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HomeMy WebLinkAboutEHPR-05-2016-23846.TIF �Y A OG THIS IS NOT A PERMIT Case # EHPR-05-2016-23846 Q - CATAWBA COUNTY HEALTH DEPARTMENT 0 •o ' . D 'It ° PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Dr. 1842 sM Environmental Health Plan Review - Repair go t''.0 eir o AUTH_CONST - REPAIR • - o Applicant TRACIE FORREST, 1804 BUFFALO SHOALS RD, CATAWBANC 28609 C:7047995303 Land Owner PRM-6 (ALICE LAWING), 4211 W BANDYS CROSS RD, CLAREMONT NC 28610 H:8282414258 C:8282444762 HOME:8282414258 Owner CHARLES MACKIE, 1823 BUFFALO SHOALS RD, CATAWBANC 28609 H:8282413422 C:8283207832 HOME:8282413422 NAME TO APPEAR ON PERMIT Trade Forrest SITE ADDRESS: 1804 BUFFALO SHOALS RD, CATAWBA NC 28609 PIN # 367904821727 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 82,328.40 Acres 1.89 DIRECTIONS: Hwy 16 South, Left on Buffalo Shoals Rd, Go about 2 miles&house is on the Right just after Feed Lot Rd. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: System is very old & house is being sold. New owners want a new system installed due to age of 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: 36x56 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 4 PROPOSED CONSTRUCTION BASEMENT? Yes BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: 19-chapplicaurni 05/12/2016 15:17 Page 1 of 1qA \ CATAWBA COUNTY Case# EHPR-0 5-20 1 6-23 846 r C' Gin � Public Health Department Subdivision 2 c=oq Environmental Health Division PIN# 367904821727 °l(4 PO Box 389, 100-A Southwest Blvd, Newton,NC 28658 18 2 ,w NAME ON PERMIT: (TRACIE FORREST), 1804 BUFFALO SHOALS RD, CATAWBA NC 28609 ( Tracie Forrest) Site Address: 1804 BUFFALO SHOALS RD, CATAWBA NC 28609 Property Size: Square Feet 82,328.40 Acres 1.89 Directions: Hwy 16 South, Left on Buffalo Shoals Rd, Go about 2 miles& house is on the Right just after Feed Lot Rd. 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 omplete ite evaluation can be performed. Date: 5i 12. I lip Signature of Applicant or Agent `■-- An Environmental Health Specialist will contact you within 5 working days of application date. If you need further information or assistance please call 828-466-7291 AREA1 FEl WEE ..l9ll iiiiii N 4ir1 ' i nr, , 1llll;i 9' ilill hoiiiili uf .- ENAME i , ' i X !�.G G " . k ,DATE lFEE AMOUNT; Authorization to Construct(Repair) Fee 05/12/2016 $300.00 t iE:11�9° 1 I�N TiTOTALFi EES" . Y, r T r r'1a;. .�r i �ulIIIIIIIllrl .I Ili �T '1P s30000 11 t� ,7t} IhP NWIW8.117p6 op,.`! ! wa=, i t�.Iu s. .: fWWIG N:flldY6i(t Wu.�41atl lLiI ii 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-ehappl ication 05/12/2016 15:17 Page 2 of 4 NVCiA re/KM ft ..•." "� l�uL�1`,r11 r1YV YJL 1Z CATAWRA COUNTY HEALTH DEPARTMENT c..\ Application for EnvironmentalServicesI Page 1• Improvement Permit Li Authorization to Construct❑ Septic Repair, Septic Malfunction❑ Septic Expansion D. New Well Permit Replacement Well ❑. Well Abandonment❑i' Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑; Application es for Ncw Construction,'❑ Existing Facility.TS, Property Address l'QJOz- ' L P kL-0 SN�4-1 AtIsulbdivisioh G AV��R t4C- 2- (U09 Lot#' Aires 2 • Section/Block/Phase Driving Ducctions:to Property' I.(i? tea°`xk1 —[-° 1.)G1=A1-a ���.1-t-fit.-S 'L�h ; —10.1:1•2- Pe-E--n( •(f4 .2 ;M let s. ' otii -nk6 12—i [r • NAME TO APPEAR ON•PLRMIT? ❑ Owner q'Applicant ® Contractor ApplicantContactInfiirmation, : 2- Name POP_Rc t Address r t lCt cfi,Cte A L _ Phone (70 ac Cell Phone;, . 0 t 5 Owner Co—ntaef nt ln for mation" +Name• 64 aLe3 :(\McaL-t ,Address t92:3 P—P • Phone ()ze7 '1'.