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HomeMy WebLinkAboutEHPR-04-2016-23594.TIF s��$,A NoG THIS IS NOT A PERMIT Case # EHPR-04-2016-23594 rrt CATAWBA COUNTY HEALTH DEPARTMENT Or{te, O ,�'� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES �"+ " a., 1842 sM Environmental Health Plan Review - Septic Malfunction r 00-o , AUTH CONST- SEPTIC MALFUNCTION Le } O Ada TMI l'ex,i\ - fl, (4? *AnespAcow1 mc, Owner DAN& KATHY HUNSUCKER, 3216 JOHN DANIEL DR NE, CONOVER NC 28613 C:8283129666 NAME TO APPEAR ON PERMIT Dan & Kathy Hunsucker SITE ADDRESS: 823 ROCK BARN RD NE, CONOVER NC 28613 PIN # 374215732307 NAME of SUBDIVISION: Lot It Section/Block PROPERTY SIZE: Square Feet 257,875.20 Acres 5.92 DIRECTIONS: Rockbarn Road, cross over Thornburg Dr, quarter mile on left. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: 'water is on the ground. 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 EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 56x41 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 4 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: 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. Date: Signature of Applicant or Agent 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 t+#t##tx♦#**##+#####k*t***i••t##++itkt####+#####ttiikt#Y**t***YY+++*#+*Y*#•tt k•+##•+++#*4M##i#######4***#### E9-chappliomiun 04/07/2016 13:43 Page 1 of 7 �aA CATAWBA COUNTY Case a EHPR-04-2016-23594 ittly Public Health Department Subdivision " ® c.: - -s �, Environmental Health Division PINd 374215732307 1. dc- PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 1842 s NAME ON PERMIT: (DAN & KATHY HUNSUCKER), 3216 JOHN DANIEL DR NE, CONOVER NC 28613 ( Dan & Kathy Hunsucker) Site Address: 823 ROCK BARN RD NE, CONOVER NC 28613 Property Size: Square Feet 257,875.20 Acres 5.92 Directions: Rockbarn Road, cross over Thornburg Dr, quarter mile on left. �.. t itd r -v a4 B.FEENAME ',`" F<�7 :aaf <_,..._.._.,•../i"±itflt.<t3ttteiu, ,`IDATE_W FFEtAMOUNTH Authorization to Construct (Repair) Fee 04/07/2016 $300.00 Via aE 1TOTAL FEES 1 i11 1 a s $300 00 1 _..< ,1 4,if,,..,,. ,,,,„,.al 3a to rf.... ..°�'iai¢t .i ..:i+ 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) 139-6141666(6100n 04/07/2016 13:43 Page 2 of 7 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 374215732307 Owner: HUNSUCKER KATHY Parcel Address: 823 ROCK BARN RD NE Owner2: null City: CONOVER, 28613 Address: 3216 JOHN DANIEL DR LRK(REID): 68325 Address2: null Deed Book/Page: 2010E/0025 City: CONOVER Subdivision: null State/Zip: NC 28613-8972 Lots/Block: null/ null Last Sale: School Information: Plat Sale: age: School District: NEWTON CONOVER Legal: 823 ROCK BARN RD NE Elementary School: SHUFORD Middle School: NEWTON CONOVER Calculated Acreage: 5.920 Tax Map: 4100 00005 High School: NEWTON CONOVER Township: CLINES School Map State Road #: 1709 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: CONOVER County Fire District: CONOVER RURAL Zoningl: R-20 Building(s) Value: $112,400 Zoning2: null Land Value: $80,200 Zoning3: null Assessed Total Value: $192,600 Zoning Overlay: null Year Built/Remodeled: 1952/null Small Area: null 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 #: 3710374200J Building Details 2010 Census Block: 2009 WaterShed: null 2010 Census Tract: 010102 Voter Precinct: P8 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. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=3742157323078ctyp=P 4/7/2016 ,..44y,A • THIS IS NOT A PERMIT Case # EHPR-04-2016-23594 � 1.1 CATAWBA COUNTY HEALTH DEPARTMENT 0 ' � / PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES + - I842 sM Environmental Health Plan Review - Septic Malfunction :o n+ =o , I •Y RUTH CONST- SEPTIC MALFUNCTION -.,o o — — 0 . . 1 w Owner DAN & KATHY HUNSUCKER, 3216 JOHN DANIEL DR NE, CONOVER NC 28613 C:8283129666 NAME TO APPEAR ON PERMIT Dan & Kathy Hunsucker SITE ADDRESS: 823 ROCK BARN RD NE, CONOVER NC 28613 PIN # 374215732307 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 257,875.20 Acres 5.92 DIRECTIONS: Rockbarn Road, cross over Thornburg Dr, quarter mile on left. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Requesting Gravel system so that it can be self installed. 