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HomeMy WebLinkAboutEHPR-05-2016-23808.TIF 4�13A • THIS IS NOT A PERMIT Case # EHPR-05-2016-23808 , Oil CATAWBA COUNTY HEALTH DEPARTMENT D V. r1 " f 0 U v ,.. i► F \ � II PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES \842 sM Environmental Health Plan Review - Septic Malfunction : oo o ■+ f. Ir T AUTH CONST- SEPTIC_MALFUNCTION .� ir.�oY ;} Owner KENNETH & PAMELA PEGRAM, 2236 37TH AV NE, HICKORY NC 28601 k� H:8282564593 C:8288503833 HOME:8282564593 NAME TO APPEAR ON PERMIT Kenneth & Pamela Peg ram SITE ADDRESS: 2236 37TH AV NE, HICKORY NC 28601 PIN # 372409263352 NAME of SUBDIVISION: HICKORY WOODS Lot k 5 Section/Block B PROPERTY SIZE: Square Feet 15,246.00 Acres 0.35 DIRECTIONS: Kool Park Rd NE, Left onto 22nd St NE, Right onto 37th Ave NE, Last house on the Right. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: Sewage is on the ground.* Open Violation - EH-03-2016-5939 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: 55x61 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 3 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 identificafon and labeling f all property lines and corners and making the site ac e sible so that a a• plate site evaluation ca. •. .. • ed. Date: Co — / Co Signature of Applicant or Agent • Ads_at • An Environmental Health Specialist will contact you within-5 working days,'iication date. If you need further information or assistance please call 828-466-7291 AREA2 I:9-ehapplication 05/06/2016 12:28 Page 1 of7 33A • CATAWBA COUNTY Case# EHPR-05-2016-23808 Public Health Department Subdivision HICKORY WOODS 4 isuz „c, Environmental Health Division PINN 372409263352 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 /842 s. NAME ON PERMIT: (KENNETH& PAMELA PEGRAM),2236 37TH AV NE, HICKORY NC 28601 ( Kenneth & Pamela Pegram) Site Address: 2236 37TH AV NE, HICKORY NC 28601 Property Size: Square Feet 15,246.00 Acres 0.35 Directions: Kool Park Rd NE, Left onto 22nd St NE, Right onto 37th Ave NE, Last house on the Right. u� �a"'ht�Phlh (IFFFNAVtE ul'{(� I ILL }Il�iilruhmlgltr7 T6 w �,a.;� UJit:d , Ittill)DATE �( li� FEEAMOUNT Authorization to Construct (Repair) Fee 05/06/2016 $300.00 •�f �l°19�1i�1 }rTO,TA.LjFEEs N'1'Il;ry tIII1il;iilll„!;I;IW�Idk;;fl'I� 1111 'III1111I�Rt ��I�kt 7ui ' $300 o0m i11 a t I II illil VIII !I IIIIIN��.... "'• I ' tPII1ilJlultl.5lu `�=' v 'ntinIlIIIiIIIIIIVil4G WI41CdL".WIIIInL9;;!WIIIIPSut *_ �pjp11 1� 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) 1_`9-ehnppl ieoGnn 05/06/2016 12:28 Page 2 of 7 CATAWBA THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT Ho„ti „— Application for Environmental Services Page 1 Improvement Permit ❑ Authorization to Construct❑ Septic Repair 7 Septic Malfunctio n -. Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair Existing System Inspection (Pre-Approval Required) Application is for New Construction ❑ Existing Facility% nt,L Property Address 2-3 to 27 - A-v, Al L Subdivision Jy` }f i CtCo ry )J ( 25,2(„e / Lot# Acres Section/Block/Phase Driving Directions to Property ‘��r 1-.4.