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HomeMy WebLinkAboutEHPR-04-2016-23670.TIF THIS IS NOT A PERMIT Case# EHPR-04-20 1 6-23 67 0 r CATAWBA COUNTY HEALTH DEPARTMENT 0 1o• '-S 0 ) PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES '1 • • Ft- ir 842 sn Environmental Health Plan Review - Septic Malfunction o no .o. 1 .1 AUTH_CONST- SEPTIC_MALFUNCTION .0 • d - o Owner BRADFORD STEELE,2841 SIGFIELD DR, CLAREMONT NC 28610 C:8032374888 NAME TO APPEAR ON PERMIT Bradford Steele SITE ADDRESS: 2841 SIGFIELD DR, CLAREMONT NC 28610 PIN # 375212868982 NAME of SUBDIVISION: SIGFIELD ACRES Lot# PT 1-8 Section/Block E PROPERTY SIZE: Square Feet 60,984.00 Acres 1.4 DIRECTIONS: 140 East, Exit 135- Left at stop sign, 1/2 mile & Sigfield is on the Left, 2nd house on Left. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: Water is on the ground. Last pumped 4 weeks ago. 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, Building EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: House 58x47, Bldg 20x50 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 responsibl�r the proper identification and lab ling of all property lines and corners and making the site acce ibte o that a co ..e - site u- ion cce-"rbF pe j Date: �� _ ( �/ 4- Signature of Applicant or Agent A - i i An Environmental Health Specialist will contact youyithin 5 working d./ of application date. F r If you need further information or assistance please call 82:-466-7291 AREA2 F9-ehapplicouon 04/18/2016 10:34 Page I of 7 -c,A CATA VSA COUNTY Case# EHPR-04-2016-23670 .f' lak: Public Health Department Subdivision SIGFIELD ACRES d net 4 Environmental Health Division PIN# 375212868982 \s..1 t- PO Box 389. 100-A Southwest Blvd,Newton,NC 28658 /8,2, ,. NAME ON PERMIT: ( BRADFORD STEELE),2841 SIGFIELD DR, CLAREMONT NC 28610 ( Bradford Steele) Site Address: 2841 SIGFIELD DR, CLAREMONT NC 28610 Property Size: Square Feet 60,984.00 Acres 1.4 Directions: 140 East, Exit 135- Left at stop sign, 1/2 mile & Sigfield is on the Left, 2nd house on Left. IJIIFEENAME{ ILL 21 ...y, r1 I l �if�`Fllliui�li,iiIii rIDATE �li� FEE'�A'MOUIN11T1�' I r�i� E,�Illi,.ull, 41111 Authorization to Construct(Repair) Fee 04/18/2016 $300.00 ; � , i t Il i 1,� i l nm �t p i 1 1 { '�1 �p;�rTOTA ,FEES I ,. ` ��� „1�11.N II IIV��VIItiIIHli11llV1lli��u�,� �:'I[I�ilil"JI F�iUVl11G4$3oo 0011.; ( i(iw1 t.o-UVd mild L.. - -.s,.x. ,'Lel . iotL"f191i.ILlflllltll?IIdBINIBt, imaiii uIiNJtI a1- u iumIki 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 ication 04/18/2016 10:34 Page 2 of 7 CATAWBA THIS IS NOT A PERMIT COUNTY y >� CATAWBA COUNTY HEALTH DEPARTMENT „o„„c.„ Application for Environmental Services Page 1 • Improvement Permit n Authorization to Construct n Septic Repair n Septic Malfunction) Septic Expansion n New Well Permit❑ Replacement Well ❑ Well Abandonment Well Repair n Existing System Inspection (Pre-Approval Required) Application is for New Construction ❑ Existing Facility Property Address'L`{jkt rc N Subdivision CL.ocetc NC— 2- E)).0 Lot# Acres Section/Block/Phase ” /\ Driving Directions to Property , \ E E1?< l 35 Lt # o S�v(� Skt1 /7 Pecil NAME TO APPEAR ON PERMIT? Owner ❑ Applicant n Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name"R�ac_.�vc'c1 `j\cc\ Address 2<y 1 `J �cA2\cL Th-c Phone Cell Phone 2R^ r“S< Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT?XeOwner n Applicant n Contractor Description of Existing Structures on Site }- i=• rjQ / ,b1, ; La r� #of Bedrooms *t (5 Structure Dimensions J #of Occupants S Basement ❑ Yes '-''No Basement Fixtures ❑ Yes r rArl ,D 7( \ l) The Applicant shall notify the local health department upon submittal of this application i any of the following apply to the property in uestion. If the answer to any question is "yes”, applicant must attach supporting documentation. ❑ Yes Does the site contain any jurisdictional wetlands? Yes * N'o Does the site contain any existing wastewater systems? ❑ Yes c�No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes Is the site subject to approval by any other public agency? ❑ Yes Are there any easements or right of ways on this