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HomeMy WebLinkAboutEHPR-07-2016-24346.TIF ss�A O THIS IS NOTA PERMIT Case # EHPR-07-2016-24346 G 4 ` CATAWBA COUNTY HEALTH DEPARTMENT ❑' r , 1u• L >yy - PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES . 1842 sM1+ Environmental Health Plan Review - Septic Malfunction • \ n 13 •� r••• AUTH_CONST- SEPTIC_MALFUNCTIONEl Contractor POWELL SEPTIC SERVICE (KEVIN POWELL), 360 POWELL RD, TAYLORSVILLE NC 28681 H:8286321791 C:8283020758 HOME:8286321791 Owner JACK& TERESA WALTER, 3000 PEACHTREE ST EXT, CLAREMONT NC 28610 H:8282678319 C:8283208910 HOME:8282678319 NAME TO APPEAR ON PERMIT Jack & Teresa Walter SITE ADDRESS: 5907 FLAMINGO DR, CONOVER NC 28613 PIN # 374519526107 NAME of SUBDIVISION: CLEAR SPRINGS Lot# TR 1 Section/Block B PROPERTY SIZE: Square Feet 106,722.00 Acres 2.45 DIRECTIONS: Hwy 16 North, to Springs Rd about 1.2 miles, Right onto Flamingo Dr, go about 400 ft, Left onto the gravel drive to the home. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: Tank Only Replacement* 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: 32x56 NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 1 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: lig-chappllcaGon 07/21/2016 14:33 Page 1 or 7 4l3A CATAWBA COUNTY Case# EHPR-07-2016-24346 ,C G Public Health Department Subdivision -/. CLEAR SPRINGS �;PPI�., Environmental Health Division PIN# 374519526107 tF PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 /A 2 s+ NAME ON PERMIT: (JACK& TERESA WALTER), 3000 PEACHTREE ST EXT, CLAREMONT NC 28610 ( Jack & Teresa Walter) Site Address: 5907 FLAMINGO DR, CONOVER NC 28613 Property Size: Square Feet 106,722.00 Acres 2.45 Directions: Hwy 16 North, to Springs Rd about 1.2 miles, Right onto Flamingo Dr, go about 400 ft, Left onto the gravel drive to the home. 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 nece -ary inspections to determine compliance with applicable lawsrand rules. I underst d that I am solely responsible fo tie " proper identification and labe ng of all .roperty lines and corners and making the site accessib,- so .- a co to site v uatign can a perfor ed' Date: 9 c?-.. ae/ Signature of Applicant or Agent '. l/ n Envir.nmental Health Specialist will contact you within 5 orking days of application date. If you need further information or assistancelpie,se call 828-466-7291 AREA2 ************************************************************************************************************ �FEENA�MEt 7"i�liligua 1� a!, CATAWBA TI-IIS IS NOT A PERMIT )1J0 1\c. 0* couNr ���.� CATAWBA COUNTY HEALTH DEPARTMENT " ,c.•7, Application for Environmental Services Page 1 Improvement Permit E Authorization to Construct D Septic Repair in Septic Malfunction Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment Well Repair D Existing System Inspection (Pre-Approval Required) ❑ Application is for New Con traction L Existing Facility ❑ Property Address 5.-907 _ /907 L m1 Apo 0C Subdivision CQJY�-0-1T��/ C-� Lot# Acres g ' V / �/ Sectjon/Block/P ase Driving Directions to Property /i0 /U� TD SR / 9c 0 7 , a 'T L._ AT- an. FL 0-,--or yo Pk_ • if-o o FT +/— NAME TO APPEAR ON PERMIT. DliCv ner ❑ Applicant 5 Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information �/�/�� � � �� Name *S� c)c -F'TEAF S 4 w if LIE i< 142lvrvc✓LI.. AIL--�� Address ]00 ,Pp-2G/tre¢� T C.Yi-�' 70-a24.0-__ phone g 3T-..67.