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HomeMy WebLinkAboutEHPR-05-2016-23928.TIF /$A THIS IS NOT A PERMIT Case # EHPR-05-2016-23928 O Q sr� CATAWBA COUNTY HEALTH DEPARTMENT 0., io• , � ,w''i PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES { r Ig42 sM Environmental Health Plan Review - Septic Malfunction o rya o 1 t f . AUTH CONST- SEPTIC MALFUNCTION �0 t o 0i7 LIIIuPA liSilr J[4 1/ _es I Applicant Kt CLAY 3049 8TH AVE SE, CONOVER NC 28613-8007 C:8288389324 Owner JAMES RUSSELL KELLER HEIRS,2351 27TH ST PL NE, HICKORY NC 28601 NAME TO APPEAR ON PERMIT James Russell Keller Heirs SITE ADDRESS: 2351 27TH ST PL NE, HICKORY NC 28601 PIN # 372306388733 NAME of SUBDIVISION: CLEARVIEW ACRES PL 9-49 Lot# 5& PT 4 6 Section/Block D PROPERTY SIZE: Square Feet 20,037.60 Acres 0.46 DIRECTIONS: Springs Rd NE, Turn beside Old Circle S Diner onto 28th St NE, 2nd Left onto 23rd Ave PI NE, Left onto 27th St PI NE, 2nd house on the Right. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: Water is on the ground.* 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: 80x30 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 accessible so that a complete site evaluation can be performed. Date: 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 AREA2 E9-ehapplication 06/06/2016 08:26 Page I of 7 ���A THIS IS NOT A PERMIT Case # EHPR-05-2016-23928 ««rp CATAWBA COUNTY HEALTH DEPARTMENT 0 .r.o vx1 ,09�9' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 sM Environmental Health Plan Review - Septic Malfunction or o a I :re. AUTH CONST - SEPTIC MALFUNCTION .: d =1 • Applicant KIM CLAY, 3049 8TH AVE SE, CONOVER NC 28613-8007 H:8283087293 C:8288289324 I-IOME:8283087293 Owner JAMES RUSSELL KELLER HEIRS,2351 27TH ST PL NE, HICKORY NC 28601 NAME TO APPEAR ON PERMIT James Russell Keller Heirs SITE ADDRESS: 2351 27TH ST PL NE, HICKORY NC 28601 PIN # 372306388733 NAME of SUBDIVISION: CLEARVIEW ACRES PL 9-49 Lot# 5 & PT 4 6 Section/Block D PROPERTY SIZE: Square Feet 20,037.60 Acres 0.46 DIRECTIONS: Springs Rd NE, Turn beside Old Circle S Diner onto 28th St NE, 2nd Left onto 23rd Ave PI NE, Left onto 27th St PI NE, 2nd house on the Right. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: Water is on the ground.* 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: 80x30 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 thaLa mplete site evaluation can be performed. Date: 5 I 3 k l0 Signature of Applicant or Agent CO An Environmental Health Specialist will contact you within 5 working days ofion date. If you need further information or assistance please call 828-466-7291 AREA2 .<.....W9444444444444444 44444444444 44444444444 44444444444444444444 4444444444444 44444444444444444444444444444 E9-ehapplieation 05/23/2016 14:56 Page 1 of 7 3 • CATAWBA COUNTY Cases PHPR-05-2016-23928 iU G Public Health Department Subdivision CLEARVIEW ACRES PL 9-49 ®t ^ „"�, Environmental Health Division PIN/ 372306388733 lgg2yi PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 NAME ON PERMIT: (JAMES RUSSELL KELLER HEIRS),2351 27TH ST PL NE, HICKORY NC 28601 ( James Russell Keller Heirs) Site Address: 2351 27TH ST PL NE, HICKORY NC 28601 Property Size: Square Feet 20,037.60 Acres 0.46 Directions: Springs Rd NE, Turn beside Old Circle S Diner onto 28th St NE, 2nd Left onto 23rd Ave PI NE, Left onto 27th St PI NE, 2nd house on the Right. a flnilJll�fl(4 I t,l(- 1 l In 1 i 1 r F"s - h P 4 1 1� 11 1 1 i H w AEEENAMEur I i r d l i i " „ignATE1 O0U0rN�0,�0 P ) Authorization to Construct (Repair) Fee 05/23/2016 $300.00 lCl I11� +yTOAL�FEES, hili i� ILI0WWa • oftutailLaintarL =1nnlaib,) gy9� gl 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) E9-ehappl ication 05/23/2016 14:56 Page 2 of 7 CATA\ \ it ® THIS IS NOT A PERMIT ti COUNTY �,.0 lf. CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permit I I Authorization to Construct❑ Septic Repair n Septic Malfunction Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment ❑ Well Repair n Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction Existing Facility',IC • Property Address 351 r7 ST PL NE: Subdivision Clear u 1 'ul) 11 C reS N C ,-.)?(oh I Lot# Acres � ) Section/BlocyPhase Driving Directions to Property Spr N-o.5 1 E \f\s beS Oe Oh Q icC1 e S Dine t' o n e a s'k^ s M E a ND I ec t o N t O ,3 Q.