Loading...
HomeMy WebLinkAboutEHPR-06-2016-24086.TIF Y'A THIS IS NOT A PERMIT Case # EHPR-06-2016-24086 �G Q f CATAWBA COUNTY HEALTH DEPARTMENT O' �'t O �o ''e` PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 SM v. Environmental Health Plan Review - OSWP o �q� • 0 }.fir •y IMPROVEMENT 0 o - o Applicant PAMULA SOLBASKKEN, 150 BOST NURSERY RD, MAIDEN NC 28650 C:7043084746 Owner MARTHA OWENBY, 150 BOST NURSERY RD, MAIDEN NC 28650 C:8289707176 NAME TO APPEAR ON PERMIT Pamula Solbaskken SITE ADDRESS: 150 BOST NURSERY RD, MAIDEN NC 28650 PIN # 364612869611 NAME of SUBDIVISION: Lot# 1 Section/Block PROPERTY SIZE: Square Feet 20,037.60 Acres- 0.46 DIRECTIONS: HWy 321 Business, Left on Main St, Straight onto Island Ford Rd, left onto Bost Nursery Rd, House is on the Corner of Grand Acres& Bost Nursery Rd. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: IP Only at this time. Looking to add addition to home 12x12 of 1 BdRm. Will also have to look at relocating existing septic lines along with expansion. 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, Storage Bldg EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: House 60x44, Bldg 8x15 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 6 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: Addition to back of home 12x12 #OF NEW BEDROOMS:: 1 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: E9-ehapplication 06/13/2016 11:44 Page 1 of4 /gt• \ CATAWBA COUNTY Case# EHPR-06-2016-24086 .i Public Health Department Subdivision G , ® ^a Environmental Health Division PIN# 364612869611 \84Z PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 NAME ON PERMIT: (PAMULA SOLBASKKEN), 150 BOST NURSERY RD, MAIDEN NC 28650 ( Pamula Solbaskken) Site Address: 150 BOST NURSERY RD, MAIDEN NC 28650 Property Size: Square Feet 20,037.60 Acres 0.46 Directions: HWy 321 Business, Left on Main St, Straight onto Island Ford Rd, left onto Bost Nursery Rd, House is on the Corner of Grand Acres& Bost Nursery 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 acc Bible so that a complete site evaluation can be performed. Date: LO-13'(t-Q Signature of Applicant or Agent tilyVULOa 339.\0.lx-KC11. 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 iglngi ,J . : a�tim iN'y� 4�a yi U tipu w • FEENAME t / j DATE", � a FIhElue E•Aa M U OUNI;T •. Improvement Permit Fee 06/13/2016 $150.00 A 11 11 t 11 51OTAIFEES 4 M I UMMi 1111 I iillE u t 1111111 111»i1S$150 0 ,,,,Li• ,NL'NIliU Vtu�ta m1n z, ar�lmisih+UW{Li111�'IIIIIIttlfd-a: ,,I�naJi¢"af.�BGIW,t�st>;31.19'n`:v 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 06/13/2016 11:44 Page 2 of 4 CTA1\ \ � . A THIS IS NOT A PERMIT Cou1l ---\, CATAWBA COUNTY HEALTH DEPARTMENT f Application for Environmental Services Page 1 Improvement Permit% Authorization to Construct❑ Septic Repair Lf Septic Malfunction U Septic Expansion ❑ New Well Permit I 1 Replacement Well ❑ Well Abandonment Well Repair Existing System Inspection (Pre-Approval Required) n Application is for New Construction 1 I Existing Facility _;/ Property Address\5U ZDv+ Nl C","se ' �t Subdivision ll�_ 64-e & l - .% .Sd Lot# Acres Section/Block/Phase Driving Directions to Property 3D\ bus. 1 VC-k O i` fYlat in ''5+ i 511019 h l- CM hp ad •' • e 4- cr .oS ur. - J_ NAME TO APPEAR ON PERMIT? ] Owner t-Applicant n Contractor Applicant Contact Information Name Ryy\uka SolOckKizen Address 1 j Pp� ?JUfSevU Rd Mulder\ MC 9SU0 Phon - (y— y1 q0 J Cell Phone Owner Contact Information Name ç{\o,(-1'ho- Ovaenbi Address 1:-) t∎ Olf YL3 lid. maiden-) NC- (SLD5� Phone '39Th. 9-76-1 Lc, JJ Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? n Owner Applicant ❑ Contractor Description of Existing Structures on Site hN y5e I Do \d i nci r # of Bedrooms *.i. 3 Structure Dimensions ft of Occupants LO Basement ❑ Yes s—No Basement Fixtures Q Yes 0 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 Does the site contain any jurisdictional wetlands? 