The URL can be used to link to this page

Home My WebLink AboutEHPR-04-2016-23690.TIF .aY A O THIS IS NOT A PERMIT Case # EHPR-04-2016-23690• ' CATAWBA COUNTY HEALTH DEPARTMENT 0 �. .v• f 0 v dj7O' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ea e/842 sM Environmental Health Plan Review - Septic Malfunction 'a1� u o�: AUTH_CONST- SEPTIC MALFUNCTION T o . D -c Owner LINDA MILLER, 2242 BET/-ZANY CHURCH RD,NEWTON NC 28658 H:8284646463 C:8283087255 HOME:8284646463 NAME TO APPEAR ON PERMIT Linda Miller SITE ADDRESS: 2981 EMMANUEL CHURCH RD, CONOVER NC 28613 PIN # 375012860375 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 22,651.20 Acres 0.52 DIRECTIONS: Hwy 10 East, LEft onto Emmanual Church Rd, 1st house on Left PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: Tank Only Replacement' Septic inspection for sale of home found a crack in the tank. 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: 30x36 NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 1 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 identification and labeling of all property lines and corners and making the site accessible so that a complete site evalua ion can be performed. Date: __2D- /42 Signature of Applicant or Agent S d. Y An Environmental Health Specialist will contact you within 5 working days of aiplication date. If you need further information or assistance please call 828-466-7291 AREA2 F9-ehapplicaaon 00./20/2016 13:00 Page 1 of 7 ,,‘q ,. CATAWBA COUNTY Case tl EHPR-04-2016-23690 C !i Z Public Health Department Subdivision 6 --^� . Y Environmental Health Division PIN# 375012860375 -66 - PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 18.2 ,. NAME ON PERMIT: (LINDA MILLER), 2242 BETHANY CHURCH RD,NEWTON NC 28658 ( Linda Miller) Site Address: 2981 EMMANUEL CHURCH RD, CONOVER NC 28613 Property Size: Square Feet 22,651.20 Acres 0.52 Directions: Hwy 10 East, LEft onto Emmanual Church Rd, 1st house on Left IDi: :EENAME,. Sri` I RP I�'I '`I�'' r' 'm.'';( �l�I'IIIl! r� �I I� DATE L , ijlCE�EE AMOUN I+' Ii.L�__.... al II M �.ra( 41t,IW''�u..�lPflVt1 �Ill 'Up IILI) l �(L:��,ll�1.�.. u Authorization to Construct (Repair) Fee 04/20/2016 $150.00 l� r (If''��',l ,� 1iiTOTAE!FEEsPit<Illlillllllilliill4illtilllliIhli1IP�11 ��;''1lliffi kVa ills �� 'lilllilllll)au+�$1§TO611 p7.•i Mild •Jiiii Watu 1U'WliWBlUll il'IMIIIIIiiDliald.r..'. r ,, :SainiLrldt., ; IniilLn fM9IIIIWWI6tuilnrl101I('hi�•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) F9-ehapplication 04/20/2016 13:00 Page 2 of 7 CATAwBA THIS IS NOT A PERMIT couNTr CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 i Improvement Permit r] Authorization to Construct n Septic Repair n Septic Malfunction* Septic Expansion n New Well Permit IT Replacement Well ❑ Well Abandonment IT Well Repair ❑ Existing System Inspection (Pre-Approval Required) Application!is for New Construction Existing Facility Property Addresso2 ei / /Hama ( CA 2j Subdivision Ccnnve✓' /L2" -254/.3 Lot# Acres a C Section/Block/Phase Driving Directions to Property f{tli,./a.„ /0 e c—( en /etI 6A Fmnan t / e.A. /rd. / %{ NAME TO APPEAR ON PERMIT? ❑'Owner I Applicant IT Contractor Applicant Contact Information Name L 4 ; Le r Address 02ay�Z f�`.e 'h / 1/ew7o/lr N C . }-4 IS° Phone _ /1/o i /4/6.