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HomeMy WebLinkAboutEHPR-04-2016-23674.TIF 13A �G THIS IS NOT A PERMIT Case # EHPR-04-2016-23674 4 CATAWBA COUNTY HEALTH DEPARTMENT D - o ' o e j1hvq `� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 SM Environmental Health Plan Review - Repair • • o + o , AUTH CONST- REPAIR 0' D Contractor BUMGARNER SEPTIC TANK&GRADING (MICHAEL BUMGARNER), 1190 DUDLEY SHOALS GRANITE FALLS NC 28630 8:8283961795 C:8283200878 Owner CLAUDE&SALLY ROJZMAN, 3485 BRIDGEFORD LN, NEWTON NC 28658 H:8282946789 C:8282447393 HOME:8282946789 NAME TO APPEAR ON PERMIT Claude & Sally Rojzman SITE ADDRESS: 3485 BRIDGEFORD LN, NEWTON NC 28658 PIN # 371018427043 NAME of SUBDIVISION: Lot# 2 Section/Block PROPERTY SIZE: Square Feet 77,101.20 Acres 1.77 - DIRECTIONS: From Newton, Down Sandy Ford Rd, Go past Catawba Country Club, 1st Left Bridgeford Lane (one way St) before the bridge, 4th house on the Left. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Existing drain field runs across to another property. Neighbor is wanting to grade his property over& is requiring that she relocates her drain field. Needing to relocate the drain lines to her property. 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, Pool. Pool house EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: House 75x64, Pool house 10x10 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 2 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-ehapp I ication 04/18/2016 11:44 Page 1 ors ty,A CATAWBA COUNTY Casein EHPR-04-2016-23674 7 all Public Health Department Subdivision G woit lINk Environmental Health Division 371018427043 PO Box 389. 100-A Southwest Blvd, Newton.NC 28658 Ig 2 ,w NAME ON PERMIT: (CLAUDE& SALLY ROJZMAN), 3485 BRIDGEFORD LN, NEWTON NC 28658 ( Claude & Sally Rojzman) Site Address: 3485 BRIDGEFORD LN, NEWTON NC 28658 Property Size: Square Feet 77,101.20 Acres 1'77 Directions: From Newton, Down Sandy Ford Rd, Go past Catawba Country Club, 1st Left Bridgeford Lane (one way St) before the bridge, 4th house on the Left. 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 under nd that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site acc-.'ible so at a co I e site 7�a�luaa ' can be performed. Date: /-t- j'�• ( (p Signature of Applicant or Agent r—. � / 4 An Environmental Health Specialist will contact you within 5 working .ays of p tcation date. If you need further information or assistance please call 828-466-7291 AREA2 EiTllllilil!fhh... _ tl it h 111 'a I�I{���I ��I�I'% k f�9II I111� .9:1(' �"I hlni;(I6Trl I',FEENAME I���li l� "' l�i]Mt Ill �III!�lll�ilti DATE��(I1�� iFEE'A'MOUNTrt Authorization to Construct (Repair) Fee 04/18/2016 $300.00 �11l111�€i1 &TOTAL FEESI I!iI!iI ii�ll�fa��1 i gi(!�I{�I[I�i@•;rI211 1/1191$300100,711 hill f Nun,._.—tL.Wi!I�JIWI�, .,t'.t>!'Adii a0L'IIINW41t�1118i1h I(i...• - • ngilWJiIlllsadi iillllts• .0!N uL11UL6811WU ifL t 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) P9-ehapplicatH 04/18/2016 11:44 Page 2 of 5 CATAWBA THIS IS NOT A PERMIT cou�T CATAWBA COUNTY HEALTH DEPARTMENT �. Application for Environmental Services Page 1 Improvement Permit El Authorization to Construct❑ Septic Repair `fh Septic Malfunction❑ Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility Property Address * 05 (i)6ctrb(Pa) ,LN Subdivision G- 9•&(SCS Lot# Acres ( , 7 7 Section/Block/Phase Driving Directions to Property