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HomeMy WebLinkAboutEHPR-04-2016-23655.TIF , G THIS IS NOT A PERMIT Case # EI-IPR-04-2016-23655 v L CATAWBA COUNTY HEALTH DEPARTMENT 0 -;1;1... f . 0 411,"' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES k' • a 7 1842 sM Environmental Health Plan Review - Septic Malfunction -•o.. o • AUTH_CONST- SEPTIC_MALFUNCTION � ;moo ° • Applicant JULIA MENDEZ, 3635 34T1-1 AV PL NE, HICKORY NC 28601 C:8285145266 Owner AGUSTIN IBARRA-LEMUS, 3635 34T1-1 AV PL, HICKORY NC 28601 C:8285145266 NAME TO APPEAR ON PERMIT Agustin Ibarra-Lemus SITE ADDRESS: 3635 34TH AV PL NE, HICKORY NC 28601 PIN # 373409050029 NAME of SUBDIVISION: SPRINGWOOD TERRACE Lot 15-18 Section/Block A PROPERTY SIZE: Square Feet 22,215.60 Acres 0.51 DIRECTIONS: Sulphur Springs Rd NE go past Cowboy Country Store, about 4 streets down on Right will be a sign "Springwood Terrace", Take a Right at the sign onto 34th Ave PL NE, 2nd House on the Left past the apartments. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Tank was been pumped twice within the last 6 months. 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, Shed EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: House 64x30, Shed 5x5 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: E9-chapplication 04/15/2016 09:54 Page 1 of 8 xsA CATAWBACOUNTY Case# EHPR-04-2016-23655 . G Public Health Department Subdivision SPRINGWOOD TERRACE 119 4, Environmental Health Division PIN# 373409050029 IL® PO Box 389, 100-A Southwest Blvd.Newton. NC 28658 18,11. :u NAME ON PERMIT: (AGUSTIN IBARRA-LEMUS), 3635 34TH AV PL, HICKORY NC 28601 ( Agustin Ibarra-Lemus) Site Address: 3635 34TH AV PL NE, HICKORY NC 28601 Property Size: Square Feet 22,215.60 Acres 0.51 Directions: Sulphur Springs Rd NE go past Cowboy Country Store, about 4 streets down on Right will be a sign "Springwood Terrace", Take a Right at the sign onto 34th Ave PL NE, 2nd House on the Left past the apartments. 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:_L/,/f (p Signature of Applicant or Agent '//� t..�w ✓/ri'1",�. 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 ************************************************************************************************************ f� FEENAriIEry� GI 1I llmaiihd mil l T Illi�j[% D TE f�1�a FEEAMOUNTt� II �� �� I ��1 b �II�I�IIh�� �l,i. Authorization to Construct(Repair) Fee 04/15/2016 $300.00 1'TOTAli jFEElllllllH'�I'lO�Illllllttlll(:IIYf�llllllllllllllilllllil _ fl IIw� �I{It1I'krr '��II�tllhi� . L!�ill�'a I l�l..i � tl ii 8u ii[� I '��� � �i it +� MIL ltJ- u nIffi9fNIW111101 Ir ;,tWy'-"i'ilFralailL.l=lilllfhW,1iD'dllS °.', JWWldL..1161,tL.ilCilithl6 r,�g1W ��i FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) h9-ehtpplicati-n 04/15/2016 09:54 Page 2 of 8 CATAWBA THIS IS NOT A PERMIT C UNTT CATAWBA COUNTY EALTH DEPARTMENT Ne.;ti.soy;;. ` Application for Environment 1 Services Page 1 Improvement Permit n Authorization to onstruct ❑ Septic Repair ❑ Septic Malfunction i Septic Expansion ❑ New Well Per it❑ Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing S stem Inspection(Pre-Approval Required) ❑ Application is for New Cinstruction ❑ Existing Facility '� Property Address 71o3c "")t-I-\I1 Ave ?L. N . Subdivision 1-1ic1<rn NIc 2,9&(71 Lot# Acres Section/Block/Phase �— Driving Directions to Property f f 011 S r 1 OYi1 C' e. YIeX-}� I it). t a YTh i v Ic k.e-Pk NAME TO APPEAR ON PERMIT?Owner n Applicant ❑ Contractor Applicant Contact Information 4kName ,AlAti'a Menck -i (, ,1 Address ''Dtc 3J 2cNi n hit K NE .}sc1(0/y Ale 2,q01 Phone ] Cell Phone I1j$ -/q 05-70 S,' Owner Contact Information iJ� Name/AGUc4.-;A lbeekrta LeY'11,t5 Address J3 Co -ifs ThciIk h /Rve Pi_ hiF Phone Cell Phone (2S C) Li --S-7(zte Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? n Owner `>. Applicant ❑ Contractor Description of Existing Structures on Site # of Bedrooms *t 3 _ Structure Dimensions # of Occupants 5 Basement ❑ Yes V No Basement Fixtures ❑ Yes No "1_ 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 I /No Does the site contain any jurisdictional wetlands? Yes I No Does the site contain any existing wastewater systems? ❑ Yes dNo 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 LU No Are there any easements or right of ways on this property? Describe Existing water supply in use Si Individual Well U