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HomeMy WebLinkAboutEHPR-04-2016-23616.TIF yagA �� THIS IS NOT A PERMIT Case# EHPR-04-2016-23616•a CATAWBA COUNTY HEALTH DEPARTMENT 0 r e : u � � V," J PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES \4842/sM Environmental Health Plan Review - Septic Malfunction oo. . ea fi ? AUTH_CONST- SEPTIC_MALFUNCTION • of Owner ANA MARIE RODRIGUEZ, 2241 BELMAR ST, NEWTON NC 28658 H:8285783440 HOME:8285783440 NAME TO APPEAR ON PERMIT Ana Marie Rodriguez SITE ADDRESS: 2241 BELMAR ST, NEWTON NC 28658 PIN # 364920708843 NAME of SUBDIVISION: DUAN ACRES Lot ft 5 Section/Block PROPERTY SIZE: Square Feet 13,503.60 Acres 0.31 DIRECTIONS: 321, Left on Prison Camp Rd, Left St James Church Rd, Right onto Jenkins Printing Dr, left onto Belmar St,2nd house on the Left. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Community Well DESCRIBE WORK: Water is on the ground* Last pumped 2 months ago & again on 4/7/16 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: 53x37 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 identificatio an labeling of all property lines and corners and making the site acce sible so that a complete sA e e aluation can be performed. Date: `tv`�� 1,6 Signature of Applicant or Agent Ana l�AfiA r "/l�dez 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 419-ehapplle,11 n 04/08/2016 15:10 Page I of 8 pan CATAWBA COUNTY Case ft EHPR-04-2016-23616 e ri Yi Public Health Department Subdivision DUAN ACRES < a, Environmental Health Division '5 P1N# 364920708843 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 1g42 :u NAME ON PERMIT: (ANA MARIE RODRIGUEZ), 2241 BELMAR ST,NEWTON NC 28658 ( Ana Marie Rodriguez) Site Address: 2241 BELMAR ST,NEWTON NC 28658 Property Size: Square Feet 13,503.60 Acres 0.31 Directions: 321, Left on Prison Camp Rd, Left St James Church Rd, Right onto Jenkins Printing Dr, left onto Belmar St, 2nd house on the Left. ri FEENAME Ci, '" ` s ,DATE - - yi ` FEE'AMOUNT':§ Authorization to Construct(Repair) Fee 04/08/20]6 $300.00 1 ' -Witt; TOTALa FEES ., .m ', S,.p +-7,11 ., i`1'r,?:a' . t. 3,^". E�-,"a; .;.s4 ": $300 00 ;€ r i ti.n atg 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) E9-ehapplication 04/08/2016 15:10 Page 2 of 8 CATAWBA THIS IS NOT A PERMIT ``�counr ��L 1� � --, a CATAWBA COUNTY HEALTH DEPARTMENT „o„�� ,v Application for Environmental Services Page 1 Improvement Permit ❑ Authorization to Construct H Septic Repair H Septic Malfunction Septic Expansion ❑ New Well Permit n Replacement Well n Well Abandonment H Well Repair H Existing System Inspection (Pre-Approval Required n Application is for New Construction H Existing Facility Property Address a� I 1 By/rr)a Y 3+ Subdivision /lieu) I on Iv( 2-S5 g- Lot# Acres Secfion/Bloc hase *. Driving Directions to Property nqn� .3 2_ 1 ke f on iris/on CA�"n' e 0 r So.n a6\Irrl S re,i`3h-I- on NAME TO APPEAR ON PERMIT?`Owner n Applicant ❑ Contractor Applicant Contact Information �\ Name Address Phone Cell Phone Owner Contact Information pp i Name Arta rill UOdric3Ua?