-- S 1?(A 4-n--.1 a•iic koo( f�r k. h'a{ . Cc a��P rr)2 : f-r II 2 r”-It. n � %� �f'itPh )2;T-1\A- t1/,.1-r� �(� 4r-.. Ave n/C, %I..'.� irk ^t n, f(� 072 — Sf.ri/e_ fir.-ir-�. try' 41- D.�./zl YJ R-_e 9L , lilt= .Dr-r1/'C Jr ,. EiLi. /VA t- Iv Par K NAME TO APPEAR ON PERMIT? XOwner ❑ Applicant ❑ Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information *' Name KannPf ) ?/',eJ-'(av-� L I Address 023 (r 2i /1"t/? /Je rl o C/�or y AA 2'J L-O r Phone g 2g -25-6)- #-C-9, Cell Phone sag _ W0- 32,3.3 Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? Owner _ Applicant n Contractor Description of Existing Structures on Site ) &.c(1'9 /-r t(a±.- e ^ ^ # of Bedrooms *j' 2 Structure Dimensions J X �_0 I # of Occupants 2 Basement ❑ Yes o Basement Fixtures ❑ Yes LJ' 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 litiClo Does the site contain any jurisdictional wetlands? 63Yes ❑ No Does the site contain any existing wastewater systems? ❑ Yes 2'o 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 no Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well ❑ Community Well 7 Semi-Public Well FR-County/City/Township Water Line Is a public water supply available? ** 2-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 EV ny c A T"Aw-B A THIS IS NOT A PERMIT `COUNTY CATAWBA COUNTY HEALTH DEPARTMENT „„„„ ,,,,�, Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence n New Residence n Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions #of Occupants Basement — Yes n No Basement Fixtures ❑ Yes ❑ No ❑ Accessory Structure(s) Describe # of New Bedrooms *j if applicable Structure Dimensions # of Occupants Accessory Dwelling n Yes n No Plumbing n Yes n No Describe Plumbing Needed ❑ Multi-Family Residence#Units #Bedrooms per Unit*t Total #Bedrooms *j Structure Dimensions ❑ 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 Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type n Individual Well ❑ Semi-Public Well 7 Community Well Abandonment Type n Drilled H Bored n Dug n Unknown Well Repair Requested 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. 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 infonnation 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 Agen / ',� L Date �� ' /(p Printed Name of Owner or Agent I�B/t4 p�h E ?el-('¢ qA • CATAWBA COUNTY ENVIRONMENTAL HEALTH -z a 2 ENVIRONMENTAL HEALTH COMPLAINT FORM a�'v 4 EH-03-2016-5939 �e .o "c 1842 :M SEPTIC COMPLAINT Complainant SANDRA GAY, 2230 37TH AV NE, HICKORY NC 28601 C:8282449852 Violator KENNETH & PAMELA PEGRAM, 2236 37TH AV NE, HICKORY NC 28601 SANITARIAN: Steven Price PROPERTY ID#: 372409263352 STATUS: In Violation CALLBACK: YES MEDICAL CONFIDENTIAL: NO STREET ADDRESS: 2236 37TH AV NE, HICKORY NC 28601 DIRECTIONS: Kool Park Rd NE, 37th Ave NE, Left onto 22nd St NE, Right onto 37th Ave NE, Last thouse on Right. Septic Complaint Septic Complaint COMPLAINT: 1 VIOLATIONS: VIOLATION DESC: Sewage is on the ground on the Right side of the house. by the trees that border the neighbors