Community Well T Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** n Yes No If applying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Ty e(s): (systems can be ranked in order of your preference) _,N10 Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other Any cATA% BA THIS IS NOT A PERMIT COUNTY ,E `^�, CATAWBA COUNTY HEALTH DEPARTMENT es —„0„„c"—;;;;;,--,It, Application f'or Environmental Services Page 2 Proposed Facility Type n Primary Residence n New Residence ❑ Addition to Residence #of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement ❑ Yes n 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 n 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.) n Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts n 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 Li Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored Dug [ Unknown Well Repair Requested [ Yes n Na 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 Pennits 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. 4t Signature of Owner or Agent Date �' ) 5 _ I 0�p J�' Printed Name of Owner or Agent j (/t I F � e CZ Catawba County Environmental Health s czP \ 0.0 1335 \ 1g \ \ \\ \ \ \ \ \ \ \ \ \ \ \ 133 1013 \\ \\ \ Ca \ \ \ \ \ \ • \ \ \ \ \ \ V A \ V \ . \ \ \ \ \ \ • \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ `'a \ \ a \ \ �-, \ \ t \ \ \ \� \ \ \ . \ \LP t attV A \ \• \ \ \ \ T \ \ \ \ \ \ � \ \ \ \ \ \ \ \ \ \ f \ \ \ \ \ \ \ / \ \ \ \ ` _ 120 9 \ \ \ so \ 10° \ Nc\ \ \\ \\ 3A�P Parcel: 373409050029, 3635 34TH AV PL NE 1in=40ft 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 thereof by any person or entity. Copyright 2014 Catawba County NC 04/15/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 373409050029 Owner: IBARRA-LEMUS AGUSTIN Parcel Address: 3635 34TH AV PL NE Owner2: null City: HICKORY, 28601 Address: 3635 34TH AVE PL NE LRK(REID): 50173 Address2: null Deed Book/Page: 3201/1017 City: HICKORY Subdivision: SPRING WOOD TERRACE State/Zip: NC 28601-7722 Lots/Block: 15-18/A Last Sale: $48,000 on 1989-11-01 School Information: School District: COUNTY Plat Book/Page: 12/42 Elementary School: SNOW CREEK Legal: LOT 15-18 15-18A PL12-42 SPRINGWOOD PL 12-42 Middle School: ARNDT Calculated Acreage: .510 High School: ST STEPHENS Tax Map: 1412 04011 School Map Township: CLINES State Road #: 1643 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: ST STEPHENS Zoningl: R-20 Building(s) Value: $66,300 Zoning2: null Land Value: $14,800 Zoning3: null Assessed Total Value: $81,100 Zoning Overlay: null Year Built/Remodeled: 1964/null Small Area: ST STEPHENS/OXFORD 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 #: null Building Details 2010 Census Block: 1036 WaterShed: null 2010 Census Tract: 010301 Voter Precinct: P33 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=373409050029&typ=P 4/15/2016 SA CATAWBA COUNTY i A IOOASOUTHWESTBLVD y NEWTON, NORTH CAROLINA 28658 RECEIPT U\ QVa;� PHONE: 828.465.8399 �aso.' Friday, April 15, 2016 W 1842 SM www.catawbacountync.gov PAYOR: Mendez,Julia PAYMENTS TRANSACTION NUMBER: TRC-655576-15-04-2016 PAYMENT DATE : 04/15/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 04-16-327253 Authorization to Construct (Repair) 5220.00 Fee TOTAL PAYMENTS : $220.00 EHPR-04-2016-23655 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 3635 34TH AV PL NE, HICKORY NC 28601 Applicant JULIA MENDEZ, 3635 34T1-1 AV PL NE, HICKORY NC 28601 C:8285145266 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner AGUSTIN IBARRA-LEMUS, 3635 34TH AV PL, HICKORY NC 28601 C:8285145266 receipt 04/15/2016 09.51 Page I of 1 4'A CATAWBA COUNTY 4e O IOOASOUTHWESTBLVD r' NEWTON, NORTH CAROLINA 28658 RECEIPT .1P PHONE: 828.465.8399 V wv��); C Friday, April 15, 2016 /842 SM www.catawbacountync.gov PAYOR: Mendez,Julia PAYMENTS TRANSACTION NUMBER: TRC-655578-15-04-2016 PAYMENT DATE : 04/15/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 04-16-327253 Authorization to Construct (Repair) $80.00 Fee TOTAL PAYMENTS : $80.00 EHPR-04-2016-23655 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 3635 34TH AV PL NE, HICKORY NC 28601 Applicant JULIA MENDEZ, 3635 34TH AV PL NE, HICKORY NC 28601 C:8285145266 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner AGUSTIN IBARRA-LEMUS, 3635 34TH AV PL, HICKORY NC 28601 C:8285145266 receipt 04/15/2016 09:54 Page I of 1