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HomeMy WebLinkAboutEHPR-04-2016-23724.TIF CH-tillr .1 A THIS IS NOT A PERMIT Case # EHPR-04-2016-23724 CATAWBA COUNTY HEALTH DEPARTMENT 0 r 0 /� i !' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 842 5M1, Environmental Health Plan Review - Repair -'o . • o all AUTH_CONST- REPAIR 0'`' o to Owner SEAN PAGE, 4865 LEE CLINE RD, CONOVER NC 28613 C:828-461-0971 OTHER:828-461-4062 NAME TO APPEAR ON PERMIT SEAN PAGE SITE ADDRESS: 4865 LEE CLINE RD, CONOVER NC 28613 PIN # 374418416543 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 43,560.00 Acres 1 DIRECTIONS: County Home Rd, Turn onto Lee Cline Road, Go past CB Farm Rd about 1/2 mile on the Left. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Existing drain field runs onto neighboring property. Need to relocate the existing lines. 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? Yes Property Easements Description: Access ROW APPLICATION FOR: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF House, Garage, Pool EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: House 58x47, Garage 20x24, Pool 14x28 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 4 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: 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 accessi le so that a complete site evaluation can be performed. Date: 9-a5-/6 Signature of Applicant or Agent , An Environmental Health Specialist will contact you within 5 working days application date. If you need further information or assistance please call 828-466-7291 AREA2 E9-elrapplication 04/25/2016 14:05 Page 1 of4 CATAWBA COUNTY Case s# EHPR-04-2016-23724 f' Public Health Department Subdivision 2 *Jo G' Environmental Health Division I�P .�, PIN# 374418416543 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 184 0 NAME ON PERMIT: ( SEAN PAGE), 4865 LEE CLINE RD,CONOVER NC 28613 ( SEAN PAGE) Site Address: 4865 LEE CLINE RD, CONOVER NC 28613 Property Size: Square Feet 43,560.00 Acres 1 Directions: County Home Rd,Turn onto Lee Cline Road, Go past CB Farm Rd about 1/2 mile on the Left. FEENAME II 11011 I ITl ' 9IEDAT 11 EAMNL 1 Q1• Authorization to Construct (Repair) Fee 04/25/2016 $300.00 �i1lj TOTAllEEES �Ifill'l'tl�iPlhi�u,ll" �(I,rylil m ; ' $300100 �y �I 1 htl t; N„�I ,I ���1 I ,l I I Vl�,,n J lallllih, lr,�LIIII,Nd� • „� 1 ,! �..,,iN1 .A. e '+Iu;t 'l uvr . ._nhlll➢'�Wy'•- +0116111A, ;Ild111WI0016I a^ ” 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-ehapplicatinn 04/25/2016 14:05 Page 2 of 4 CATA\ BA THIS IS NOT A PERMIT COUNTY _,r.n-0.z,, CATAWBA COUNTY HEALTH DEPARTMENT N,,,ti Application for Environmental Services Page 1 Improvement Permit I Authorization to Construct n Septic Repair rii Septic Malfunction ❑ Septic Expansion ❑ New Well Permit n Replacement Well n el Abandonment Well Repair n Existing System Inspection (Pre-Approval Required) n Application is for New Construction ❑ Existing Facility Property Address /2 .6 /oft ((,'n e kel Subdivision Lot# Acres / Section/Block/Phase * Driving Directions to Property roc/ 4 fip,.g e (I fu r n n n 'iv 4-CC(6 h e lk 6 a .5 5 C !3 Farm Rol 7hnu,f %a ,.,;Lc on Ce -E'f NAME TO APPEAR ON PERMIT? Owner n Applicant n Contractor Applicant Contact Information ////// ��`��` Name • , Address • y L , ; •Phone Cell Phone ?GU._ ' ,/ —0. 