home. DUEDATE 04/18/2016 VIOLATION DATE 03/16/2016 ENDDATE DATE RECEIVED: 03/1412016 PRELIMINARY DATE : 03/14/2016 CLOSED DATE: EXTENSION DATE: ACTIVITY DATE NAME COMMENTS Code Activities 03/16/2016 Notice of Violation letter SP INSPECTION# STATUS TYPE COMPLETED Septic Complaint EHINSP-319930 Failed EH First Inspection Steven Price 03/14/2016 03/16/2016 Older son came to the door, apparently mother was also home but did not come to door, and told him there was a complaint about sewage smell and asked if they had any septic issues. He said they had some ponding in the side yard and some bad smells. He took me to the side yard and showed me the spot. There was sewage on top of the ground on top of the septic tank. I let him know that I would be sending an NOV and they would need to apply for a septic repair permit. rehcomplaintform 05/06/2016 12:19 Page 1 of l Catawba County Environmental Health ....i ‘ ^O F=/ • • o 160.61 34.07 y 130 130 o a 0 r` Aall 100 100 • o FM g• II ill s . • • ri*Iiirr \ ,,... ,.. 100 • b d�I, o Co ,-a 0 ..111100_ . • • • 0 in : 0 \\\i Parcel: 372409263352, 2236 37TH AV NE 1 in=50ft HICKORY, 28601 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 05/06/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 372409263352 Owner: PEGRAM KENNETH RAY Parcel Address: 2236 37TH AV NE Owner2: PEGRAM PAMELA H City: HICKORY, 28601 Address: 2236 37TH AVE NE LRK(REID): 65461 Address2: null Deed Book/Page: 2177/0374 City: HICKORY Subdivision: HICKORY WOODS State/Zip: NC 28601-8271 Lots/Block: 5/ B School Information: Last Sale: $119,000 on 1999-11-01 Plat Book/Page: 14/145 School District: COUNTY Legal: LOT 5 5B PL 14-145 HKY WDS PL 14- Elementary School: CLYDE CAMPBELL Middle School: ARNDT 145 Calculated Acreage: .350 High School: ST STEPHENS Tax Map: 226H 05005 School Map Township: HICKORY State Road #: 2274 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: HICKORY County Fire District: ST STEPHENS Zoningl: R-1 Building(s) Value: $118,700 Zoning2: null Land Value: $16,100 Zoning3: null Assessed Total Value: $134,800 Zoning Overlay: null Year Built/Remodeled: 1981/null 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 #: 3710372400J Building Details 2010 Census Block: 3013 WaterShed: null 2010 Census Tract: 010302 Voter Precinct: P29 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. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=372409263352&typ=P 5/6/2016 CATAWBA 'COUNTY HEALTH DEPARTMENT NEWTON, NORTH CAROLINA COMPLETION PERMIT FOR. SEPTIC TANKS s • PERMIT # C — 2751 DATE : OWNER ADDRESS n BU=LD NG CONTRA,. CTOR R elol( ErJ, & l.D,tstl4lsUBDIVISION /j4ou, W9o15 VAA) (1147 LOCATION "_seise � - /sr /T '`-2240 a OrSt4f a' OTr ' LOT SIZE`Y Litt_ BLOCK OR SECTION HOUSE (V} MOBILE HOME ( ) BUSINESS ( ) OTHER ( ) FHA-VA LOAN ( ) SEPTIC TANK: (SIZE /000 GALS) WATER SUPPLY: / NO. BEDROOMS S NO FIXTURES 2— NDIVIDUAL PUBLIC ✓ GARBAGE DISP5L UNIT:YES ( ) NO (✓) IF WELL, TYPE : BORED DRILLED DUG AUTO WASHING MACHINE : YES _) NO ( ) DISTANCE FROM SEPTIC TANK OR NExRESr NITRIFICATION FIELD: )Q fs V SQ.FT . POLLUTION: FT. 1) NUMBER OF LINES SEPTIC TAtjK N ALLED BY: 2) LENGTH AND WIDTH-OF LINES [J�t fhiQwl/ IC x12- ----- PERMIT FEE $ Q a) BED SYSTEM ( ✓� CERTIFICATE OF CO ETION BY: b) TRENCH SYSTEM ( ) u✓ 3) DEPTH'-OF STONE IN LINES /0 REMARKS : ADEQUATE FALL (GRADE) ON: 1) BUILDING (HOUSE) SEWER LINE : 2) NITRIF7CATIION LINES : DATE INSTALLED: I0is go YES V) NO ( ) SEPTIC TANK LAYOUT -----%-..