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HomeMy WebLinkAboutEHPR-04-2016-23695.TIF •G THIS IS NOT A PERMIT Case # EHPR-04-2016-23695 Mit CATAWBA COUNTY HEALTH DEPARTMENT 0} .v;"i (-) ^4frY PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES t 1842 sM Environmental Health Plan Review - Septic Malfunction _aL o 14..13 AUTH CONST- SEPTIC_MALFUNCTION { o ;: Owner JIMMY ISENHOUR, 3375 BETHANY CHURCH RD, CLAREMONT NC 28610-9511 H:8284642843 C:8284553368 HOME:8284642843 NAME TO APPEAR ON PERMIT JIMMY ISENHOUR SITE ADDRESS: 3375 BETHANY CHURCH RD, CLAREMONT NC 28610 PIN # 376005290001 NAME of SUBDIVISION: Lot 4 Section/Block PROPERTY SIZE: Square Feet 94,960.80 Acres 2.18 DIRECTIONS: Take Hwy 10 East, Left onto Bethany Church Rd, Go about 1/4 mile& house is the 7th house on the Left. # is on the Garage PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Tank was pumped about a year & 1/2 ago. Pumped again 4 months ago. Has been advised that tree roots have grown through the system. 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: 75x52 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 2 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: 09-chappllcatinn 04/20/2016 14:58 Page 1 of8 sc, CATAWBA COUNTY Case# EHPR-04-2016-23695 .Q' l Public Health Department Subdivision 2 j®�,Environmental Health Division PIN# 376005290001 \k— PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 1841 a NAME ON PERMIT: (JIMMY ISENHOUR), 3375 BETHANY CHURCH RD,CLAREMONT NC 28610-9511 ( JIMMY ISENHOUR) Site Address: 3375 BETHANY CHURCH RD, CLAREMONT NC 28610 Property Size: Square Feet 94,960.80 Acres 2.18 Directions: Take Hwy 10 East, Left onto Bethany Church Rd, Go about 1/4 mile & house is the 7th house on the Left.#is on the Garage 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 an• •les\ I understand that I am sole responsible for the proper identification and labeling of all property lines and corners and making the site accessi• - so that a co p= e e evalua can be performed. Date: G"— 0 —//o Signature of Applicant or Agent allow- . ..c e.,‘i An Environmental Health Specialist will contact you wi ' 5 we•mg days of application date If you need further information or assista/•- pie se call 828-466-7291 AREA2 r BEENAME Imr1 if'�I ir.i l if�i'�11''�(IIIliir h�11� '1i IT�'�II�IIIII� ;`' DATrE111, ?II EE�AMOUNT.� Valhi m ' iJ '11.iJEI" Iju li th{.i j1�ibi, 1,i�t., I II IL Ii I MO! Id Authorization to Construct (Repair) Fee 04/20/2016 S300.00 .1 i'I N,t 1 i( 111 IM !Ito 111 " Iilhk:d �1�r� 1 tllil r' 5300'00 1l 11111°I� r =TOTAL FEES �� �plli ,l ,�,l I 11 P!illihlll�I(I! i�11j u�inll� .........,Ili., . i.0 .1011.11111:41: 1Nwifu!hi1l11111 hiJ Id61a;14L8.•11:ILIIl811Wui"i iafl lllliL'LIIWim eessugilary 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) [9-ehnpplication 04/20/2016 14:58 Page 2 of 8 C/,T AWBA THIS IS NOT A PERMIT cou�ry b Y CATAWBA COUNTY HEALTH DEPARTMENT e 1 •-- „,,,„�o--,�, Application for Environmental Services Page Improvement Permit❑ Authorization to Construct n Septic Repair n Septic Malfunction Septic Expansion n New Well Permit In Replacement Well n Well Abandonment❑ Well Repair P Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction n Existing Facility L9 Property Address 337r ,{, '.e Subdivision //o. -� . . _ - O Lot# Acres .92• 5� Section/Block/Phase Driving Directions to Property ,E/ yF 6 f/c v/Xt/0 44$--1—44$% —0 / P 72 4' 7 c/` 47,42 o ,a,,C ,f orb /47 O A/ r 2� 6( 6 NAME TO APPEAR ON PERMIT? U-O truer n Applicant n Contractor Applicant Contact Information Name — /.. -SCA44494fs� Address �3.�� et,/ ,P1J Phone _ H6v_,,?sea Cell Phone �12S .47SS=33og Owner Contact Information Name Address Phone Cell Phone Contractor Contact Information Name Address Phone ` Cell Phone WHO WILL BE THE PRIMARY CONTACT? I"Owner I Applicant n Contractor Description of Existing Structures on Site # of Bedrooms * 3 Structure Dimensions # z of Occupants sins Basement es ❑ No Basement Fixtures Yes 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. El Yes fd No Does the site contain any jurisdictional wetlands? Yes ® No Does the site contain any existing wastewater systems? 