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HomeMy WebLinkAboutEHPR-06-2016-24134.TIF s ' THIS IS NOT A PERMIT Case # EHPR-06-20 1 6-24 1 3 4 1 ;W CATAWBA COUNTY HEALTH DEPARTMENT , '�• ,f 0 NWit" u�y PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES I. - 3�T 184ti sM Environmental Health Plan Review - OSWP • IMPROVEMENT •0y 4 ' Contractor COOL PARK PUMPING,INC (KELLY ISENHOUR), 1535 VICTORIAN HILLS CIR, CONOVER NC H:8286327137B:8282562926 C:8282171596 I-IOME:8286327137F:828-256-2926 SAME AS PHONE ISENHOUR4@EMBARQMAIL.COM EMBARQMAIL.COM Owner PETER&JACKIE HATCH, 121 SPRING CREEK CT, WINSTON SALEM NC 27106 C:3364063118 NAME TO APPEAR ON PERMIT Peter & Jackie Hatch SITE ADDRESS: 6565 PROSPECT DR, CONOVER NC 28613 PIN # 374501486478 NAME of SUBDIV ISION: Lot# PT 1 Section/I31ock _ PROPERTY SIZE: Square Feet 40,946.40 Acres 0.94 DIRECTIONS: HWY 16 North, Right onto St. Peters Church Rd, Right onto Valwood, Left onto Wedgewood, Left onto Prospect, Home is on the Left. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Existing drain lines for home run onto neighboring property. IP to evaluate for relocation of the drain lines onto their 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 EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 68x50 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 1 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: E9-ehapplication 06/21/2016 08:31 Page 1 o14 4-i3A CATA\1BA COUNTY Case t+ EHPR-06-2016-24134 n� Public Health Department Subdivision 4 ba.'t Environmental Health Division PINJ/ 374501486478 1,1119‘90.- PO Box 389. 100-A Southwest Blvd.Newton. NC 28658 1842 :w NAME ON PERMIT: (PETER R.JACKIE HATCH), 121 SPRING CREEK CT, WINSTON SALEM NC 27]06 ( Peter & Jackie Hatch) Site Address: 6565 PROSPECT DR, CONOVER NC 28613 Property Size: Square Feet 40,946.40 Acres 0.94 Directions: HWY 16 North, Right onto St. Peters Church Rd, Right onto Valwood, Left onto Wedgewood, Left onto Prospect, Home is 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 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 �Ii�FkECnAMEaB'i j�liilll}Ii'IitilPk'd1� � l jg3d lr PIp{Y 'IIIIIiIDATE �� +ijFEGAMOUNT is _ �.1���.1 G�� t Gw.0 r.:il.�� Jw�Jilll�l,-n�l� A M Improvement Permit Fee 06/21/2016 $150.00 iihIRE Iryi!RvTOTAL_FEES lletll,!f;?�t ��IiIIIi��rS Ail' ui11litinS1500Qljl;, �: •11 IilN.du-.x:= wLL !(ti.Y9Ri H J,�IIB;u �lltlJU!W81WL',IkIWIY9IIIlIII 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-ehapplication 06/21/2016 08:31 Page 2 of4 • CATAWBA THIS IS NOT A PERMIT s coury CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permit n Authorization to Construct❑ Septic Repair❑ Septic Malfunction❑ Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment,❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility u Property Address 6565 Prospect Dr Subdivision Conover, NC 28613 Lot# 1 Acres .940 Section/Block/Phase PT Driving Directions to Property 16 North lett on St Peters Church rd. right on Valwood left on wedgewood left to Prospect,home is on the left NAME TO APPEAR ON PERMIT? 0 Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name Peter&Jackie Hatch Address 121 Spring Creek Ct Winston Salem NC 27106 Photie336-406-3118 Cell Phone 336-406-3118 Owner Contact Information Name Same As Above Address Phone Cell Phone Contractor Contact information Name Kelly Isenhour Address 1535 Victorian Hills Cir Conover, NC Phone828-632-7137 Cell Phone 828-217-1595 WHO WILL BE THE PRIMARY CONTACT? ❑ Owner o Applicant B Contractor Description of Existing Structures on Site 3 Bedroom Home N of Bedrooms *t 3 Structure Dimensions ff of Occupants Basement U Yes ❑ No Basement Fixtures Cl Yes D 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 [7 No Does the site contain any jurisdictional wetlands? * Yes ®No Does the site contain any existing wastewater systems? ©Yes ? No Is any wastewater going to be generated on the site other than domestic sewage? 