property? Describe Existing ww ter supply in use n Individual Well ❑ Community Well n Semi-Public Well LVC ounty/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 >Any cATAB A THIS IS NOT A PERMIT cocnry VV 1? CATAWBA COUNTY HEALTH DEPARTMENT „o„; 21 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 IT No Basement Fixtures ❑ Yes ❑ No ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes n No Plumbing n Yes n No Describe Plumbing Needed n Multi-Family Residence/4 Units #Bedrooms per Unit*t Total # Bedrooms *j 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 n No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type n Individual Well ❑ Semi-Public Well n Community Well Abandonment Type n Drilled ❑ Bored ❑ Dug n Unknown Well Repair Requested ❑ 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. f 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 comers and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent Val Date 1 C�`l i Printed Name of Owner or Agent 9[OE/81/40 ON Aluno0 egmele0 6loa 146uAdoo Aulua io uosiad/ue Aq yoaiagl asn ad io lonpoid podai/dew sill WW1 asue hew io sasue yaigm Ie!uanbasuoo 10 laanpui 'pail's iaglagm'61Imagei!io ssoI'sa6ewep He pue Rue Jo;aigep play aq lou Heys pue wiepsip'jauuosJad pus'saue6e'saaAoidwa s!i egmele0 yo 61unoO all Jasn aqi Aq lonpoid podal/dew sill uo paweluoa elep hue yo uogeayuan luapuadapua all spuawwooai pue salowoid Aluno0 egmele3 pods.]sail uo elep io dew sail uo pauieluoa uoilewioyui Euijagei pue=wool Jo Amnon all amsua of spoils aeguelsgns spew seq RlunoO egmeleO saaaniag uonewJoyui aepedsoa0 ON 'Aiuno0 egmele°aql woe paiedaid sem ionpwd podai/dew sail O198Z 'INOIN3EN1O 1109=u!l Ida 0-1313JIS 11783 '3969993139LE :leafed / -----Th "St 71 lit}, `. 9 uili; `} 4 ,,, tlH _ l' 4111a`..it �ryalli1I'lins`',' 1 / 176' f OOZ 1 DOZ Fr1 / I _ 1 I o ill 1 I T et I z w I I c4 80 0131e0I6 \--------, 9,6 004 4.\\\\----,, I I gUIEeH IeTuewuoalnuB ATunoD BgMB B3 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 375212868982 Owner: STEELE BRADFORD Parcel Address: 2841 SIGFIELD DR Owner2: STEELE TARAH City: CLAREMONT, 28610 Address: 2841 SIGFIELD DR LRK(REID): 68177 Address2: null Deed Book/Page: 3270/0846 City: CLAREMONT Subdivision: SIGFIELD ACRES State/Zip: NC 28610-8624 Lots/Block: PT 1-8/ E Last Sale: $72,000 on 2014-12-18 School Information: Plat Book/Page: 13/35 School District: COUNTY Legal: LOTS 41-48 & PT LOTS 1-8 BLOCK E Elementary School: CLAREMONT Middle School: RIVER BEND PLAT 13-35 Calculated Acreage: 1.400 High School: BUNKER HILL Tax Map: 3313 03002 School Map Township: CLINES State Road #: 2415 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: CLAREMONT Zoning District: CLAREMONT County Fire District: All in City Zoning1: R-1 Building(s) Value: $77,700 Zoning2: null Land Value: $20,100 Zoning3: null Assessed Total Value: $97,800 Zoning Overlay: null Year Built/Remodeled: 1971/null Small Area: null Current Tax Bill Split Zoning Districts: null/null Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710375200J Building Details 2010 Census Block: 3014 WaterShed: WS-IV Protected Area 2010 Census Tract: 010102 Voter Precinct: P6 Agricultural District: PROXIMITY Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. ©2016, Catawba County G vernment, North Carolina. All rights reserved. \rtc\J2S Ki 0 —1 ELI 1)*fr) \N- ) (eAr \ek\k \ - 'it http://gis.catawbacountync.gov/nomap/parcel_report.php?key=375212868982&typ=P 4/18/2016 „\j'A Cc CATAWBA COUNTY rT G7, 100A SOUTHWEST BLVD ”+I ' NEWTON, NORTH CAROLINA 28658 RECEIPT { aa>e g PHONE: 828.465.8399 U oa►o Monday, April 18, 2016 /i8 c�° / 1$x}2 sM www.catawbacountync.gov PAYOR: Steele, Bradford PAYMENTS TRANSACTION NUMBER: TRC-657312-18-04-2016 PAYMENT DATE : 04/18/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 04-16-327318 Authorization to Construct(Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-04-2016-23670 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 2841 SIGFIELD DR, CLAREMONT NC 28610 Owner BRADFORD STEELE, 2841 SIGFIELD DR, CLAREMONT NC 28610 C:8032374888 ** NO PEOPLESOFTACCOUNTASSIGNED ** receipt 04/18/2016 10:33 Page 1 el 1