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HomeMy WebLinkAboutEHPR-04-2016-23633.TIF $A • THIS IS NOT A PERMIT Case # EHPR-04-2016-23633 v *4-4 " CATAWBA COUNTY HEALTH DEPARTMENT 0 -.A-au' . 0 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES � 1842 sM Environmental Health Plan Review - Septic Malfunction o o d __o • • 'Y AUTH CONST- SEPTIC_MALFUNCTION : Ao 0 Owner PHILLIP VAN JOHNSON, 336 27TH ST DR NE, HICKORY NC 28601 C:8283021935 NAME TO APPEAR ON PERMIT Phillip VAN Johnson SITE ADDRESS: 402 27TH ST DR NE, HICKORY NC 28601 PIN # 372206387471 NAME of SUBDIVISION: MERIDIAN PARK Lot 411-15 &ADJ Section/Block A PROPERTY SIZE: Square Feet 20,473.20 Acres 0.47 DIRECTIONS: Fairgrove Church Rd, Left onto Old Hwy 70 towards Hickory&go about 1 mile, Right onto 27th St Dr NE, 2nd house on the Right. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Community Well DESCRIBE WORK: 'water on the ground. Community Well is located in the backyard of home. 5 homes are currently connected. 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, 2 Bldgs EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: House 65x46, 2 Bldgs 10x20 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 5 PROPOSED CONSTRUCTION BASEMENT? Yes BASEMENT FIXTURES? Yes 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�I property lines and corners and making the site accessibl so tha mplete site evaluation can be performed. Date: �/1e� II b _ 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 E9-ehappllcetion 04/12/2016 11:44 Page 1 of 8 ,8 CATAWBA COUNTY Case# EHPR-04-2016-23633 .T .� � Public Health Department Subdivision MERIDIAN PARK 12 �,c;,Environmental Health Division PIN# 372206387471 ®� „ PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 84%sM NAME ON PERMIT: ( PI-IILLIP VAN JOHNSON), 336 27TH ST DR NE, HICKORY NC 28601 ( Phillip VAN Johnson) Site Address: 402 27TH ST DR NE, HICKORY NC 28601 Property Size: Square Feet 20,473.20 Acres 0.47 Directions: Fairgrove Church Rd, Left onto Old Hwy 70 towards Hickory&go about 1 mile, Right onto 27th St Dr NE, 2nd house on the Right. 7r., : kz . Mir z,m, IF'J{t 11 ° 5 1111201 a II - r' 'a1:1 2 r. FEENAMFt cmsu"C"., _ 4 i30aaa .t9..' t i •. ..�«,zE:u DATE, ,s im FEEAMOUNTQ Authorization to Construct(Repair) Fee 04/12/2016 $300.00 C:rri ii r r{ l* yl f n "52i. spa '! €�(, ��,'� � TOTAL FEES ; � � is'� ;r� ' � x$300 00 `� a x W. 0t i 9i+4 C.`..,A V-.. ..,., ..01 ktk,. n.!.$,in!:ag ;M:., . ..±Z,iHr, i..,. ii .,.,._1xa.—..N.<n.a.r.emu 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-ehapplic Lion 04/12/2016 11:44 Page 2 or8 CATAWBA THIS IS NOT A PERMIT counry CATAWBA COUNTY HEALTH DEPARTMENT ,,„, � Application for Environmental Services Page 1 Improvement Permit❑ Authorization to Construct❑ Septic Repai• , Septic Malfunction bvii Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection(Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility g] n fl Property Address I-1-0 2- 7-0417 $h DC: Ve /L. Subdivision Mt' da l o/' �%fr)ra'y 0/ Lot# Acres Section/Block/Phase Driving Directions to Property FairGroe1P CA (itch Road to 0/cf 7d /Ka(74_4 eft- Gn % l-1fllf 1-4rr /Z, htoA lei 14 rt,Or;P-e N. 5: in t/ louse./ o '1 A;f NAME TO APPEAR ON PERMIT? [Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name 1/21N JJhhSx jj'� 7�tI _ Address b 2'1L f&z2,-r L E H. L /79r J J n Phone Cc Lt— 302-19 3 r y Cell Phone 30 2 - Owner Contact Information Name Address Phone Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ® Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site S p/,* /. Eve) /fo 0 ) -4- #of Bedrooms *t 3 Structure Dimensi ns (cA (H(o #of Occupants Basement ® Yes ❑ No Basement Fixtures Yes ® No 7 100/1 100/1 , The Applicant shall notify the local health department upon submittal of this application ' any of the following apply to the property in question. If the answer to any question is"yes", applicant must attach supporting documentation. ® Yes Does the site contain any jurisdictional wetlands? )(Yes NN Does the site contain any existing wastewater systems? o Yes N Is any wastewater going to be generated on the site other than domestic sewage? CI Yes C Is the site subject to approval by any other public agency? 