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HomeMy WebLinkAboutEHPR-04-2016-23595.TIF $A THIS TS NOT A PERMIT Case # EHPR-04-2016-23595 Lita CATAWBA COUNTY HEALTH DEPARTMENT 0 Ln•o •f 0 "A°l .v PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES r kr 1842 zµ Environmental Health Plan Review - Septic Malfunction • C• o -v o T r •• 1.6 AUTH CONST- SEPTIC MALFUNCTION { • Owner LAYM ITCHELL, 3546 BETHANY CHURCH RD, CLAREMONT NC 28610 C:8288504265 NAME TO APPEAR ON PERMIT Laymon Mitchell SITE ADDRESS: 3546 BETHANY CHURCH RD, CLAREMONT NC 28610 PIN # 376118306841 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 52,707.60 Acres 1.21 DIRECTIONS: Hwy 10 , Left at country market, travel past Daves Auto Parts, 1st Black mailbox on the Right. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Public Water DESCRIBE WORK: Water is on the ground. Last pumped Oct. 2015. 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, well house, EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: House 43x38, Bldg 14x20 NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 3 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 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 09-ehapplicntion 04/07/2016 09:58 Page I of7 �A CATAWBA COUNTY Case EHPR-04-2016-23595 T ��..rr..`� L Public Health Department Subdivision 4 ® 4, \' j'c Environmental Health Division PIN# 376118306841 \" PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 1841 NAME ON PERMIT: (LAYMON MITCHELL), 3546 BETHANY CHURCH RD, CLAREMONT NC 28610 ( Laymon Mitchell) Site Address: 3546 BETHANY CHURCH RD, CLAREMONT NC 28610 Property Size: Square Feet 52,707.60 Acres 1.21 Directions: Hwy 10 , Left at country market, travel past Daves Auto Parts, 1st Black mailbox on the Right. %- —'°3 3z 'E i 7 RM71- . '3 Ala r r- i �r tv>>s � t I� � §' n �k t r /E�4 q I s '"� vn.{ y i d xou. ytFEENAMEi}: a!''I�.S ar_ y�yAta L ':_=�»�.iH�.."a.%.DATEjo _m. FEFxAMOUNT,g, �e Authorization to Construct(Repair) Fee 04/07/2016 $300.00 I ih is TOTAFEEs-a.vo,...o y4 *,0 5i `fi YN s gil " ' .$.300001� i sp ti V1044444. tf v :.a'.__. �ta�...u�.,a.u.aad� tuam ut44..1 ._e._,:�r_u tea :-s: a:w 1 v s:. _ _.,n i It 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) E9-ehappliraion 04/07/2016 09:58 Page 2 of7 SBA �G THIS IS NOT A PERMIT Case # EHPR-04-2016-23595 d , CATAWBA COUNTY HEALTH DEPARTMENT D`-0. �o•P t D jv9 fir: /`) ` 1 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 847, sM Environmental Health Plan Review - Septic Malfunction . o tin • D ?. AUTH_CONST- SEPTIC_MALFUNCTION r d Owner LAYMON MIRCHELL, 3546 BETHANY CHURCH RD, CLAREMONT NC 28610 C:8288504265 NAME TO APPEAR ON PERMIT La mon Mirchell SITE ADDRESS: 3546 BETHANY CHURCH RD, CLAREMONT NC 28610 PIN # 376118306841 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 52,707.60 Acres 1.21 DIRECTIONS: Hwy 10 , Left at country market, travel past Daves Auto Parts, 1st Black mailbox on the Right. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Public Water DESCRIBE WORK: Water is on the ground. Last pumped Oct. 2015. 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, well house, EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: House 43x38, Bldg 14x20 NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 3 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 accessible that a complete site,e I on can be performed. Date: 17` 7 6 Signature of Applicant or Agent ,i , . , 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 ************************************************************************************************************ E9-ehapplicati n 04/07/2016 09:49 Page 1 of 7 A��A CATAWBA COUNTY Case# EHPR-04-2016-23595 /T ctin 2 Public Health Department Subdivision L`°'°^. , '' Environmental Health Division PIN/t 376118306841 ®,, /�/ PO.Box 389, 100-A Southwest Blvd,Newton,NC 28658 is 4%SM NAME ON PERMIT: ( LAYMON MIRCHELL), 3546 BETHANY CHURCH RD, CLAREMONT NC 28610 ( Laymon Mirchell) Site Address: 3546 BETHANY CHURCH RD, CLAREMONT NC 28610 Property Size: Square Feet 52,707.60 Acres 1.21 Directions: Hwy 10 , Left at country market, travel past Daves Auto Parts, 1st Black mailbox on the Right. -Ei r`/Et _F,TH ,R 6 1 rs Is ilv a(�i '7' .Y t� r�ia�'roa-i- i^a.. mss e a�,'�!�N tyr FEENAME Ftyla �'t at, 3littY.DATE !,AvrvtFEE+A iMOUNT/I Authorization to Construct (Repair) Fee 04/07/2016 $300.00 tt �'r TOTAI FEES y 'at''��1 ' srsa ra iuw. �' s e�1h " $30000�r_ �9�f1 r� ,. .I•F rfrn.d ++? „",�.,e., E,...h.}�g„k,.w_,.e.o.t.....,a Hd.z... c t..,,.. ti,n.,.,a,.u..;..A ;u,.z:udq..ara._.. .:. §74a':icrtot u+. 