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HomeMy WebLinkAboutEHPR-04-2016-23745.TIF \3A •G THIS IS NOT A PERMIT Case # EHPR-04-2016-23745 a CATAWBA COUNTY HEALTH DEPARTMENT 0 Le r!o t 0 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 842 sM Environmental Health Plan Review - Septic Malfunction of o AUTH_CONST - SEPTIC MALFUNCTION `o" Applicant JOHN PAYSOUR III, 3384 MAYS CHAPEL CIR, NEWTON NC 28658 C:8287810125 NAME TO APPEAR ON PERMIT SITE ADDRESS: 3384 MAYS CHAPEL CIR, NEWTON NC 28658 PIN # 364707570746 NAME of SUBDIVISION: PAUL J MCREE Lot# PT 3 Section/Block PROPERTY SIZE: Square Feet 24,393.60 Acres 0.56 DIRECTIONS: Take Left onto Hwy 16 towards Charlotte, Right onto St James Church Rd, continue straight past Maiden Rescue Squad, Right onto Mays Chapel Circle, 1st house on the Left. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: `Water is on the ground. Septic has been pumped twice in the last 3 months. Community well is in the back of the property. (Aqua) Primary source of water is Individual Well on the 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 EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: House 53x44, Pool 24x47 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 6 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: 19-ehapplicat ion 04/27/2016 09:57 Page 1 of 8 oiA CATAWBA COUNTY Case# EHPR-04-2016-23745 .f' ', Public Health Department Subdivision PAUL J MCREE 19�� ^fie Environmental Health Division PIN# 364707570746 ^j' PO Box 389, 100-A Southwest Blvd, Newton,NC 28658 18.2 sv NAME ON PERMIT: Site Address: 3384 MAYS CHAPEL CIR, NEWTON NC 28658 Property Size: Square Feet 24,393.60 Acres 0.56 Directions: Take Left onto Hwy 16 towards Charlotte, Right onto St James Church Rd, continue straight past Maiden Rescue Squad, Right onto Mays Chapel Circle, 1st 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 understand that I am solely responsible for the proper identification arid labeling of all property lines and corners and making the site accessib e so tt tt complete site evaluation can be performed. Date: q-2 `7'/1 Signature of Applicant or Agent i�Lf� An Environmental Health Specialist will contact you within working days of application date. If you need further information or assistance please call 828-466-7291 AREA1 **********4*****4*4****4444*******44****44444*4***44**************44*1**4444****4***+4444**4444***44444***** -'71•77, t q77,�-;a -.;. • gy ; v u'' L 1_ PTs l l r ,FEENAME jk t aHlDAT , AFEE'AMOUNT Authorization to Construct(Repair) Fee } 04/27/2016 $300.00 ISC�!Ys , T �.i !�I (I lea � a l"^�Jctfkp sl r� III!uTOTAL FrE_ES IilwlFl��,,ill�d�f ll�3�l kip,. Illrlll u�slu �r.;,? ol I , It�.�: $300 OOE�,: IBl !LI u itaira I"+a nem annCL4IIIMI WL @6JMWIIILWI1511 tt.Tr 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-ehapplication 04/27/2016 09:57 Page 2 of CATAWBA THIS IS NOT A PERMIT cou�n CATAWBA COUNTY HEALTH DEPARTMENT 1 Application for Environmental Services Page Improvement Permit ❑ Authorization to Construct❑ Septic Repair u Septic Malfunction ❑' Septic Expansion ul New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) El Application is for New Construction ❑ Existing Facility f- Property Address 3 3 Ft/ YSN'a4( I (vc'e Subdivision }d rJC 2 $6 5g Lot# Acres Section/Block/Phase Driving Directions toProperty TAk't �e + a- I-�,jLQe7 16fas`1J cl.cc1,4e }vim r/zy t 0; 5 3 4r 0ad//++ c`o%}ih,e jl�r4; 1,1 �u s"� N+c,.'cIe re Xcie S uan/ 4-urh r' k J'1 M- c eL I Circle -1 CO 1ADu Se 1S kle5- o+, lei+: —NAME TO APPEAR ON PERMIT? Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name ;poi hav F yfOvr a i Address —338`1 Ayr (40t1 Circle NC AtJ., MC 28%51 Phone Cell Phone lit2 s- 7 8/ - 0125 Owner Contact Information Name 'S,l.K D Pay10`•. Address •j.3 1iv, Ne✓6,. NC Ztt5I Phone Cell Phone 32t-7g/- 0125 Contractor Contact Information Name Address Phone � U� Cell Phone WHO WILL BE THE PRIMARY CONTACT? ICI wner C. Applicant ❑ Contractor Description of Existing Structures on Site Sn'ck baud 1.4i+L P(”) # of Bedrooms *'j. 3 Structure Dimensio s #of Occupants Co Basement Q'Yes ❑ No Basement Fixtures Yes No The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in question. If the answer to any question is"yes', applicant must attach supporting documentation. ❑ Yes 11}'No Does the site contain any jurisdictional wetlands? /Yes ®"No Does the site contain any existing wastewater systems? Yes El No Is any wastewater going to be generated on the site other than domestic sewage? ® Yes ,$No Is the site subject to approval by any other public agency? - Yes ID No Are there any easements or right of ways on this property? Describe Existing water supply in use {t Individual Well fl Community Well [J Semi-Public ell Pi County/City/Township Water Line Is a public water supply available? ** Yes ❑ No If applying for an Improvement Permit or Authorization to Construct, Please Indicate Desire System Type(s): (systems can be ranked in order of your preference) ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other ti<Any cATAwBA THIS IS NOTAPERMIT CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence n New Residence ❑ Addition to Residence # of New Bedrooms *'j Project Description Structure Dimensions #of Occupants Basement n Yes U No Basement Fixtures CI Yes n No l Accessory Structure(s) Describe # of New Bedrooms *j' if applicable Structure Dimensions # of Occupants _ Accessory Dwelling ❑ Yes n No Plumbing Ti Yes n No Describe Plumbing Needed I I Multi-Family Residence# Units #Bedrooms per Unit*t Total#Bedrooms *j Structure Dimensions I I Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) # Employees per Shift # of Shifts Dining Area(Sq. Ft.) I-1 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 n Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type n Drilled In Bored ❑ Dug Ti 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. 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 9.4 Date Y-Z 7- /E mar Printed Name of Owner or Agent 'Tol 1�ysou. Catawba County Environmental Health S a;: : >r 94-Q o ° 1 r` `197} - ' (�' 115.00 5 1000 0 0 U 35.0 1 aw ct r . 0 . r7 } o - 0 h N �+`It N CV NQ O O -00- , • a 0 O 0 00 60 100.00 50.00 100.0 MAYS CHAPEL CHURCH RD o Parcel: 364707570746, 3384 MAYS CHAPEL tin=50ft CIR 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 04/27/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 364707570746 Owner: PAYSOUR JOHN III Parcel Address: 3384 MAYS CHAPEL CIR Owner2: null City: NEWTON, 28658 Address: 3384 MAYS CHAPEL CIR LRK(REID): 14671 Address2: null Deed Book/Page: 3110/1499 City: NEWTON Subdivision: PAUL J MCREE State/Zip: NC 28658-9010 Lots/Block: PT 3/ null Last Sale: $130,000 on 2005-06-15 School Information: School District: COUNTY Plat Book/Page: 12/99 Legal: LOT PT 3 P MCREE PL 12-99 Elementary School: MAIDEN Middle School: MAIDEN Calculated Acreage: .560 Tax Map: 013M 04022 High School: MAIDEN Township: NEWTON School Map State Road #: 2610 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: MAIDEN County Fire District: MAIDEN RURAL Zoningl: R-15 Building(s) Value: $108,100 Zoning2: null Land Value: $10,300 Zoning3: null Assessed Total Value: $118,400 Zoning Overlay: null Year Built/Remodeled: 1964/1968 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 #: 3710364700J Building Details 2010 Census Block: 1053 WaterShed: null 2010 Census Tract: 011601 Voter Precinct: P20 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 unty Governmen "-Jrth Carolina. All rights reserved. � 33 dI yn 1 • evisyat . ,,/ . . l http://gis.catawbacountync.gov/nomap/parcel_report.php?key=364707570746&typ=P 4/27/2016 4'p' CATAWBA COUNTY ` 71 171 100ASOUTHWESTBLVD RECEIPT NEWTON, NORTH CAROLINA 28658 d fia" ∎iiRil i PHONE: 828.465.8399 Ul'W ,,, .0a01 ' 4 Wednesday, April 27, 2016 1842 SM www.catawbacountync.gov PAYOR: Paysour III, John PAYMENTS TRANSACTION NUMBER: TRC-662581-27-04-2016 PAYMENT DATE : 04/27/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 04-16-327664 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-04-2016-23745 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 3384 MAYS CHAPEL CIR, NEWTON NC 28658 Applicant JOHN PAYSOUR III, 3384 MAYS CHAPEL CIR,NEWTON NC 28658 C:8287810125 **NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 04/27/2016 09:56 Page 1 of I