- Address 9_�*) IMP in a( 54 Phone Cell Phone (g_g) 575'-3t/40 Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? Owner n Applicant n Contractor Description of Existing Structures on Site l(7, # of Bedrooms *t Struc re Dimensions 300 ; f # of Occu ants S Basement ❑Yes No Basement Fixtures n Yes D)<o X 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 *No Does the site contain any jurisdictional wetlands? ` Yes g 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 No Is the site subject to approval by any other public agency? ❑ Yes No Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well 4S,Community Well ❑ 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): 4/(systems can be ranked in order of your preference) \vl ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other S$ny CATAWBA BA THIS IS NOT A PERMIT COUNTY,. VY�* "-�4' CATAWBA COUNTY HEALTH DEPARTMENT „o,N;„o Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence Ti Addition to Residence #of New Bedrooms *t Project Description Structure Dimensions #of Occupants Basement Ti Yes ❑ No Basement Fixtures ❑ Yes ❑ No ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing Yes ❑ 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.) ❑ Business Specific Type of Business Retail Floor Space #of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Church# of Seats Kitchen Ti Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type Ti Individual Well Semi-Public Well ❑ Community Well Abandonment Type n Drilled Ti Bored n Dug n Unknown Well Repair Requested ❑ Yes Ti 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 figure 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 ybe performed. ■ t. Signature of Owner or Agent h/)_k Far kcif fg(U t Date c /c5// Printed Name of Owner or Agent Catawba County Environmental Health Zfe (1) 0 °o P r o il Mt IJI (1 82) 178.49 co u, Ni 0 8 $ 8 cn 0 8 Si 164.36 Imi. ®' . I co to a 0 174'5 r c31 o N 0 qn / : 0 R ic (P r :. 149.43 z nv pp ti 6 O pp O 139.97 g a alt 1.0.00 60 JENKINS PRINTING DR ( Parcel: 364920708843, 2241 BELMAR ST 1in=50ft NEWTON, 28658 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 04/08/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 364920708843 Owner: RODRIGUEZ-CHAVEZ JOSE TOMAS Parcel Address: 2241 BELMAR ST Owner2: RODRIGUEZ ANA M City: NEWTON, 28658 Address: 2241 BELMAR ST LRK(REID): 29351 Address2: null Deed Book/Page: 2850/1439 City: NEWTON Subdivision: DUAN ACRES State/Zip: NC 28658-9484 Lots/Block: 5/ Last Sale: $99,500 on 2007-07-13 School Information: Plat Book/Page: 15f20 School District: COUNTY Legal: LOT 5 5 PL 15-20 DUAN ACRES PL 15- Elementary School: TUTTLE Middle School: MAIDEN 20 Calculated Acreage: .310 High School: MAIDEN Tax Map: 042N 04005 School Map Township: NEWTON State Road #: 2612 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: NEWTON RURAL Zoningl: R-40 Building(s) Value: $85,400 Zoning2: null Land Value: $9,400 Zoning3: null Assessed Total Value: $94,800 Zoning Overlay: null Year Built/Remodeled: 1975/null Small Area: BALLS CREEK 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 #: 3710364900J Building Details 2010 Census Block: 1008 WaterShed: null 2010 Census Tract: 011601 Voter Precinct: P32 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. AM rights reserved. , Lu k' ' `'"' 00( ,s, � `, \� Q(ssk http://gis.catawbacountync.gov/nomap/parcel_report.php?key=364920708843&typ=P 4/8/2016 A p CATAWBA COUNTY G IOOA SOUTHWEST BLVD � NEWTON,NORTH CAROLINA 28658 RECEIPT > PHONE: 828.465.8399 U ®a- Friday, April 8, 2016 1842 sM www.catawbacountync.gov PAYOR: Rodriguez,Ana Marie PAYMENTS TRANSACTION NUMBER: TRC-651868-08-04-2016 PAYMENT DATE : 04/08/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 04-16-327028 Authorization to Construct(Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-04-2016-23616 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 2241 BELMAR ST, NEWTON NC 28658 Owner ANA MARIE RODRIGUEZ, 2241 BELMAR ST, NEWTON NC 28658 H:8285783440 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 04/08/2016 15:09 Page 1 of 1