FAD WI ftf l• 070 IJ / 1)oWn f rx-zA. Rcb,[ l • / Past- Ceti'aw bar ( L (-Ado / Pitt- -(c-y∎ Fv /er L C h ckF„Ne_ 17hAore) i._ ftt ko-hce 9u (� NAME TO APPEAR ON PERMIT? 'Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name CLv17i „ //�� u-, poi-2M fJ Address 3425 SRI-D6c, SP b ��R K L D,3 . Jf Phone to, , 9441_ t77 l / Cell Phone 5(2 — 4.4_ '7&5 Owner Contact Information Name `Ja tV(f ot-c7 6t9c•r e Address Phone Cell Phone Contractor Contact Information Name Wit cAn t dt Address ( I6(D I)u7DC€- )et �S i et Phone�� _ �c�_J 7 y Phone g-a_t — 3-7,0 — pSy' WHO WILL BE THE PRIMARY CONTACT? Owner ❑ Applicant Contractor Description of Existing Structures on Site U • ` u ♦• #of Bedrooms *t �j Structure Dimensions' / X L #of Occupants Basement ❑ Yes sp No Basement Fixtures 0 Yes No 'pr, Hot) I(DY'l( 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. jYes ®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? ED 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 U Community Well U Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes lklo 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 cou�ry CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence #of New Bedrooms *t Project Description Structure Dimensions #of Occupants Basement ❑ 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 Li 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.) LJ Business Specific Type of Business Retail Floor Space #of Employees per Shift #of Shifts ❑ 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 way \ Date . /c /Cp Printed Name of Owner or Agent CJ,Q-L``L•l ' ,Ur z_AAA-AS Catawba County Environmental Health (399 (178) BRIDGEFORD LNG - 03471 (2031 r_ ......, 0 .0 I . i i ,, 0 5 / ie wit 3 0 iii, wzq 0 N .348 Go 9. no et Ns�� w� a co aa,, it • 0 ...110.00 * Q)S tto.o1 _ 0 u ./r Parcel: 371018427043, 3485 BRIDGEFORD LN 1in=60ft 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 04/15/2016 Parcel Report • Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 371018427043 Owner: ROJZMAN CLAUDE C Parcel Address: 3485 BRIDGEFORD LN Owner2: ROJZMAN SALLY V City: NEWTON, 28658 Address: 3485 BRIDGEFORD LN LRK(REID): 38038 Address2: null Deed Book/Page: 1780/0147 City: NEWTON Subdivision: State/Zip: NC 28658-8415 Lots/Block: 2/ Last Sale: $126,500 on 1992-05-01 School Information: Plat Book/Page: 29/85 School District: COUNTY Legal: LOT 2 2 PL29-85 COUNTRY CL PL 29-85 Elementary School: BLACKBURN Middle School: JACOBS FORK Calculated Acreage: 1.770 Tax Map: 072N 01002 High School: FRED T FOARD Township: NEWTON School Map State Road #: 2921 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: HICKORY RURAL Zoningl: R-20 Building(s) Value: $157,600 Zoning2: null Land Value: $28,100 Zoning3: null Assessed Total Value: $185,700 Zoning Overlay: ED-O Year Built/Remodeled: 1952/null Small Area: STARTOWN 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 #: 3710371000J Building Details 2010 Census Block: 2027 WaterShed: null 2010 Census Tract: 011701 Voter Precinct: P34 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 at 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. Nf n 3 N -Frue Nc L . 3 .� �CMa. C nN i 4fbef--1- I (Luc N � � http://gis.catawbacountync.gov/nomap/parcel_report.php?key=371018427043&typ=P 4/18/2016 t 0;(5 CATAWBA COUNTY-HEALTH DEPARTMENT Telephone: (828)465-8270 TDD: (828)465-8200 WLS# &D LO/7 IP AC 4 RBi. Print. Opr. Prmt._Sys. Type Well Prmt. Replacement We11�Well Rpr. Prtnt. Owner gent /4 C ' Z �ln Phone Address ,..