- 742-7_ • Cell Phone r(er,3Z(3)' 72o ,,— 7� 'S ' . Contractor Contact Information;' Name Address f lions ' . Cell Phone: - • ,.: WHO WILL RF THE PRIMARY CONTACT? ❑ Owner pplicant ❑ Connractor Description of Lxisttng Structures on Site. }--(0CY : #'ofBedrooms *i 3 • 'Structure Dimensions '3s)4. #;ofOccupants q-. Basement p'Yes ❑ No 13ascmcnt Fixtures ❑ Yes 1XNo 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",'applicantmust attach supporting documentation. ❑ Yes, ,No Does the sac contain any jurisdictional wetlands? '' &l Yes ❑No ''' Doesihe sttc contain any existing wastewater sy stems? .❑ Yes' lSt No Is any wastewater going to be generated on the site other than domestic sewage 6;1.. _• •Yes ;24 No- Is the site subject to apprriktal,by any other public agency? • ❑ Yes p No Are there any casements'or,right of ways on?this.property? 1)c-scribe Existing water supply,nuse U Individual Well=' U'.Community;Well ❑ Semi Public;Well 1522 Count /Cit y y/Ttnanship NatcrCine Is a pulihc water supply nvailablc? ** Yes ❑^Nti If applying for an improvement-Permit or Authorization to Construct,Please Indicate 1)isired System Type(s): (systems can be ranked•in order of your preference) • •• ❑Accepted O Alternativ e O Coti.enuonal Imtovauvc ❑ Other , • + : `. ;, Any , • • .. , �.... c•t, - , ... , , .. , tit: + t T THIS IS NOT'A'PERMIT, ' CA.TAWB I CATAWBA:COUNTY HEALTH DEPARTMENT I'Application for Environmental Services Page 2 Proposed Facthty;Type Primary Residence ❑'New Residence .Addition to,Residencc # of New Bedrooms st 3 ' • ProjixtDiw'scription T?CM'ot.. EntS77P4E7 Se-PVC S'Y sit r-,v ANO. 1NSgmest.t b4 •StructurcDimensions ?'X45 of Occupants' • Basement..= Yes, !❑ No Basement Lixtures ❑ Yes `2•No Aciessory Structure(s)s`;Describc #'ofNew Bedrooms •t,if applicable Structure Dimensions #of Occupants I Accessory Dwelling ❑ Yes .;® No ' Plumhing'❑ Yes ,❑ No,, '.'Describe.Pluinbing•Needed• U Muiti,Fantily Residence:#Units ; #Bedrooms perUriit*; • :' Total#Bedrooms t Structure i •,. n;� _ nureDimcnsions Food Service Specify'I',vpc - `' #Seats ,i'"- I Idol'Space Entire Food Service Facility (Sd Pt) ; #1 mplgyces per Shift #of Shifts Dining Arc t(Sq:,Ft.). ❑:Business Specific.Type of 13usitiess • Retail Floor Space #.ofEniployees per Shift ,a. if of Shifts " 06 Other Facility Type Specify ` • ' -.. r If Church#of Seats .` Kitchen ❑ Yes ❑ No . 'If Daycare•Specify Occupancy • ApplicationiforWill Construction/Abandonment/Repair ' Proposed Well Type ❑ Individual Well ❑;Semi-Public Well ❑ Community Well Abandonment Type ® Drilled ❑ !Bored '''0 Dug', ®' Unknown Well Repair Requested ❑'Yes ® No .IDescribcy' , Calculated Design', low Commercial t . Addition l informationl'may be required to'determine• - .tit- , design'flow from certain facilities.- This value will be determincil during consultation with on site staffs `.*'Any room•ih d will'Ile intended:for sleeping at the tithe'ofconstruction or for future consideration should be noted as a'bedroom and countedfon•all applications.'The nurnhcr of bedrooms will be conhrmed by rooms identified on house plans'as a bedroom at the time• of:building permit issu mce This may prevent the need for septic system size increase in the future. :, .t If structure is plumbed but no bedrooms calculated.dcsign flow is required. **,If No a well permit must be issued withthe Authorization to Construct. •- SYSI'EM REDESIGN AND/OR R ET12IP WILL INCUR AN ADDITIONAL CHARGE(SEE FEE SCHEDULE) • Improvement Permits issued as a result of this information are valid for 5 years or may he non-expiring under certain specified' conditions An Aiithonintion to Construct issued by this department is valid for(5)'live years:from the date issued +nd isiiot transferable Improvement Permits and;Vile!!Permits me transferrable:Permits may be revoked if the.information on.this'.application; Bite plans or intended use changes for tlie'"proposed facility.