'Yes *No 4BS Does the site contain any existing wastewater systems? O Yes No Is any wastewater going to be generated on the site other than domestic sewage? El Yes No Is the site subject to approval by any other public agency? O Yes -No Are there any easements or right of ways on this property? Describe Existing water supply in use Individual Well [ Community Well ❑ Semi-Public Well ] County/City/Township Water Line Is a public water supply available? ** ❑ Yes II-No If applying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s): V (systems can be ranked in order of your preference) ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other VLATIY C ATAUU TRA THIS IS NOT A PERMIT couNU ll�y CATAWBA COUNTY HEALTH DEPARTMENT �sr Application for Environmental Services Page 2 . Proposed Facility Type n Primary Residence n New Residence IA Addition to Residence # of New Bedrooms *1. Project Description !issd_. •,_%. • cx t.'• _ as Structure Dimensions 102 # of Occupants Basement n Yes I I No Basement Fixtures ® Yes n No F1 Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling n Yes In No Plumbing n Yes n No Describe Plumbing Needed r I 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.) n 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 n Semi-Public Well n Community Well Abandonment Type n Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ 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 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 belI'performed. n Signature of Owner or Agent • ,(,(�Cl �❑79 b{k, r-e4A- Date 19 ' \L( Printed Name of Owner or Agent / l UI a L .. Y' 9 1.00s 1190 ON Alunoo egmeleo 17 LO?1g6uAdoo 'Nllua io uosied Aue Aq loaJagl esn ayl Jo lonpmd 1.10dOJ/dew siyl woJj aspe hew JO saspe ya!ym Iepuenbesuoo Jo low!pu! 'loai!p Jeq egM'Aj!I!gep io ssoi'sa6ewep lie pue Aue Jol algep play eq lou Heys pue'w!eps!p'iauuosiad pue'slue6e'saaAo1dwa s2'egmeleo to Alunoo au'Jean ayl Aq lanpmd podw/dew s!yl uo pau!eluoo elep Aue jo uogeoyuan luepuedepui.ayl spuawwooa,pue sa;owwd Alunoo egmeleo'pada'spp uo elep io dew sly;uo peuieluoa uogewlolui bugagei pue uope0oi to Aoemooe ayl ansua of spode!eguelsgns spew seq Alunoo egmeleo 'saa!nJag uogewiolui!epedsoao oN'Alunoo egmeleo ayl wop paiedeid sem lonpoJd podai/dew spyl 0998Z `NDOIVIN ad 1109=u!l. AEOSaf1N 1308 091- ' I.L9699Z 1-9V9£ :IeOJEd A 10. 1 y mss, �a. I •it 11_ 91:1... a Ilk 4 I sip!" ( e '114111\ ..." . d * 1'^ IOfl Q • r r CI' .ti gggE ite C'°S 0 I �u 179'9 L El ,N k b : q1 ' f ; ll,.1T(J)C� 6,i , i i l p ad -,c'' 16 r ° ��. -r'9 • , es. Sb it frr a.0, / / . / , tJ 9d • 7 ulleaH Ialuewuoalnu3 Alunoo egMEleo Parcel Report Page 1 of I Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 364612869611 Owner: OWENBY EDWARD J Parcel Address: 150 BOST NURSERY RD Owner2: OWENBY MARTHA A City: MAIDEN, 28650 Address: 150 BOST NURSERY RD LRK(REID): 200966 Address2: null Deed Book/Page: 3294/1379 City: MAIDEN Subdivision: null State/Zip: NC 28650-9524 Lots/Block: 1/ null Last Sale: $118,000 on 2015-06-17 School Information: Plat Book/Page: 52/75 School District: COUNTY Elementary School: MAIDEN Legal: LOT 1 PLAT 52-75 Middle School: MAIDEN Calculated Acreage: .460 High School: MAIDEN Tax Map: null Township: CALDWELL School Map State Road #: 1869 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: MAIDEN County Fire District: MAIDEN RURAL Zoningl: R-20 Building(s) Value: $107,900 Zoning2: null Land Value: $9,900 Zoning3: null Assessed Total Value: $117,800 Zoning Overlay: null Year Built/Remodeled: 