7/ Owner Contact Information Name Address Phone Cell Phone Contractor Contact Information Name I License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? x wner n Applicant ❑ Contractor Description of Existing Structures on Site (-(CL hQ (r bore sJ � ( # of Bedrooms *t 3 Structure Dimensions j�T # of Occupants �1 Basement [ es ❑ No Basement Fixtures n Yes o 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 @ Does the site contain any jurisdictional wetlands? Ca Yes ❑ No Does the site contain any existing wastewater systems? ❑ Yes liNo Is any wastewater going to be generated on the site other than domestic sewage? ❑ YYes C�No Is the site subject to approval by any other public agency? is Yes ❑ No Are there any easements or right of ways on this property? Describe Existing water supply in use ✓individual Well Community Well F1 Semi-Public Well Fl 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 Type(s): (systems can be ranked in order of your preference) V ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other EYAny cArrA wfQA THIS IS NOT A PERMIT COUNTY i `"i' h,. 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 n 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 ❑ Community Well Abandonment Type n Drilled n Bored n Dug ❑ Unknown Well Repair Requested n 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. 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, 0 Date if- c2 55 - Printed Name of Owner or Agent Catawba County Environmental Health in ",./ o O \ h \ • \ 1 • \ 208.71(690 \ 7 qny \ I _ •- - _— t m __ N — — _ A • _ , __ _ _ _ J 1 Q • 208.71 8. . .. . ... it __ _ c.,, __ _ _ _ _ _ • \ ._.4 _ . _.i. , _ _ • \ _ _ __ _ _ _... ........ i ___. • : µ • (690) 1 Parcel: 374418416543, 4865 LEE CLINE RD 1in=50ft 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 04/25/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 37441 841 65 43 Owner: PAGE SEAN V Parcel Address: 4865 LEE CLINE RD Owner2: null City: CONOVER, 28613 Address: 4865 LEE CLINE ROAD LRK(REID): 401874 Address2: null Deed Book/Page: 3207/1301 City: CONOVER Subdivision: null State/Zip: NC 28613-8796 Lots/Block: null/ null Last Sale: School Information: School District: COUNTY Plat Book/Page: 46/172 Legal: PL 46-172 PL 46-172 Elementary School: LYLE CREEK Middle School: RIVER BEND Calculated Acreage: 1.000 High School: BUNKER HILL Tax Map: null Township: CLINES School Map State Road #: 1486 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: OXFORD Zoningl: R-20 Building(s) Value: $147,100 Zoning2: null Land Value: $10,500 Zoning3: null Assessed Total Value: $157,600 Zoning Overlay: null Year Built/Remodeled: 1998/null Small Area: ST STEPHENS/OXFORD Current Tax Bill Split Zoning Districts: null/null Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710374400J Building Details 2010 Census Block: 1000 WaterShed: null 2010 Census Tract: 010202 Voter Precinct: P33 Agricultural District: Proximity Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. ©2016, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=3 744 1 84 1 6543&typ=P 4/25/2016 I' ` W CATABA COUNTY 3 I$EALTH DEPAR NT 4 - Telephone: (704) 465-8270 TDD: (704) 465-8200 _ 2 6 M. (� - Improve. Permit Authorization to Construct Repair Permit_Oper. Permi/t_System Types \ Owner/Agent /3 i2 Q !I 'I t /� 1IJ OR Phone '4 4) '- 07 7 J Address t e,.-,-.mss r eS -■ss _". - Al4Cr Subdivision . Section/Block/Phase ot# Lot Size �r �! t ...,�. .�� ��1. 9 r Facility: House f, Mobile Home Business . Other: Tax Map # , 00 ^ • '� Multi-family _` Other . Zoning Approval # ii-R7*!970e # Bedrooms �3 # Seats # Employees . Application Rate- g ' Flow 3 GC-1 , Hot Tub or Spa yes/no Special Fixtures . 100% Repair Area yes/n Basement yes/no Basement Plumbin yes/no Water Supply: Private Well;.( Public j Type of System: Trench // Bed Pump///) Pump/Panel Panel LPP Other Tank Size: Septic Tank Size /0610 al Pump Tank Size ri/ Nitrification Heidi Total Square Feet 9-0(e, Depth of Stone fa Bed Size Trench Width ( Total Length of All Trenches �QC) Nuyber of Trenches . 