0 Yes ra No 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 Ft No Are there any easements or right of ways on this property? Describe Existing water supply in use individual Well F Community Well Semi-Public Well n County/City/Township Water Line Is a public water supply available? ** n Yes lel 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 `OUNT\ r " — \ CATAWBA COUNTY HEALTH DEPARTMENT --- --;';3 Application for Environmental Services Page 2 eo.m c�.m��e-� Proposed Facility Type n Primary Residence fl New Residence ❑ Addition to Residence # of New Bedrooms Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ® Yes rj No ❑ Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling n Yes ❑ No Plumbing H Yes n No Describe Plumbing Needed Multi-Family Residence# Units #Bedrooms per Unit*t Total# Bedrooms *fi Structure Dimensions n 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 it of Shifts ❑ Other Facility Type Specify If Church # of Seats Kitchen ❑ Yes n No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well n Community Well Abandonment Type ❑ Drilled n Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes P 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 maybe 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 dpi` X/L�LC , Date � X20 Ye Printed Name of Owner or . ent .H . 1 Sce-s//fcie-e, Catawba County Environmental Health • \ \ 65.29 .........._r•-'" mipw 1 945 •°t4lid, it l! k- \ 46,8-96 ,lilgl1 '�Gnl 02 ._ ... __ ...... _ _ . , ___ _ Ait ,/- - - - -Too ~ — ' Jl r / / 8 , -z- e- , Z 55 3 5 Zg :082 CO I / •0.6 l FY / l o<CSr 1 49. • O. / / 49.4 • / . !' m C / / f Parcel: 376005290001 , 3375 BETHANY 1 in=100ft CHURCH RD CLAREMONT, 28610 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: 376005290001 Owner: ISENHOUR JIMMY L Parcel Address: 3375 BETHANY CHURCH RD Owner2: ISENHOUR DOROTHY CAROLYN City: CLAREMONT, 28610 Address: 3375 BETHANY CHURCH RD LRK(REID): 38620 Address2: null Deed Book/Page: 1479/0353 City: CLAREMONT Subdivision: State/Zip: NC 28610-9511 Lots/Block: / Last Sale: $2,000 on 1984-10-01 School Information: Plat Book/Page: School District: COUNTY Elementary School: CLAREMONT Legal: 3375 BETHANY CH RD Middle School: RIVER BEND Calculated Acreage: 2.180 High School: BUNKER HILL Tax Map: 074N 02019A Township: NEWTON School Map State Road #: 1722 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY • County Fire District: CLAREMONT RURAL Zoningl: R-20 Building(s) Value: $174,100 Zoning2: null Land Value: $19,900 Zoning3: null Assessed Total Value: $194,000 Zoning Overlay: WP-O Year Built/Remodeled: 1986/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 #: 3710376000J Building Details 2010 Census Block: 1057 WaterShed: WS-IV Protected Area 2010 Census Tract: 011401 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. ©2016, Catawba County Government, North Carolina. All rights reserved. )) cn is (mil http://gis.catawbacountync.gov/nomap/parcel_report.php?key=376005290001&typ=P 4/20/2016 ., CATAWBA COUNTY !�{�I IOOA SOUTHWEST BLVD 'sA" �0� NEWTON, NORTH CAROLINA 28658 RECEIPT d pw„,;",--.;.. e e PHONE: 828.465.8399 0 `I vasv! i'> Wednesday, April 20, 2016 842 s www.catawbacountync.gov PAYOR: ISENHOUR,JIMMY PAYMENTS TRANSACTION NUMBER: TRC-658837-20-04-2016 PAYMENT DATE : 04/20/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 04-16-327426 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-04-2016-23695 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 3375 BETHANY CHURCH RD, CLAREMONT NC 28610 Owner JIMMY ISENHOUR, 3375 BETHANY CHURCH RD, CLAREMONT NC 28610-9511 H:8284642843 C:8284553368 **NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 04/20/2016 14:57 Page I of 1