� Cell Phone c2 _ 36 9- 2-,2 $5 Owner Contact Information Name Address Phone Cell Phone Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? [71 Owner IT Applicant IT Contractor Description of Existing Structures on Site 1403 A 2. # of Bedrooms *t 2- Structure Dimensions-&)X,{&_O # of Occupants U Basement ❑ Yes 7 No Basement Fixtures n Yes ✓I No 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 liNo Does the site contain any jurisdictional wetlands? d Yes ❑ 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 3 No Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well IT Community Well ❑ Semi-Public Well n County/City/Township Water Line Is a public water supply available? ** M 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 El/Any cATA\ BA THIS IS NOT A PERMIT COUNTY VY .iJ CATAWBA COUNTY HEALTH DEPARTMENT • rr Non Application for Environmental Services Page 2 M1 Comllna Proposed Facility Type n Primary Residence New Residence I I Addition to Residence #of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement n Yes n No Basement Fixtures ❑ Yes n No I 1 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 I 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 n Yes ❑ 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 n Bored _J Dug n Unknown Well Repair Requested UI Yes rl 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. j 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. /r u / Date / Signature of Owner or Agents ��,� � ��- Printed Name of Owner or Agent ,�,r� ra. k i //e r Catawba County Environmental Health - I _ • - - _ - - - - - - - . - - - - - I _ - - _ - - I / ' - - / / ass - ' I - - N 65 O .,...,1 0_,3 a. - - 3 01 C ^1 u, r 0 n x c A - �. x - ` A O 4231* C'75° -- •-- IT /7/1"5.Thrt."---- "") • • r !--- _ _ _ _ - - Parcel: 375012860375, 2981 EMMANUEL tin=50ft CHURCH RD CONOVER, 28613 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 04/20/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 375012860375 Owner: BANAARD TRACY MILLER Parcel Address: 2981 EMMANUEL CHURCH RD Owner2: CALDWELL KATHY K City: CONOVER, 28613 Address: 2242 BETHANY CHURCH RD LRK(REID): 34146 Address2: null Deed Book/Page: 2014E/0872 City: NEWTON Subdivision: null State/Zip: NC 28658-8213 Lots/Block: null/ null Last Sale: School Information: Plat Book/Page: School District: COUNTY Legal: null Elementary School: CLAREMONT Middle School: RIVER BEND Calculated Acreage: .520 Tax Map: 060N 01029 High School: BUNKER HILL Township: NEWTON School Map State Road #: 1732 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: NEWTON RURAL Zoningl: R-20 Building(s) Value: $45,400 Zoning2: null Land Value: $10,400 Zoning3: null Assessed Total Value: $55,800 Zoning Overlay: WP-O Year Built/Remodeled: 1941/null Small Area: CATAWBA 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 #: 3710375000J Building Details 2010 Census Block: 2000 WaterShed: WS-IV Protected Area 2010 Census Tract: 011300 Voter Precinct: P22 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. rnes* 016, Catawba ounty Government, North Carolina. All rights reserved. W►�lt1\C J . )62 Cat pcM,-E-, http://gis.catawbacountync.gov/nomap/parcel_report.php?key=375012860375&typ=P 4/20/2016 A- CATAWBA COUNTY 100A SOUTHWEST BLVD aNEWTON,NORTH CAROLINA 28658 RECEIPT inePe PHONE: 828.465.8399 Wednesday, April 20, 2016 1842 sm www.catawbacountync.gov PAYOR: Miller, Linda PAYMENTS TRANSACTION NUMBER: TRC-65 87 1 1-20-04-2 0 1 6 PAYMENT DATE : 04/20/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 04-16-327418 Authorization to Construct (Repair) 5150.00 Fee TOTAL PAYMENTS : $150.00 EHPR-04-2016-23690 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 2981 EMMANUEL CHURCH RD, CONOVER NC 28613 Owner LINDA MILLER, 2242 BETHANY CHURCH RD,NEWTON NC 28658 H:8284646463 C:8283087255 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 04/20/2016 12:59 Page 1 oil