Septic Expansion n New Well Permit n Replacement Well n Well Abandonment n Well Repair n Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction Existing Facility n *Property Address M() drawn &wyQ,f R4 (q,, ,,,,,J IS.,s Subdivision /l! A 7 Lot # Acres • 4C1 Driving Directions to Property E C1Sw C ple, `d p s� � Section/Block/Phase On efown. Clictip-i C r-e5-s bii i 3_44-P d }a 66' bin. On lei( be$'ar,z Wkih'n1for kn NAME TO APPEAR ON PERMIT? n Owner X.pplicant n Contractor Applicant Contact Information Name 7n- g-5 - c5 Address o (vo c 367 7 rra.l1 t3C 2-%C-CC2- Phone Zo`1 - Cocli _ (337-55 Cell Phone Owner Contact Information Name S - P Prop Qs+ e•✓5 crc- )2ky.> - LL C Address po 13cse S z 7 . co leQ, ,nR.-2. tjc 220 1q Phone 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 (U 0l\-L # of Bedrooms *t Structure Dimensions #of Occupants Basement ❑ Yes n No Basement Fixtures n Yes n 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. ❑ Yes gNo Does the site contain any jurisdictional wetlands? ❑ Yes isfr No Does the site contain any existing wastewater systems? ❑ Yes XI No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes RNo Is the site subject to approval by any other public agency? ❑ Yes t No Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well n Community Well 7 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) ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative Other I ❑ Any cArrA 1 VY]'BA THIS IS NOT A PERMIT . COUNTY 17 CATAWBA COUNTY HEALTH DEPARTMENT NoM Ce;llna Application for Environmental Services Page 2 Proposed Facility Type n Primary Residence g New Residence n Addition to Residence #of New Bedrooms *t Project Description Wcv-i tic.),-) 5-44--, Structure Dimensions -t° x '-'O #of Occupants Basement ❑ Yes No Basement Fixtures n Yes No ❑ Accessory Structure(s) Describe ft of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling n Yes n No Plumbing Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence# Units #Bedrooms per Unit*j Total At 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.) El 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 n Semi-Public Well n 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 perfon.-d Signature of Owner or Agent -∎1 Ste vossr Date 9 - 1 )c Printed Name of Owner or Age s Catawba County Environmental Health • 9eQ s • (211) / , tp 11. 1. • 0. Q f j.. (151) O °_ .- 0 (.05) er ,_ v Z O . ■ coi:// S V~ 1 Parcel: 470001178019, 1410 BROWN CHAPEL 1in=50ft RD CATAWBA, 28609 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 03/31/2016 Katherine Harris From: Jonathan Greer Sent: Thursday, March 31, 2016 4:29 PM To: Katherine Harris Subject: Re: 1410 Brown Chapel Rd Yes they can apply for septic. They are not required to connect to sewer. Jonathan Greer Utilities& Landfill Project Manager On Mar 31, 2016, at 4:18 PM, Katherine Harris <KHarris @CatawbaCountyNC.gov> wrote: Jonathan, There is a sewer line showing in front of the property on GIS at 1410 Brown Chapel Road. Homeowner states it is a high pressure main & unable to connect. I just want to confirm that it is okay for them to apply for a septic permit on this property & they are not required to connect to the sewer line. 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 addressed.If you are not the intended recipient,you are notified that any use,distribution or copying of the message is strictly prohibited. If you received a message in error, please contact the sender immediately by replying to the email and delete the material from any computer. 1 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 470001178019 Owner: S & M PROPERTIES OF DAVIE LLC Parcel Address: 1410 BROWN CHAPEL RD Owner2: null City: CATAWBA, 28609 Address: PO BOX 587 LRK(REID): 14251 Address2: null Deed Book/Page: 3223/1853 City: COOLEEMEE Subdivision: State/Zip: NC 27014-0587 Lots/Block: / Last Sale: $5,500 on 2003-06-25 School Information: Plat Book/Page: School District: COUNTY Legal: BROWN CHAPEL RD Elementary School: CATAWBA Middle School: MILL CREEK Calculated Acreage: .700 Tax Map: 013AY 01003 High School: BANDYS Township: CATAWBA School Map State Road #: 1819 Tax/Value 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: $0 Zoning2: null Land Value: $11,800 Zoning3: null Assessed Total Value: $11,800 Zoning Overlay: WP-O Year Built/Remodeled: null/null Small Area: SHERRILLS FORD 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 #: 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 eflods 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.php?key=47000 1 1 780 1 9&typ=P 3/31/2016 gA Cp CATAWBA COUNTY . + % IOOA SOUTHWEST BLVD RECEIPT s NEWTON, NORTH CAROLINA 28658 C i►`! PHONE: 828.465.8399 C ' v4r Thursday, March 31, 2016 \842 srw www.catawbacountync.gov PAYOR: GEMINI HOMES OF THE CAROLINAS INC GEMINI HOMES OF THE CAROLINAS INC PAYMENTS TRANSACTION NUMBER: TRC-647283-3 1-03-201 6 PAYMENT DATE : 03131/2016 PAYMENT TYPE: Check 1048 INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-326719 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 E 1-1 P R-0 3-2 016-2 3 5 3 6 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 1410 BROWN CHAPEL RD, CATAWBA NC 28609 Applicant JIM ESTES. PO BOX 376,TERRELL NC 28682-0376 C:7046410325 Land Owner SRN PROPERTIES OF DAVIE, LLC, PO BOX 587, COOLEEMEE NC 27014 Paid By GEMINI HOMES OF THE CAROLINAS INC, PO BOX 367,TERRELL NC 28682 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 03/31/2016 15:11 Page 1 of 1