0 Yes ID No Is the site subject to approval by any other public agency? O Yes D No Are there ally easements or right of ways on this property? Describe Existing water supply in use [J Individual Well ❑ Community Well ❑ Semi-Public Well ❑ 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 Desired System Type(s): (systems can be ranked in order of your preference) O Accepted ❑Alternative ❑ Conventional ❑ Innovative ❑ Other- ❑ Any CATAWBA THIS IS NOT A PERMIT , cco LINTY r* .; ,1/24% CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type 0 Primary Residence ❑ New,Residence ❑ Addition to Residence #of New Bedrooms * Project Description Structure Dimensions II of Occupants Basement ❑ Yes ❑ No Basement Fixtures © Yes ®No L] Accessory Structure(s) Describe • #of New Bedrooms *t if applicable Structure Dikncnsions #of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑No Describe Plumbing Needed Li Multi-Family Residence II Units ilBedrooms per Unit*t Total#Bedrooms *t Structure Dimensions U Food Service. Specify Type 4 Seats Fluor Space-Entire Food Service Facility (Sq Ft) i #Employees per Shift it of Shifts i Dining Area (Sq.Ft.) U Business Specific Type of Business h f Retail Floor Space #of Employees per Shift it of Shifts ❑ Other Facility Type Specify If Church/t of Seats Kitchen ❑ Yes ❑No If Dtiycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ' ❑ Unknown Well Repair Requested ❑ Yes ❑No Describe 1 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. ' I *Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as abedroom and counted on all applications.The number of bedrooms will be confirmed by rooms identifies!on house plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system site 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 RE'FRIP WILL INCUR AN ADDITLONAL 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 year 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 compliancewith applicable laws andrules. 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. ��µ�niryyas�e ey v.meua>. �dL4ie.9d Peter & Jackie:; �,a.�a. �,a. i l« ' Date (24 (20[C Signature of Owner or Agent a-=6, _,d,�d m� Printed Name of Owner or Agent ( ►�_ � I Catawba County Environmental Health 0 i \\\11 0 ` , 186.0 I I ii 1 40 11'11 1 I. v r'J° A^ I M4r "rO 32. 6 �7 SAF r,'�� 18.07 CTO °f, 8. 'P 1911 243 88 — "1"6.Y1 Y O 11 27 — w�W.�C) ah 83.5 w ill al O 1 3:.83 / / a. It.t � / 2.,.9 / / J 83 / 1 .95 / / 4 I`tk. 1 31 1,11—Eril ///j / 1b�° LI 43.80 g / 227.80 Hr� / �k� " 1 ' 1o.00 / / / ,�'1�' Kt IA,11 6.85 / / �� 3/ 41I1CV i i fl / l' i'1, ivfie''f,,f / / 4`I}'fq� ii4t ' I i rt i t:i a " 4...4itilli t i� �1 T• 1 '1/4 co t,l Atli ,f 1' i S'it ull � '�Y, II ilInit Ilf I I� I M „. 4ry e Parcel: 374501486478, 6565 PROSPECT DR tin=50ft CONOVER, 28613 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 06/21/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 374501486478 Owner: HATCH PETER K Parcel Address: 6565 PROSPECT DR Owner2: HATCH JACQUELYN J City: CONOVER, 28613 Address: 121 SPRING CREEK CT LRK(REID): 400746 Address2: null Deed Book/Page: 3015/0969 City: WINSTON SALEM Subdivision: null State/Zip: NC 27106-2652 Lots/Block: PT 1/ null School Information: Last Sale: Plat Book/Page: 60/77 School District: COUNTY Legal: LOT PT 1 PL 60-77 Elementary School: OXFORD Middle School: RIVER BEND Calculated Acreage: .940 Tax Map: null High School: BUNKER HILL Township: CLINES School Map State Road #: null Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: OXFORD Zoningl: R-40 Building(s) Value: $221,900 Zoning2: null Land Value: $95,700 Zoning3: null Assessed Total Value: $317,600 Zoning Overlay: CRC-O Year Built/Remodeled: 1995/null Small Area: ST STEPHENS/OXFORD Current Tax Bill Split Zoning Districts: null/null Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-12-18 Building Permits for this parcel. Firm Panel #: 3710374500K Building Details 2010 Census Block: 1010 WaterShed: null 2010 Census Tract: 010201 Voter Precinct: P33 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/parcet_report.php?key=374501486478&typ=P 6/21/2016 ��•1 ' C t;aT CATMVBA COUNT tr i a Case 'i OP-06-2015-061418 s.' Public Ilealth Depurlmeni •'.'� �, � Subdivision F �2 .� Envi onment�tl lle.dlh Division �• �ti 73-• PIN; 374501486478 V Art PO 13tH 389. 