- g 319 jL Cell Phone (5 as) 3 a 0-89 /0 Contractor Contact Information , Name /cIvjit) 175A Pi Address ,G,O e - i %4`lo/ s di LLE NC ' s6 S/ Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant 5 Contractor Description of Existing Structures on Site f/aaw.¢- /. 0-1-a-13 etterL . �'D a L # of Bedrooms *j' -9- Structure Dimen ions #of Occupants A/l'9 Basement F.-Yes ❑ No Basement Fixtures a Yes 0-9-o- --- The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property i question. If the answer to any question is "yes", applicant must attach supporting documentation. El Yes No Does the site contain any jurisdictional wetlands? / El Yes EI N Does the site contain any existing wastewater systems? O Yes 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? C Yes C ANO- 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? ** 5 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 0 Alternative 0 Conventional 0 Innovative ❑ Other Any / C^T^`j Tl�C'1 Q ^ THIS ISNOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT tie„„�„ Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ® Yes ® No ❑ Accessory Structure(s) Describe ft of New Bedrooms *t if applicable Structure Dimensions ft of Occupants Accessory Dwelling ❑ Yes 5 No Plumbing ❑ Yes ❑ No Describe Plumbing Needed Multi-Family Residence# Units #Bedrooms per Unit*t Total# Bedrooms *t Structure Dimensions 5 Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift #of Shifts Dining Arca (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 5 Individual Well ❑ Semi-Public Well n Community Well Abandonment Type ❑ Drilled ❑ Bored 5 Dug ❑ Unknown Well Repair Requested ❑ Yes 5 No Describe Calculated Design Flow, Commercial j' 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. f 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 07 / D�� Printed Name of Owner or Agen � �C k LL., LTE Catawba County Environmental Health k I 1 1 1 t I 1 1p65 1 1 I 1 (021 1 O 1 i 57 1 1 �teo 5 I 66I 60 1 53 1 1 7."17"7 363 02 t 5• iii 1 10`Q5�' 29.9E3 2 126 vvr p 379.N. or W 'S 1pIP C, rieri-i ( r I 043 It1 �'1 P1 th ta � � ix I, yllp°4, �,� :III 1,,,,,: , !i: 1 �� "a in v I i4 ?11�j� kI 84 Irll,�l�Il y1i il'I Iii BHHti`!.4h IIS 'tiidJ1 IIt4,„""II911f ��I Ipp���lij 1,ill itii�' 11(I11r iPt' 5 I 3 11. ,,,,,,„,„„, iii . . . , ha ft'0 .I .aai di 10• 4'' I I I I IIN I I - / I I /1p�yp I I I I 26675 lOi1461 Pr 22 ,.._ 269.7 � -0— 1N9�oR 21 FSM �� Parcel: 374519526107, 5907 FLAMINGO DR 1 in=80ft 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 07/21/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 374519526107 Owner: WALTER JACK R JR Parcel Address: 5907 FLAMINGO DR Owner2: WALTER TERESA DALE City: CONOVER, 28613 Address: 3000 PEACHTREE ST EXT LRK(REID): 42791 Address2: Deed Book/Page: 3107/1597 City: CLAREMONT Subdivision: CLEAR SPRINGS State/Zip: NC 28610-8641 Lots/Block: TR 1/ B Last Sale: School Information: Plat Book/Page: 44/185 School District: COUNTY Legal: Elementary School: OXFORD LOT TR 1 PL 44-185 Middle School: RIVER BEND Calculated Acreage: 2.450 Tax Map: 0909 03015 High School: BUNKER HILL Township: CLINES School Map State Road #: 2378 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: OXFORD Zoningl: R-20 Building(s) Value: $92,600 Zoning2: Land Value: $17,900 Zoning3: Assessed Total Value: $110,500 Zoning Overlay: Year Built/Remodeled: 1992/ Small Area: ST STEPHENS/OXFORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-12-18 Building Permits for this parcel. Firm Panel #: 3710374500K Building Details 2010 Census Block: 1013 WaterShed: 2010 Census Tract: 010201 Voter Precinct: P33 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 Geospafial 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=374519526107&typ=P 7/21/2016 CATAWBA COUNTY-HEALTH DEPARTMENT Telephone: (704) 465-8270 TDD: (704) 40-8200 Improve. Permit//7,,Authorization to Construct Repair Permit[/Oper. Permit System Type Owner/Agent f-&A /id / /. Phone Address Subdivision Sec 'gn/Block/Phase Lot# Lot i Dire ions: IOW ' a a sass 6,1_ Facility: House Mob]. Home Business . Other: Tax Map # Multi-family Other . Zoning Approval # # Bedrooms # Seats # Employees . Application Rate GPD Flow Hot Tub or Spa yes/no Special Fixtures . 100% Repair Area yes/no Basement yes/no Basement Plumbing yes/no Water Supply: Private Well Public Type of System: Trench Bed�7n P,,um��// --��99----Pump/Panel Panel LPP Other Tank Size: Septic Tank Size taQiiyx/l, Pump Tank Size Nitrification Field: Total Square Feet 15U Depth of Stone �--x77// Bed Size Trench Width .3/ Total Length of All Trenches .f-6 Number of Trenches . Individual Trench Length / "LS / / / Feet on Center 9 Maximum Trench Depth % 1 Distance of Nearest Well :— *DO NOT INSTALL WHEN WET* Tops 3'S % Slope Texture C:11.,(-1-5," °- Structure 5e} Clay Min. / I` . __ _ - _ _ _ — . _ . _. _ Soil Wetness141 " Soil Depth " Restric. Hoz. at, -� " Available space e no - - • Overall Claes S *JOU _ - --) Comments: � **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** *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) lye yeapp rom date issued and is not transferable. Permit Date / 9, ,4, Y Owner/Agent _ San}},,taria - Installed By �i, ' Date 1{-„t- Y"9 Sanitarian/s� L_ V'c4.0 oC / � a White-Office ' Yellow-Owner/Agent z 'w '+ 0M1-0() 05461 ctn.TAWBA. COUNTY`° I-IEAI,TI-I DE/AB2TMENT (704) 465-8270 Lot Eval. K Improve. Permit X Repair Permit Cert. of Comp. Permit % Oper. Permit Wick Owner/Agent b, vin L. Phone Address Subdivision Section/Block/Phase Lot# J, `Size Directions: .! . - an- - I Ky - 4,G I�YJ1 F707/7:14-413M--M0 „_p , y'-cc-e,:— j, - rLr4 - // Facility: House_ Mobile Home X Business_ . Other: Zoning Approval yes/no # Multi-family_ _ Other . Tax Map # Bedrooms Z Seats Employees . Application Rate ' GPD Flow Hot Tub or Spa yes/no Special Fixtures . 100% Repair Area yes/no REPAIR NOTICE: Basement yes/0 Basement Plumbing yes/ ). REPAIRS MUST BE WITHIN 30 DAYS OR Water Supply: Private X Public_ . DAYS FROM DATE OF PERMIT. Type of System Trench X Bed_Pump_Pump/Panel_Panel_LPP_Other Tank Size: Septic Tank /C6)0 Pump Tank Nitrification Field: Total Square Feet [9()C) Depth of stone/Zifz4 Bed Size Trench Width 3 -Pt- Total Length of All Trenches ZOO Number of Trenches 3 i Individual Trench Length�7/l0 7/ 6�J 7/ / Feet on Center Maximum Trench Depth Distance of Nearest Well Lot Evaluation: Approved yes/no (Void After 24 months) Topo 5 % Slope Sketch of lot Evaluation Site - System Design - Final Texture Crain 0 0 - - -- _ __ �_.� — ^ -- � — -,_. . - . -o p 'f/0 Structure �l -. )i Clay Min. /1/ /foil Wetness / Soil Depth f iaCC:t\ 1 / Restric. Hoz. att "I • a Available space yes/no Overall Class S PS U Comments: q " k\ c¢Illf t,...