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 EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 56x41 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 4 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: 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 bounty ..d state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I unders . + t e am solely responsible for the proper identification and labeling of all property lines and corners and making the site acce ible so that a cy et- +'evaluation can be performed. Date: 7'lry Signature of Applicant or Agent ;� . An Environmental Health Specialist will contact you within 5 working e•ys of application date. If you need further information or assistance please call 828-466-7291 AREA2 F.9-ehsppl Ication 04/07/2016 09:15 Page 1 of 7 �$ CATAWBA COUNTY Case n EHPR-04-2016-23594 .Q71.11 Public Health Department Subdivision Q 71 �) 4 Environmental Health Division PIN# 374215732307 --a- PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 18.2 ,M NAME ON PERMIT: ( DAN & KATHY HUNSUCKER), 3216 JOHN DANIEL DR NE, CONOVER NC 28613 ( Dan & Kathy Hunsucker) Site Address: 823 ROCK BARN RD NE, CONOVER. NC 28613 Property Size: Square Feet 257,875.20 Acres 5'92 Directions: Rockbarn Road,cross over Thornburg Dr,quarter mile on left. .L *: ''41 k°*'F.IY,"4s,RA7 P I ;46- k FEENAMEt • vE.. �e rt;42::a #,<,h.., .rti DATE 3 t :, �'.4 FFE`AMOUNT iul Authorization to Construct (Repair) Fee 04/07/2016 $300.00 "1 aa°.TOTALFEES� 11 4'"i" : =-`rte t -4 gl x ° a. $30000ry 1 s d Ar 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 04/07/2016 09:15 Page 2 of 7 CATAWBA THIS IS NOT A PERMIT COUNTY ,.!° °a�.. CATAWBA COUNTY HEALTH DEPARTMENT North ea,on�.-- Application for Environmental Services Page 1 Improvement Permit_ Authorization to Construct n Septic Repair ❑ Septic Malfunctio Septic Expansion n New Well Permit❑ Replacement Well n Well Abandonment❑ Well Repair n Existing System Inspection (Pre-Approval Required) n Application is for New Construction n Existing Facility X -Property Address Pork ,P`ac& Subdivision Connuer IV-C . ,3 t(,13 Lot# Acres Section/Block/Phase Driving Directions to Property NAME TO APPEAR ON PERMIT? Owner n Applicant in Contractor Applicant Contact Information Name Address Phone Cell Phone • y[ Owner iCJontact Information Name KR+ 7 . {-{unSuC kg C Address • k• �.A. ► C-• KS 'r � .0 - Phone g�r�. ; 1a,el6,,,�, Cell Phone Contractor Contact information Name License# Address ° Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? XOwner n Applicant ❑ Contractor description of Existing Structures on Site }{pie # of Bedrooms *t 3 Structure Dimensions # of Occupants 4 Basement alYes n No Basement Fixtures n Yes 7No The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the properly in question. If the answer to any question is "yes", applicant must attach supporting documentation. ❑ Yes o Does the site contain any jurisdictional wetlands? Yes ❑ No Does the site contain any existing wastewater systems? ❑ Yes XNo Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes ' No Is the site subject to approval by any other public agency? ❑ Yes L 'No Are there any easements or right of ways on this property? Describe Existing water supply in use X/ Individual Well [ Community Well ❑ Semi-Public Well E1 County/City/Township Water Line Is a public water supply available? ** ❑ Yes XNo 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 'Any c ^T^ZT BA THIS IS NOT A PERMIT _ COOUNTYC ,--.. CATAWBA COUNTY HEALTH DEPARTMENT Noe,ft Cerallna Application for Environmental Services Page 2 Proposed Facility Type [ Primary Residence _ New Residence n Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement ❑ Yes H No Basement Fixtures ❑ Yes n No ❑ Accessory Structure(s) Describe At of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling [ Yes ❑ No Plumbing E.Yes n No Describe Plumbing Needed n Multi-Family Residence# Units #Bedrooms per Unit*I* Total ft 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 ❑ 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 RE TRIP 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. Signature of Owner or Agent I `11. (Ny\a,,yf, Date Li- 7 -1(0 Printed Name of Owner or Agent 4,-'tk H, Flumuckef Catawba County Environmental Health 0 o \ 7: 00 `oo \ vim"•1 \ \ 31.4 V A\I 4 1. \ Gy 31.4 \V 9.ch ' \ \ I , Allik /' • 6 A a, \ m lik• :. n 20. \ iv i 111, .06 is ,. 0, / c' \ . 90.9. N 127 30 \ '�' o ..06 \ 60 N \ 31 . m 1 00\ OL � lie : QO w� •:.34 d• 0 *01 • p1 /6)+14V1fr e5 m( 4; 28.05 /_/ ��'J D V` O b 91� 1t6. 101• 50.7 118.1: R? 7\ 7, e? X11O 1 X782 / fN Parcel: 374215732307, 823 ROCK BARN RD NE 1 in=100ft 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 04/07/2016 gA .\ CATAWBA COUNTY �� A CA 100A SOUTHWEST BLVD Sr NEWTON, NORTH CAROLINA 28658 RECEIPT s� dPer; PHONE: 828.466.8399 L) 71 7"�d,= Thursday, April 7, 2016 1 2 ve www.catawbacountync.gov 84 PAYOR: Hunsucker. Dan& Kathy PAYMENTS TRANSACTION NUMBER: TRC-650922-07-04-2016 PAYMENT DATE : 04/07/2016 PAYMENT TYPE: Check 1430 INVOICE NUMBER FEE NAME FEE AMOUNT 04-16-326948 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-04-2016-23594 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 823 ROCK BARN RD NE, CONOVER NC 28613 Owner DAN & KATHY HUNSUCKER, 3216 JOHN DANIEL DR NE, CONOVER NC 28613 C:8283I29666 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 04/07/2016 09:15 Page 1 of 1