2001/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 #: 3710364600J Building Details 2010 Census Block: 5019 WaterShed: 2010 Census Tract: 011602 Voter Precinct: P9 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=364612869611&typ=P 6/13/2016 CATAWBA COUNTY HEALTH DEPARTMENT wi-s 0cc1-007/3 Telephone: (828)46 -g/�70 TDD: (828)465-8200 posed N.9 akiit IP_ AC X . •r. Runt. A Opr. Print.jSys. Type tT Well Print. X. Replacement yVe,11,,, �VSi1 Bpi. Print. Owner/Age • Ara y Phone `1C�-�L27°!Y Address . lag Aira1711110: Subdivision Ve AWN. a Se 2 on/Block/'hase Lot Lot Size !. etions: align/-I. rAIIIIIMP is- • r - eil. — /f- st. _ e Property Address / i • -/ Facility: House ' Mobile Home_ Business Multi-family . Other: Pin Number Want. • s Other . Zoning Approval# #Bedrooms #Seats #Employees . Application Rate GPD Flow Rani Ilot Tub or Spa yes/CP.ecial Fixtures Basement yet . 100% Repair A • es no Basement Plumbing y-.�. Water Supply-. rivate Well y Public Semi-Public ii*i*******•••••••• *******iii*****t*******************4i*i**it*******i ii***i************Y**ii** •if Mjt+#i flit>**•*** Type of System: 'F/r�ench X ��t/ Red Pump Pump/Panel Panel LPP Othtt�er 2s Septic Tank Size Q Pump Tank Size Nitrification Field: Total Square Feet r7 Other Depth of Stone NO S Bed Size Trench Width d Total Len th of All Trenches ,/n umber of Trenches Trench Len gtir02- 2 2 / (gy n y rj 5 ,��__ Feet on Center / Maximum Trench Depth Distance of Nearest Well , *DO NOT INSTALL SEPTIC WHEN WET* WELL RECORD REQUIRED AT COMPLETION' ****t*****i***♦*F*****i*i*l********************1**the***kith•**********.***.s***,*th**•i*5Yi i***** ******i****loft*#* Tnpu % Slope I,I,�°t 0 ^ jig 11 Structure a �f" Clay Min. v Soil Wetness Soil Depth . Availab a Hoz. space a " \b l �� Available lass PS \ \ Overall Class S PS U ✓/// Comments: 6 Z aG 2Sto � + - f \� ; s ,( .. ,r ` fn' t la z - FilterRequired 3 Imo, rt ' Riser required when J tank is more than 6 �Q� gG S{- ALt' r n f inches deep. �(� "NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OFITIME THIS SYSTEM WILL FUNCTION'" ****i*******r**i*******l**l*******t*********♦**************i a************t**************i*l********•***************l*i***i* *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. Well Permit valid for 5 years provided site conditions do not change. Well location, installation,and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. The siting of the well by the Health Department staff is to provide protection from known possible sources of contamination. No volume of water is guaranteed at any site by the lealth tepartment. Or Permit Date • L Q EHS . ..# s- .4.,,,,_ a Owne A• n � Septic Ti k In•iff Mp�ryetiin�, Date �t,'ni i i EHS A �JSgl�i�. L Well Installed By .. h'w C21 Well Grout Approval Date & 7r I Well Ile. •pin. 'a D. eRelli Date Sample Collected Date of R-sul ' •esu s EHS • •a a toll q_• r White-Office Blue-Building Inspection Operation Permit Yellow-Owner/Agent Green- :ICI nspec n u i*1:tion to Cmuvuct y1p'A !.t CATAWBA COUNTY ��" rr 100A SOUTHWEST BLVD i �. Y a NEWTON,NORTH CAROLINA 28658 RECEIPT � V►ew PHONE: 828.465.8399 \\_._„, i,'t.- {1' vow , Monday, June 13, 2016 8 4 2. 5M www.catawbacountync.gov PAYOR: Solbaskken, Panmla PAYMENTS TRANSACTION NUMBER: TRC-691078-13-06-2016 PAYMENT DATE : 06/13/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 06-16-329337 Improvement Permit Fee $150.00 TOTAL PAYMENTS : S150.00 EHPR-06-2016-24086 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: I50 BOST NURSERY RD, MAIDEN NC 28650 Applicant PAMULA SOLBASKKEN, 150 BOST NURSERY RD, MAIDEN NC 28650 C:7043084746 ** NO PEOPLESOFTACCOUNTASSIGNED ** Owner MARTHA OWENBY, 150 BOST NURSERY RD, MAIDEN NC 28650 C:8289707176 receipt 06/13/2016 11:44 Page 1 of 1