\.\\ 0 ■ Arl�� h r z I° a x ro � ` F F Oa O $ le l 6-7 ID HEALTH DEPARTMENT COPY ' ( --z- � 1t/o CATAWBA COU*TYTAEALTH DEPARTMENT IMPROVEMENT PERMIT FOR SEPTIC TANKS Permit No. 11546 NAME OFD OWNER DATE /e/Vs 0 ADDRESS OF OWNER PHONE NAME OF CONTRACTOR (�, �I�r. r.... (B�o3P/1up� O.n ADDRESS • Or !at 2 I r�� LOCATION CG—_ 15 4- f-Y ' .9')--' ✓;t' p ' n p °Pie J� MX �j ` SUBDIVISION _„ ,_,iiii4 ,aa. • LOT NO. 7j SECTION OR BLOCK LOT SIZE,fI]S.'tOa FHA, VA LOAN HOUSE (/S) MOBILE HOME ( ) BUSINESS ( ) OTHER ( ) S TIC TANK LAYOUT NO. BEDROOMS (3) NO. FIXTURES ( - f0 GARBAGE DISPOSAL UNIT: YES ( ) NO (✓r PLUMBING UNDER BASEME FLOOR: YES ( ) NO (60r"SIZE OF TANK logo LIQUID GALLONS NITRIFICATION FIELD: 1. Number of lines 3 • id !0 ' 2. Length and width of lines: t �- a. Bed System )3 . X Z ft. b. Trench system ft. 3. Total Depth of stone / 0 inches GROUNDWATER INTERCEPTOR DRAIN: ' -____._. (IF REQUIRED) WATER SUPPLY: - PRIVATE ( ) PUBLIC (iv- s, • OWNER NOTIFIED TO CHECK ZONING: ICES ( •7 NO ( ) OWNER AGREES WITH LAYOUT: YES en NO ( ) OWNER AGREES WITH SPECIAL INSTRUCTIONS: YES (V<NO ( ) a OWNER OR CONTRACTOR SIGNATURE ' /% WS PERMIT FEE $,30e..."---- DAB PERMIT VOID AFTER 36 MONTHS BETA ETV(141TC)I:T; ATMCINT MUST FOLLOW ALL IMPROVEMENT PERMIT ISSUED` DETA (LAYOUT) SANITARIAN Nel HE L7H DEPARTMENT COPY SOIL CLASSIFICATION: SUITABLE ( ) PROVISIONALLY SUITABLE ( ) UNSUITABLE ( ) SITE FACTORS: . 1. SLOPE (X) S - PS - U_ 7. SOIL PERMEABILITY S - PS - U 2. SOIL TEXTURE (12-48 IN.) S - PS - U UNDER 60 MIN. - OVER 60 MIN. SANDY, LOAMY, CLAYEY S. OTHER S - PS - U 3. SOIL STRUCTURE (12-48 IN.) S - PS - U (SPECIFY) 4. SOIL DEPTH (IN.) S - PS - U 9. SOIL SERIES: 5. RESTRICTIVE HORIZONS (IN.) S - PS - U A. CECIL ( ) B. HIWASSEE ( ) (IMPERVIOUS STRATA, ROCK) C. MADISON ( ) D. APPLING ( ) 6. SOIL DRAINAGE - GROUNDWATER S - PS - U E. PACOLET ( ) F. FLOOD PLAIN ( ) (EXTERNAL - INTERNAL) G. 2-1 CLAY SOIL H. OTHER-SPECIFY _. �... ___ --, — _ . . �,Rl� ?'A C CATAWBA COUNTY S� • � ,y, jt 100A SOUTHWEST BLVD 1 s ,oq r NEWTON,NORTH E8 CAROLINA 8 28658 RECEIPT U C 4'_ yawl C Friday, May 6, 2016 1842 sm www.catawbacountync.gov PAYOR: Pegram, Kenneth & Pamela PAYMENTS TRANSACTION NUMBER: TRC-667921-06-05-2016 PAYMENT DATE : 05/06/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 05-16-328093 Authorization to Construct(Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-05-2016-23808 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 2236 37TH AV NE, HICKORY NC 28601 Owner KENNETH& PAMELA PEGRAM, 2236 37TH AV NE, HICKORY NC 28601 H:8282564593 C:8288503833 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 05/06/2016 12:27 Pagel of 1