* - " (have read this application rind certify that the information provided herein is true complete mid correct Authorized county and state of are granted right of entry to conduct necessary inspections to dcternune coniplrmcc with ripPlicable laws and rifles. I • Understand that l Ira solely responsible for the proper identification and labeling'ofall property loos rind comers and snaking the site accessible so that a°complete site ev'iluanim,can be',performed. • • Signature ofOwner or Age � !, Date 5' / t• ,J•• . Printed Nam&ofiOwner or Agent " t ca 'J.e. )1 .�'' t rCZ5 � , • • . . • l 'Catawba County Environmental Health '. • • • 180 00 \, • e9 v ? QY . ' _ 1h J�4 1 , •p. • m� • J c7 ' 3S9so 4 ' .4 ,, , , ve o�as • \ d �.1 • • I •u ° \ d� , . r • • , ■ .Parcel: 367904821727, 1804iB,UFFALO SHOALS ,.;Uin=6011• RD'CATAWBA, 28609 , • ihrs map/repon product Was prepared from the Catawba County, on this alp or.dat Lion Services. Catawba County oust pr made substantial n ecm rends 'to ensure the e t verification location and labeling information ed n this contained/rert on,this map the,user.The County run y. Camnw a,its'e loyees.a gen sand xntls .. pers nneendsnt im7ricd ish of n?be hel cliable for an thin all damn es,tos soy tae ityeLJhh r i a of Catawba„donsequ gees agch ai ses personnel;hiscta p/repo t shall not d or held liable rent y and person or damages; or liability,whether direct,indrect or cori3eyuenlial.wh¢h:5risas or may arise from this map/report product or the use thereat by any persoh or entity. _ Copyright 2014 Catawba County;NC 05/11/2016 • Parcel Report Page 1 of 1 • Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 367904821727 Owner: PRM-6 Parcel Address: 1804 BUFFALO SHOALS RD Owner2: null City: CATAWBA, 28609 Address: 4211 W BANDYS CROSS RD LRK(REID): 2666 Address2: null Deed Book/Page: 3010/1135 City: CLAREMONT Subdivision: State/Zip: NC 28610-8276 Lots/Block: / School Information: Last Sale: Plat Book/Page: 18/59 School District: COUNTY Legal: PL 18-59 Elementary School: BALLS CREEK Middle School: MILL CREEK Calculated Acreage: 1.890 Tax Map: 003 K 02018 High School: BANDYS Township: CALDWELL School Map State Road #: 1003 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: BANDYS Zoningl: R-40 Building(s) Value: $114,000 Zoning2: Land Value: $17,300 Zoning3: Assessed Total Value: $131,300 Zoning Overlay: WP-O Year Built/Remodeled: 1946/2004 Small Area: SHERRILLS FORD 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 #: 3710367900J Building Details 2010 Census Block: 2018 WaterShed: WS-IV Protected Area 2010 Census Tract: 011501 Voter Precinct: P1 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. I /.. E MIAM http://gis.catawbacountync.gov/nomap/parcel_report.php?key=367904821727&typ=P 5/12/2016 Kg:A CATAWBA COUNTY ,a t 100A SOUTHWEST BLVD NEWTON, NORTH CAROLINA 28658 RECEIPT d a� -spiivi Hy PHONE: 828.465.8399 /U l> 10) t Thursday, May 12, 2016 842 Shi www.catawbacountync.gov PAYOR: Forrest, Tracie PAYMENTS TRANSACTION NUMBER: TRC-671543-12-05-2016 PAYMENT DATE : 05/12/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 05-16-328300 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-05-2016-23846 CASE TYPE: Environmental Health Plan Review WORK CLASS: Repair SITE ADDRESS: 1804 BUFFALO SHOALS RD, CATAWBANC 28609 Applicant TRACIE FORREST, 1804 BUFFALO SHOALS RD, CATAWBANC 28609 C:7047995303 **NO PEOPLESOFTACCOUNTASSIGNED ** Land Owner PRM-6, 4211 W BANDYS CROSS RD, CLAREMONT NC 28610 H:8282414258C:8282444762 Owner CHARLES MACKIE, 1823 BUFFALO SHOALS RD, CATAWBANC 28609 H:8282413422C:8283207832 receipt 05/12/20t6 1ST? Page 1 of I