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) E9-ehappl Hit ion 04/07/2016 09:49 Page 2 of 7 cATA\ BA THIS IS NOT A PERMIT COUNTY • --,., CATAWBA COUNTY HEALTH DEPARTMENT NerIF Cara Application for Environmental Services Page 1 Improvement Permit H Authorization to Construct ❑ Septic Repair H Septic Malfunction Septic Expansion H New Well Permit H Replacement Well ] Well Abandonment H Well Repair H Existing System Inspection (Pre-Approval Required) H Application is for New Construction n Existing Facility H r' Property Address ..7,5W E alAt C/ 'Az A ,JSubdivision _ C/sI,tM0.,,,l" c/f/� K rst/ 6 Lot# Acres Section/Block/Phase .`1E Driving Directions to Property /(a In w IV Airs fn Af/o 7:1,1 4' A&-- /71 // 9 l-/ /X G-ou Nl✓f'' A.A.-At 74 60 / rs , N,p tS Ai b6 Alt/S / 6 .Cl �/Ovl` /1'1144/ , I 0,v %!e A':, At NAME TO APPEAR ON PERMIT?X,Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name /6,97,,,7_,,.// if, .41,1e•Az // Address :TS"96 ,fr t/-cm✓y Glivv AV G/1re•,41..,4/7 ,,ei `'d /' Phone Cell Phone ,rd.if _ kfo - 9;1(0-- Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? Owner n Applicant ❑ Contractor Description of Existing Structures on Site F.A; //-4/ 1 ,O,- '.r/ /,;.vr-J # of Bedrooms *t 0^ Structure Dimensions # of Occupants T Basement ❑ Yes 2 No Basement Fixtures ❑ Yes ,T 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 Q,'No Does the site contain any jurisdictional wetlands? [ 'Yes ❑ No 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 p No Is the site subject to approval by any other public agency? ❑ Yes lil No Are there any easements or right of ways on this property? Describe Existing water supply in use n Individual Well n Community Well ❑ Semi-Public Well Of 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 itr Any (mot ATA�Z 7�� fHIS IS NOT A PERMIT • l�COUNTY,L�VV".L)- CATAWBA COUNTY HEALTH DEPARTMENT - „,o„„�„ Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence n New Residence n Addition to Residence #of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement ❑ Yes n No Basement Fixtures ❑ Yes IT No ❑ Accessory, Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling n Yes No Plumbing ❑ Yes No Describe Plumbing Needed ❑ Multi-Family Residence# Units #Bedrooms per Unit*t Total#Bedrooms *t Structure Dimensions n 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 El 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 IT Drilled n Bored n Dug n Unknown Well Repair Requested IT 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 corners and making the site accessible so that a complete site evaluation can be performed. c� • Signature of Owner or Agent l/ � " " Date //7//6 Printed Name of Owner or Agent .4'J., :4/ „- , it, f e--igi-/j/ • Catawba County Environmental Health r ., /._<,, / / 4 C+� . 4,,,„, 3 Z ge P l / 4111111i (3771 1 to h / .69 / .28 47.59 / v° CeP 01 \ 4'''''.1/4" —t--.. / 1-0 M1 Parcel: 376118306841 , 3546 BETHANY 1 in=60ft CHURCH RD CLAREMONT, 28610 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 Parcel Report Page 1 of 1 • Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 376118306841 Owner: MITCHELL LAYMON BRYANT Parcel Address: 3546 BETHANY CHURCH RD Owner2: null City: CLAREMONT, 28610 Address: 3546 BETHANY CH RD LRK(REID): 24022 Address2: null Deed Book/Page: 3193/1430 City: CLAREMONT Subdivision: State/Zip: NC 28610-9519 Lots/Block: / Last Sale: $74,000 on 2013-06-14 School Information: School District: COUNTY Plat Book/Page: Legal: 3546 BETHANY CH RD Elementary School: CLAREMONT Middle School: RIVER BEND Calculated Acreage: 1.210 Tax Map: 025 Y 02015 High School: BUNKER HILL Township: CATAWBA School Map State Road #: 1722 Tax/Value 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: $61,100 Zoning2: null Land Value: $14,500 Zoning3: null Assessed Total Value: $75,600 Zoning Overlay: WP-O Year Built/Remodeled: 1953/1971 Small Area: CATAWBA 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 #: 3710376100J Building Details 2010 Census Block: 2028 WaterShed: WS-IV Protected Area 2010 Census Tract: 011401 Voter Precinct: P5 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. C 2016, Catawba County Government, North Carolina. All rights reserved, ort,\Oa,--\\D \,ocok o(tscra\ a5cAe_,( tc ,r\6•v\-i htt p://gis.catawbaeountync.gov/nomap/parcel_report.php?key=376118306841&typ=P 4/7/2016 CATAWBA COUNTY 7�A 100A SOUTHWEST BLVD �� -`f NEWTON,NORTH CAROLINA 28658 RECEIPT d a�" HONE: 828.465.8399 U W ®ad°.' )-Cr Thursday, April 7, 2016 /841, SM www.catawbacountyno.gov PAYOR: Mirchell, Laymon PAYMENTS TRANSACTION NUMBER: TRC-650968-07-04-2016 PAYMENT DATE : 04/07/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 04-16-326952 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-04-2016-23595 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 3546 BETHANY CHURCH RD, CLAREMONT NC 28610 Owner LAYMON MIRCHELL, 3546 BETHANY CHURCH RD, CLAREMONT NC 28610 C.8288504265 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 04/07/2016 09:49 Page I of I