0 Yes o Are there any easements or right of ways on this property? Describe Existing water supply in use U Individual Well X Community Well U Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** JJ 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 Any CATAWBA THIS IS NOT A PERMIT counry CATAWBA COUNTY HEALTH DEPARTMENT ,,,„,e Application for Environmental Services Page 2 Proposed Facility Type gi Primary Residence ❑ New Residence ❑ Addition to Residence #of New Bedrooms *t 3 Project Description Structure Dimensions # of Occupants Basement CZ Yes ❑ No Basement Fixtures ® Yes ®No (J Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed L] Multi-Family Residence# Units #Bedrooms per Unit*t Total # Bedrooms *t Structure Dimensions U Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) # Employees per Shift #of Shifts Dining Area(Sq. Ft.) Li Business Specific Type of Business Retail Floor Space _ #of Employees per Shift # of Shifts U 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 ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ 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. Signature of Owner or Agent / Date 4, Printed Name of Owner or Agent Pt( t fro ft TA ins a Catawba County Environmental Health -... 4S) \ . f \ \ \ /57,3.6 \ (V j0 dal ••■ ' e ._ \ _ Mg ` w NO \ \ ` 40.36 ^ 050 / \ N 1 '6596 7 s A h .... Co t \ \ `/7 0 ? \ N ` Lowy . 4 \ p s�Tq` /kyr \ I ko Pa. Lea a '6 , I \ \ \ \ . . ■∎ yAY- \ / M 1.1\ \ , \ \ / \ A V 7749 \ \ — 9e T — r 7' — --7 -...\ r / — _ 1 / •Parcel: 372206387471, 402 27TH ST DR NE 1 in=50ft 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!hereof by any person or entity. Copyright 2014 Catawba County NC 04/12/2016 Parcel Report Page 1 of 1 • • Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 372206387471 Owner: JOHNSON PHILLIP VAN Parcel Address: 402 27TH ST DR NE Owner2: null City: HICKORY, 28601 Address: 336 27TH STREET DR NE LRK(REID): 55958 Address2: null Deed Book/Page: 2528/0963 City: HICKORY Subdivision: MERIDIAN PARK State/Zip: NC 28601-8119 Lots/Block: 11-15 & ADJ/A Last Sale: $135,000 on 2003-11-03 School Information: Plat Book/Page: 11/2 School District: COUNTY Legal: LOT 11-15 & AD PL 11-2 Elementary School: ST STEPHENS Calculated Acreage: .470 Middle School: ARNDT Tax Map: 164H 03011 High School: ST STEPHENS Township: HICKORY School Map State Road #: 1599 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: HICKORY County Fire District: ST STEPHENS Zoningl: R-1 Building(s) Value: $99,000 Zoning2: null Land Value: $15,200 Zoning3: null Assessed Total Value: $114,200 Zoning Overlay: null Year Built/Remodeled: 1963/1970 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 #: 3710372200J Building Details 2010 Census Block: 2041 WaterShed: null 2010 Census Tract: 010304 Voter Precinct: P28 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. ©2016, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=372206387471&typ=P 4/12/2016 �A c- � CATAWBA COUNTY IOOA SOUTHWEST BLVD ( rye NEWTON,NORTH CAROLINA 28658 RECEIPT K__ s► PHONE: 828.465.8399 n °dd° Tuesday, April 12, 2016 is 42 sm www.catawbacountync.gov PAYOR: Johnson, Van PAYMENTS TRANSACTION NUMBER: TRC-653878-12-04-2016 PAYMENT DATE : 04/12/2016 PAYMENT TYPE: Check 1297 INVOICE NUMBER FEE NAME FEE AMOUNT 04-16-327108 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-04-2016-23633 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 402 27TH ST DR NE, HICKORY NC 28601 Owner VAN JOHNSON, 336 27TH ST DR NE, HICKORY NC 28601 C:8283021935 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 04/12/2016 11:44 Page 1 of 1