100-A Southwest Blvd. Newton. NC 28658 ii• : LO fN 1 m ft: '"". rS • NAME ON PERMIT: PETER HATCH, 121 SPRING CREEK CT, WINSTON SALEM NC 27106 Site Address• 6565 PROSPECT DR, CONOVER NC 28613 Property Size' Square reel 40,946 40 Acies 940 Directions _16_North_Left on St Peters Church Rd Right on Valwood left on Wedgewood left on Prospect Dr Lot is on the left Catawba County Health Department Operation Permit System Type IIIE - PPBPS GRAVITY DOSED SYSTEM (In accordance with Table Va) Description 50% REDUCTION PPBPS System Code PPBPS System Code Description PPBPS Types V and VI systems expire in 5 years. Owner must contact health department 6 months prior to expiration for permit renewal. System Installation Comments 3 panels only replaced due to damage PERMIT CONDITIONS 1 All maintenance, monitoring, and performance requirements shall be in accordance with 15A NCAC 18.1900, Rule .1961 2 Operation & Maintenance Specifics Subsurface system operator required? Yes No_X _ If yes, see attached sheet for additional operation conditions, maintenance and reporting This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and All conditions of the Improvement Permit and Construction Authorization Kevin Powell #1864 05/28/2015 SYSTEM INSTALLER INSfAI.LA'TION DATE Mike Cash 05/28/2015 AU111012IZED S iAT2 ACEN r DATE CI OPERATION PER;:IIT ISSUANCII Form F _irpi.nnit 06/05/2015 10 52 Page I of3 r CAT\ V3\COUNTY 'O.; r _b - Case N AU H-OS-_0 15-050617 61115 f` �! � Public Health Deportment Suhilivision peti LT) Environmental I-Icuhh Division • • d '3 } PIN?! 374501486478 PO l3uv 359. 100-A Southwest Blvd.Nen■ton. NC 28655 i ar I.OTiI 1 i_ r ofkl NAME ON PERMIT: PETER HATCH, 121 SPRING CREEK CT, WINSTON SALEM NC 27106 Site Address: 6565 PROSPECT DR, CONOVER NC 28613 Property Size• Square Feet 40,946 40 Acres 940 Directions. 1.6_Noctf .Left on St Peters Church Rd Right on Valwood left on Wedgewood left on Prospect Or Lot is on the left Authorization to Construct Permit Authorization to Construct Wastewater System (Required for Building Permit). ` See site plan and ntunher of addnium,'atlachntetas( Proposed Wastewater System• 50% REDUCTION Wastewater Flow 360 g.p d Type' IIIE - I'PBPS GRAVITY DOSED SYSTEM Soil LTAR g.p d./ft2 Permit Category. Repairs Type of Facility. Primary Residence - 3 bedroom home Basement" Yes Basement Plumbin'g') Yes Bedrooms• 3 Wastewater System Requirements Tank Size• Existing Tank 1.000 gal Pump Tank gal Grease Trap gal Dosing Volume gal Pump Specs GPM @ TDH Pressure Head ft Draw Down In Drainfield: Total Area sq ft Total Length ft Maximum Trench Depth in Aggregate Depth in Trench Width ft Minimum Soil Cover in Minimum Trench Separation ft on center Number of Drain Lines Distribution: Pre Treatment: NONE Additional Specifications. As per court injunction and agreement between property owners, this permit is issued to replace damaged PPBPS panels as identified in previous complaint No soil or site evaluation completed as only damaged panels are to be replaced in the area currently located No additional repairs or alterations to this system are authorized under this permit Landscaping or other site alterations that potentially divert groundwater or surface water toward the septic system, or prevent proper drainage away from the septic system, including the direction of gutter flows or foundation drains, is not approved, and may result in failure to approve the initial system installation, or the suspension/revocation of existing_permds »»> DO NOT INSTALL SYSTEM UNDER WET CONDITIONS ««< — —__-_ Proposed Repair--- �— --__ _-_ System Class. Proposed System Distribution Type. Soil LTAR• gpdift2 d�lrnnn 05/18/2a15 I U un face l of-1 tv;\. L CATAWBA COUNTY Case p AUTH-05-2015-060617 I .7(/— P \t Public Health Department Subdivision I! $�°a+.rr Environmental I lealth Division PIN/ 374501486478 Ni dire' '" \� 'yt--�/J I'O Box 389. 100-A Southwest Blvd.Newton. NC 28658 LOT# 1 9W' NAME ON PERMIT: PETER HATCH, 121 SPRING CREEK CT, WINSTON SALEM NC 27106 Site Address' 6565 PROSPECT DR, CONOVER NC 28613 Property Size. Square Peet 40,946 40 AC1es 940 Directions. 