--w S e / (i, Subdivision s. '. 'tom 0 • , a Sr tion/Block/Phase Lotk< 0 ize irec : �/(/��//M'g:rSI 1711171 /��el - /, [ £ iw�ssi Off �'L Oft .t Property Address z:�:,� Facility: House k Mobile Home Business_Multi-family . Other: Pin N ber — ,.�� i Other . Zoning Approval# #Bedrooms #Seats #Employees . Application Rate GPD Flow Hot Tub or Spa yes/no Special Fixtures Basement yes/no . 100% Repair Area yes/no Basement Plumbing yes/no Water Supply: Private Well Public Semi-Public 44444**44*4*444*#44*********4***444444*******44*4***********4*4444*****44*********444*4******4***********4444444*#********* Type of System: Trench Bed Pump Pump/Panel Panel LPP Other Septic Tank Size Pump Tank Size Nitrification Field: Ti . quare Feet Depth of Stone Bed Size Trench Width Total Length of • renclkeA Number of Trenches Trench Length /_/_/_/ / Feet on Center iy1af num Tren Depth Distance of Ne. est Well *DO NOT INSTALL SEPTIC WHEN WET* WELL RECORD REQUIRED •T COMPLETION* *******************4**�il**1*****4***4*t4 ** **** ***************************************4*******'*************4**** Topo % Slope �JVf1°��� „p f 1111 • Texture 5N' Structure et/4V/tl' /Clay Min. A-01C-7 . Soil Wetness " Soil Depth �_ Restric. Hoz. at " / ........., Available space yes/no ' e / •Overall Class S PS U 1 I Comments:__ _ 4 l .. hN�yy,)• .. -_ „. / 4 1 I er- I/ . 4.f .,, ,., _...„, _ C\ . ,, Filter Required Riser required when tank is more than 6 . inches deep. p/ **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEI AA THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** 4444***4444********4***4444*4***. -"' ******4************************************** "" 4**4*4********4****4**4*4 *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes the proposed facility. An Authorization to Construct is valid for(5) five years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. ' The siting of the well by the Health Department staff is to provide protection from known possible sources of contamination. No volume of water is guaranteed at an site b 'the Health Department. Permit Date ilt� J Z {JI El-IS ' Owner/Agent `_/_ 'R !.!, . v\ Septic Tank a Date EHS nnth Well Installed By A // �1Q.C, Well Grout Approval lDDate c o/ Well Head Approval Date L4 —Oo—,0.l U'Datc'Sample Collected O �p /yY ' '•�° — Date of Results Results EHS e2.4�-4 White-Office Blue-Building Inspection Operation Permit Yellow-Owner/Agent Green-Building Inspection Authorization to Construct .ySY'p' Cp CATAWBA COUNTY LT100A SOUTHWEST BLVD 8 . NEWTON, NORTH CAROLINA 28658 RECEIPT `. eanm!�ul ,„ q' H U `- 'NI,w.D ` PHONE: 828.465.8399 Monday, April 18, 2016 1$42 SM WwW.cataWbacountync.gov PAYOR: Rojzman, Claude& Sally PAYMENTS TRANSACTION NUMBER: TRC-657378-18-04-2016 PAYMENT DATE : 04/18/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 04-16-327326 Authorization to Construct(Repair) $300.00 Fee TOTAL PAYMENTS : 5300.00 EHPR-04-2016-23674 CASE TYPE: Environmental Health Plan Review WORK CLASS: Repair SITE ADDRESS: 3485 BRIDGEFORD LN, NEWTON NC 28658 Owner CLAUDE& SALLY ROJZMAN, 3485 BRIDGEFORD LN, NEWTON NC 28658 H:8282946789C:8282447393 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Contractor BUMGARNER SEPTIC TANK& GRADING, 1190 DUDLEY SHOALS RD,GRANITE FALLS T B:8283961795C:8283200878 receipt 04/18/2016 11:43 Page I of t