-° U C P L 1\1 r h I e-Ff 0■A+0 aq PLME AeM seccow- pause bra r 1tc-4- NAME TO APPEAR ON PERMIT? Owner n Applicant Contractor Applicant Contact Information Name i VY1 C, Address ,aouq *-irk-kui✓ st: CoNova- i)c ag(oR3 c Phone cza2 -8 �gi- 43ay' KI1n Or ,� � ' �30 �U ' 1) v2 Iq 3 Libb i Owner Contact Information Name ,�a m es R u,s5 P. 1 1 <tc r i-4e C '-s Address Phone Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT?,Owner ❑ Applicant Li Contractor Description of Existing Structures on Site f r c, R Cvn Cf/t , # of Bedrooms *1. 3 Structure Dimensions ,,C,-gb # of Occupants Basement . '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. 0 Yes No Does the site contain any jurisdictional wetlands? © Yes No Does the site contain any existing wastewater systems? 0 Yes No Is any wastewater going to be generated on the site other than domestic sewage? ® Yes o Is the site subject to approval by any other public agency? C)Yes NNo Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well ❑ Community Well ❑ Semi-Public Well X County/City/Township Water Line Is a public water supply available? ** F Yes n 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 cuNrt CATAWBA COUNTY HEALTH DEPARTMENT •_-1 Non„c;;;;;..., Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence U New Residence n Addition to Residence # of New Bedrooms *j Project Description Structure Dimensions # of Occupants Basement ❑ Yes I No Basement Fixtures 0 Yes No ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling n Yes fl No Plumbing n Yes I- No Describe Plumbing Needed I Multi-Family Residence# Units #Bedrooms per Unit*t Total#Bedrooms *1. Structure Dimensions ❑ 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 # of Shifts n Other Facility Type Specify If Church # of Seats Kitchen ❑ Yes [1 No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type n Individual Well n Semi-Public Well ❑ Community Well Abandonment Type n Drilled n Bored n Dug n Unknown Well Repair Requested n Yes in 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 �� Date a 3 0 Printed Name of Owner or Agent I'( I Vy■ C/ a Catawba County Environmental Health • I (120) 60 I I 150 136 I I - ` % _ _ - - I v I r TO I c I• ( s9) 1ST • 1 III ILl - (218) 1.7OS 1 1 — ' _ - - - _ - T"o _ 1 • _ _ — — " _ — _ (245) Parcel: 372306388733, 2351 27TH ST PL NE 1in=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 05/23/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 372306388733 Owner: KELLER JAMES RUSSELL HEIRS Parcel Address: 2351 27TH ST PL NE Owner2: null City: HICKORY, 28601 Address: 3049 8TH AVE SE LRK(REID): 53807 Address2: null Deed Book/Page: 2015E/0244 City: CONOVER Subdivision: CLEARVIEW ACRES PL 9-49 State/Zip: NC 28613-8007 Lots/Block: 5 & PT 4 6/ D Last Sale: School Information: Plat Book/Page: 9(49 School District: COUNTY Legal: LOT 5 & PT LOTS 4 & 6 PLAT 9-49 Elementary School: CLYDE CAMPBELL Middle School: ARNDT Calculated Acreage: .460 Tax Map: 155H 15007B High School: ST STEPHENS Township: HICKORY School Map State Road #: 1615 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: HICKORY County Fire District: ST STEPHENS Zoningl: R-2 Building(s) Value: $81,200 Zoning2: null Land Value: $10,300 Zoning3: null Assessed Total Value: $91,500 Zoning Overlay: null Year Built/Remodeled: 1962/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 #: 3710372300J Building Details 2010 Census Block: 1034 WaterShed: null 2010 Census Tract: 010303 Voter Precinct: P30 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. ,( *nrrind ‘11 keitAQA *urn& •,C (I Cc,' Yv .Ho - http://gis.catawbacountync.gov/nomap/parcel_report.php?key=372306388733&typ=P 5/23/2016 4'A CATAWBA COUNTY V ION,NORTH BLVD RECEIPT _V NEWTON,NORTH CAROLINA 28658 `< Swy�e�Ve � H PHONE: 828.465.8399 CI fv�w,9 `C Monday, May 23, 2016 �� IM- j842� $M www.catawbacountync.gov PAYOR: CLAY, KIM PAYMENTS TRANSACTION NUMBER: TRC-677896-23-05-2016 PAYMENT DATE : 05/23/2016 PAYMENT TYPE: Check 106 INVOICE NUMBER FEE NAME FEE AMOUNT 05-16-328628 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : S300.00 EHPR-05-2016-23928 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 2351 27TH ST PL NE, HICKORY NC 28601 Applicant KIM CLAY, 3049 8TH AVE SE, CONOVER NC 28613-8007 H:8283087293 C:8288289324 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner JAMES RUSSELL HEIRS KELLER,2351 27TH ST PL NE, HICKORY NC 28601 receipt 05/23/2016 14:55 Page 1 of 1