16 North I eft on St Peters Church Rd Right on Valwood left on Wedgewood left on Prospect Dr Lot is on the left The issuance of this permit by the Health Department does not guarantee the issuance of oilier permits It is the responsibility of . the applicant/property owner to insure that all Catawba C:uumy Planning/Zoning and Budding Inspections requirements are met This Authorization to Construct Permit is subject to revocation if the site plan.plat or the intended use changes.or if site conditions are altered. The Authorization to Construct Permit is not affected by a change in ownership of the property. This permit 'as issued in compliance with the provisions of the North Carolina 'Lrm�c and Rules fin Sewage Treatment and Disposal Systems' (I5A NCAC 18A.1900). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system coil continueiolunetion sahsfartori n5.for_anx oiven.yenod of tunic. • Mike Cash 05/18/2015 AIiTHORIZEU.STAVE AC ENT APPROVAI.DATE • Permit Expiration Date 05/15/2020 No grading w'consu•uc(ron acrnvm is allowed rri areas desrgnaied for.system and repair without approval q%the health Department • • clip coil 0511s12015. I0 46 Page 2 of 4 c2 ; 3a I ***Op. Permit and/or Cert. Op. Required Must be completed prior to final) N� 8 2 9� CATAWBA COUNTY HEALTH DEPARTMENT (704) 465-8270 Lot Eval. Improve. Permit /2/Repair Permit Cert. of Comp. Permit�j Oper. Permit Owner/Agent /J// 1 s ��1r.1i Phone p2W--6 0 Address !a /inmoinik/ P _� Subdivision Se do B ock/Phas- Lot# Lot Size Directions- —_ r� ,• 4. ",p-.://1-7— Facility: House 1.""Mobile Home Business . Other: Tax Map(4l o 0 ^02 — , Parf/o� Multi-famil Other . Zoning Approval # O WJ, - Bedrooms Seats Employees . Application Rate GPD Flow Hot Tub or .a yes/no Special Fixtures . 100t Repair Area no REPAIR NOTICE: Basement 0/no Bement Plumbing fno . REPAIRS MUST BE ' IN 30 DAYS OR Water Sup. y: Private 4, Public . DAYS FROM DATE OF PERMIT. Type of System: Trench Bed Pump Pump/Panel Panel LPP Other Tank Size: Septic Tank /9Q0 Pump Tank rI Nitrification Field: Total Squa e Feet Depth of Stone Bed Size Trench Width 3/ Total Length of All Trenches / Number of Trenches Individual Trench Length ! 75/ Feet on Center 7- Maximum Trench Depth V � Distance of Nearest Well /00 �t Evaluation: Approved yes/no (Void After 24 months) Topo,_ t Slap ; Sketch of lot Evaluation Site - System Design - Final Texture DO NOT Structure 9/g3 C'� �\ a WHEN -T d., ah �� roa0'v Y 1 t ` Clay Min. � 4 �] � ` Soil Wetness la/� " l r/_y� 1 ( �/ "S Soil Depth I r (V Restric. Hoz. at - " ( (+ l/r Available space / no ' l� ( ``� O Overall Class S " U ' Comments: _ I \VI-- CJ 1-4/ °Lc-'-. .0/-'-N-\,...„A‘Ori:fr* 4 Nc- Septic Tank Contractors MUST contact the Sanitarian BEFORE changing permit. **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN THROUGH THE ISSUANCE OF THIS PERMIT** Permit Date Sr 4-(1-5- (Improvement Permit vo'd after 60 months) Owner/Agent di, W . fl l i`" S t� __rian G� : . /17 Installed By �A�,MhIEWiv Date -1 ! Sani arian Ar, J/i_„,G -j'< .. ( . e any changes information in red or by sketc ' •ack) IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE IS AN ADDITIONAL $25 CHARGE. White-Office Blue -Building Inspection Completion Yellow -Owner/Agent Green-Building Inspection IP • 1 CATAWBA COUNTY ION, SOUTHWEST BLVD RECEIPT 1, NEWTON, NORTH CAROLINA 28658 K <Vm PHONE: 828.465.8399 ii;4! �. Tuesday, June 21, 2016 it y,>842 sM www.catawbacountync.gov PAYOR: Hatch, Peter&Jackie PAYMENTS TRANSACTION NUMBER: TRC-697052-21-06-2016 PAYMENT DATE : 06/21/2016 PAYMENT TYPE: Credit Card payment by phone from Peter INVOICE NUMBER FEE NAME FEE AMOUNT 06-16-329660 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EHPR-06-2016-24134 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 6565 PROSPECT DR, CONOVER NC 28613 Owner PETER&JACKIE HATCH, 121 SPRING CREEK CT, WINSTON SALEM NC 27106 C:3364063118 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Contractor COOL PARK PUMPING, INC, 1535 VICTORIAN HILLS CIR, CONOVER NC 28613 H:8286327137B:8282562926C:8282171596F:828-256-2926 SAME AS PHONE I SENHOUR4 @EMBARQMAIL.COM receipt 06/21(2016 0&31 Page I of 1