51-Individual Trench Length/yr/ U/ 7J/ Zc Feet on Center 9 Maximum Trench Deptky)C Distance of Nearest Well /apt *DO NOT INSTALL `, : WET* fit Topo./ r-(/-�7�-� �# Slope f Texture W •• Structure , - '' .ate' • 4 Clay-Min. 7 /`r- - _ _ • -y Soil Wetness �/ ` Soil Depth Cr " \ 1, 0 c-�' Restric. Hoz. at 'V Available space /no Overall Class S U , Comments: l C / el- • 4/(6,?- 1 adc **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE P RFORMANCE R LENGTH OF TIME THIS SYSTEM WILL FUNCTION** /o0 r •Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility. An Authorization to Construct is valid for (5) five years from date issued and is not transferable. Permit Date _�_ 9�' �y/7 Owner/Agent tj I ..I��1/emu t�.�1 Sanitarian v l / Installed By �M;�.��y t .,�� Date /Aga?_ W Sanitarian White-Office Blue Building Inspection Operation Permit Yellow-Owner/Agent Green-Building Inspection Authorization to Construct WELL. L\.\? -1\-2.013-1%19i 4%65 lie. Cline- M. Cowie * Well I� �I bell a4 r�IPus-1 SD-CI . CroM 4 Stec siS ems, a5t1. -(�or� Atuc�Lxes, av 544 -csmr, r t er"i \kreS . k Yeen we\k DA itrf all eoSe mer\\`o o,v,.A rtk of- \pai s • 7 E�aSlinc,1Afoi ie�k Grosses Qrove( j) lihe..Tlni5 t5 nod a QroJed• jT recall{i, ei4hev olkuiv, Sekfc eaSemerl} a Of re.loc0{e,dr in-fiecl• Serkic rtvr'it r Ore&cot er{Hev ( ion• 35' )04111 _ • In Ground b' S 1 �roud l 1 P rf 3 bedroll 9' 9 Imo. /louse. ' 9 i- �P�IL j „- lo IN 3 Al R'" Q 5,min Q,9wred Wit Areo, LID' P __- O to 208.11� „t L' G 9 1 TO Le.QineRA, L _ 50' �$• • CATAWBA COUNTY Case# WCOC-01-2014-046145 ,T tlli s Public Health Department Subdivision 4 ,moo: 4 Environmental Health Division PIN# 374418416543 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT# 1g.2 w Applicant/Owner SEAN PAGE,4865 LEE CLINE RD,CONOVER NC 28613 Nye \' -00\3 - 1S\34 4865 LEE CLINE RD,CONOVER NC 28613 Site Address: :0_4.134 . Property Size: Square Feet 43,560.00 Acres 1 Directions: COUNTY HOME RD TURE ON LEE CLINE PASS CB FARM RD ABOUT 1/2 MI ON LEFT t - o t. . WELL CERTIFICATE OF COMPLETION WATER SUPPLY: Well Type: Individual Well WELL-11-2013-043629 - - INSPECTIONS INSPECTION# COMP DATE . INSPECTION TYPE STATUS INSPECTOR EHINSP-260699 01/02/2014 EH Well Head Approved ,Megen McBride EHINSP-260698 01/02/2014 EH GPS.Pata_Collection jr I( Approved Megen McBride EHINSP-257520 11/15/2013 EH Well Redord-Received 2 ' Approved Megen McBride EHINSP-257519 • 11/15/2013. EH Well Giduting ' j Approved . - Megen McBride . h 11 C---, 1l S.Y.ii \\ d • `i lI i7/ Cfi O/` - • j v Taylorsville Well Drilling 11/15/2013 WELL DRILLER DATE DRILLED Well permits are valid for 5 years from the date of issuance and are subject to suspension and/or revocation from non-compliance with appropriate state and local rules and regulations, or if false information was given in order to obtain a permit. Wells shall be constructed in accordance with all state and local regulations and rules. The Well Completion Report must be submitted to the Health Department within 30 days upon completion of a well. Megen McBride 01/02/2014 AUTHORIZED STATE AGENT APPROVAI.DATE E9-chwcllcoc 01/10/2014 09:00 Page 1 of I CATAWBA COUNTY 100A SOUTHWEST BLVD 4i k NEWTON, NORTH CAROLINA 28658 RECEIPT d ra s►r� 3 PHONE: 828.465.8399 U rz 1V4bo 11 �G` Monday, April 25, 2016 /$42 SM www.catawbacountync.gov PAYOR: PAGE, SEAN PAYMENTS TRANSACTION NUMBER: TRC-661647-25-04-2016 PAYMENT DATE : 04/25/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 04-16-327580 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-04-2016-23724 CASE TYPE: Environmental Health Plan Review WORK CLASS: Repair SITE ADDRESS: 4865 LEE CLINE RD, CONOVER NC 28613 Owner SEAN PAGE, 4865 LEE CLINE RD, CONOVER NC 28613 C:828-461-0971 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 04/25/2016 14:03 Page 1 of 1