> r4 ^ , i -z 01.142-[)\\ , ttSeptic Tank Contractors MUST contact the I Q Sanitarian BEFORE ' changing permit. **NO GUARANTEE OR lWARRRANTY IS IMPLIED OR GIVEN THROUGH THE ISSUANCE OF THIS P1fRMIT" Permit Date ��-" OV- 13� ,� (Improvement rmi" void ' :r 60 months) Owner/Agent eec/ ay : //7G[%(6-P�c , Sanitari & , is Installed By Jt-FT- r-G2-�wAli Date 5-�4-33 Sanitaria ,` (Note any changes/information in red or by sketch on •ack)t IF A PERMIT HAS TO BE REDESIGNED AND/OkRETRIPS MADE TO THE PROPERTY, THERE IS AN ADDITIONAL $25 CHARGE. White-Office Blue-Bldg. Insp. Comp. Yellow-Owner/Agent Green-Bldg. Insp. I.P. Nit'Ar--c4 Tra4is'er« l rC-ch i, �. z --5-9 t /d/N° 04821 CATAWBA COUNTY H..Ai.TH DEPAR ENT ` I (704) 465-8270 Lot Eval. Improve. Permit X Repair Permit Cert. of Comp. Permit 'per. Permit Owner/Agent bittlI f) A.,;// e. Phone Address Subdivision _ 5��ion/Block Lopt____ Siz , 4!3 Directions ' JI1 /ik'- 0 .2 ".' -2 Yes firlon ,19 { '- Zen ) L t a- . .- if,. p, ' /,'_e / — 0-71- 3 qr 9)( i)kqP Facility: House & Mobile Home Business . Other: Zoning Approval yes/no # Multi-family Other . 100% Repair Area yes/no Bedrooms 2 Seats Employees . GPD Flow Application Rate Hot Tub or Spa yestrib Special Fixtures . REPAIR NOTICE: REPAIRS MUST BE WITHIN Basement )41, Basement Plumbing yes/& . 30 DAYS OR DAYS FROM DATE OF Water Supply: Private Public . PERMIT. Type of System: Trench X Bed Pump Pump/Panel Panel LPP Other Tank Size: Septic Tank [000 Pump Tank Nitrification Field: Total Square Feet QC Depth of Stone '2 (ncL Bed Size Trench Width 3 ' Total Length of All Trenches Zap Number of Trenches Individual Trench LengthL-7/(p7/b 7/_/_ Feet on Center - / Maximum Trench Depth Q'//'zc-4 Distance of Nearest Well Lot Evaluation: Approved yes/no (Void After 24 months) Topo % Slope Sketch of lot Evaluation Site - System Design - Final Texture tile( L el Structure - t'i � Clay Min. _ Soil Wetness Soil Depth If Restric. Hoz. atx Available space yes/no �� Overall Class S PS UN.�� e 6 IC) Comments: , 1` rz,x) j1l5/' 41 Z ( xi0,4wripethk. &� aklit, (I KG /� � �f�/�'P� ,N}A, _ _ •Pre_ Lk 1 .. =rteAggi-i a �.� �' u r6- gr:. pD **NO GUARANTEE OR3WARRANTY IS IMPLIED OR GIVEN THROUGH THE ISSUANCE OF THIS PERMIT** Permit Date /-I6 7 7 (Improvem t e t vo . -fter 60 months) Owner/Agent "L( �/' ,P- ,L Sanitaria Installed By =I �,: ,c_Xlz Date /-2é Sanitari .S i"11 ( o e any ch ages/ipfermation in red or by sketch on •=57) White-Office Blue-Bldg. Insp. Comp. Yellow-Owner/Agent Green-Bldg. Insp. I.P. 4A- CATAWBA COUNTY CA IOOA SOUTHWEST BLVD Q' . wlpi NEWTON,NORTH CAROLINA 28658 RECEIPT `11.07,,3eaVe PHONE: 828.465.8399 Vs< Thursday, July 21, 2016 is 2 sM www.catawbacountync.gov PAYOR: Walter,Jack& Teresa PAYMENTS TRANSACTION NUMBER: TRC-744537-21-07-2016 PAYMENT DATE : 07/21/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 07-16-330763 Authorization to Construct (Repair) $150.00 Fee TOTAL PAYMENTS : S150.00 EHPR-07-2016-24346 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 5907 FLAMINGO DR, CONOVER NC 28613 Owner JACK&TERESA WALTER, 3000 PEACHTREE ST EXT,CLAREMONT NC 28610 H:8282678319C:8283208910 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Contractor POWELL SEPTIC SERVICE, 360 POWELL RD, TAYLORSVILLE NC 28681 H:8286321791C:8283020758 receipt 07/21/2016 14:32 Page 1 of 1