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HomeMy WebLinkAboutEHPR-07-2016-24396.TIF �y�A THIS IS NOT A PERMIT Case# EHPR-07-2016-24396 -f, . � CATAWBA COUNTY HEALTH DEPARTMENT 0�— c • . .a 47 4.1" 'C PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES £ 1842, sM Environmental Health Plan Review - Septic Malfunction ..;r: •U•. o S. AUTH_CONST- SEPTIC MALFUNCTION "Tio a Owner BETSEY& DAVID LAWS, 2505 TIMBERLAND HILLS DR,NEWTON NC 28658 C:82831010I8 NAME TO APPEAR ON PERMIT Betsey & David Laws SITE ADDRESS: 2505 TIMBERLAND HILLS DR, NEWTON NC 28658 PIN # 371106287077 NAME of SUBDIVISION: TIMBERLAND HILLS Lot# 71-78 Section/Block C PROPERTY SIZE: Square Feet 40,510.80 Acres 0.93 DIRECTIONS: Right off Robinson Rd near Dicks Sporting Goods COmplex, behind the white church across from old entrance to the Mosteller Mansion, Wakefield Dr, Right onto Timberland Hills Dr, 2nd house on the Left. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GA R DAY• 360 WATER SUPPLY: Private Well DESCRIBE WORK. Revised 9/1/16 - Revised to 3 BdRms. In the future may finish the basementinto an additional Bedroom. HousEE) currently has 2 BdRms total. ----- Tank has been pumped 4 times in the last year* 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: 63x57 (NUMBER OF EXISTING BEDROMM2 #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION #OF NEW BEDROOMS:: 1 MENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED? Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: 19-chapplication 09/01/2016 14:04 Page 1 of 7 s$• � CATAWBACOUNTY casco EHPR-07-2016-24396 Public Health Department Subdivision TIMBERLAND HILLS CE, Environmental Health Division PIN# 371106287077 r.,tr,^ `C PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 NAME ON PERMIT: ( BETSEY& DAVID LAWS), 2505 TIMBERLAND HILLS DR, NEWTON NC 28658 ( Betsey & David Laws) Site Address: 2505 TIMBERLAND HILLS DR,NEWTON NC 28658 Property Size: Square Feet 40,510.80 Acres 0,93 Directions: Right off Robinson Rd near Dicks Sporting Goods COmplex, behind the white church across from old entrance to the Mosteller Mansion, Wakefield Dr, Right onto Timberland Hills Dr, 2nd house 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 cessible so th a co ple site evaluation can be performed. Date: 1 ( t ( I W 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 Wpaingloi. . 4Ill Iiir ; Y iI , r 41, II 1 lhuTJmL " i4l t 1WFEENAME: th . 4.i s , I dii iD_E d ;FEENAMOUNT: Authorization to Construct (Repair) Fee 07/29/2016 $300.00 E 1 f r t r tl v 4 ma 1 1 YI Ii -1 11171411111:1; NOTAL FEES.. rah ii.it ^ r uty,�ll', �J film Nally I ilii. 3 C ;EI{�.III I�� tlWLimme" tuv JIn9naID,IGfgWaiu; sa - aInitteiluu'=Iiiillfl,.:..;SfIWit11111ii WIIu01,1[' 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) 09-ehapplicat ion 09/01/2016 14:04 Page 2 of 7 ,A •G THIS IS NOT A PERMIT Case # EHPR-07-2016-24396 'I gt 11CATAWBA COUNTY HEALTH DEPARTMENT 0¢' •d4 r' E 'i° PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES117 1 ��� 1842 SM Environmental Health Plan Review - Septic Malfunction o d Igo + r r ti if AUTH CONST - SEPTIC_MALFUNCTIONd+ar o� Owner BETSEY& DAVID LAWS, 2505 TIMBERLAND HILLS DR,NEWTON NC 28658 C:82831010I8 NAME TO APPEAR ON PERMIT Betsey & David Laws SITE ADDRESS: 2505 TIMBERLAND HILLS DR,NEWTON NC 28658 PIN # 371106287077 NAME of SUBDIVISION: TIMBERLAND HILLS Lot# 71-78 Section/Block C PROPERTY SIZE: Square Feet 40,510.80 Acres 0.93 DIRECTIONS: Right off Robinson Rd near Dicks Sporting Goods COmplex, behind the white church across from old entrance to the Mosteller Mansion, Wakefield Dr, Right onto Timberland Hills Dr, 2nd house on the Left. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: Tank has been pumped 4 times in the last year* 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: 63x57 NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 3 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 l am solely responsible for the proper identifica�Qn a d labeling of all property lines and corners and making the site accessible so that a cemplet J site evaluation can be performed. Date: I 29 2[�L . Signature of Applicant or Agent /� o`U�i v, �h 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-ehappl ication 07/29/2016 11:17 Page I of 7 CATAWBA COUNTY case A EHPR-07-2016-24396 Tu L Public Health Department Subdivision TIMBERLAND HILLS t ti Environmental Health Division PINE! 371106287077 � PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 1g42 sa NAME ON PERMIT: ( BETSEY& DAVID LAWS), 2505 TIMBERLAND HILLS DR,NEWTON NC 28658 ( Betsey & David Laws) Site Address: 2505 TIMBERLAND HILLS DR, NEWTON NC 28658 Property Size: Square Peel 40,510.80 Acres 0.93 Directions: Right off Robinson Rd near Dicks Sporting Goods COmplex, behind the white church across from old entrance to the Mosteller Mansion, Wakefield Dr, Right onto Timberland Hills Dr, 2nd house on the Left. rh ."31119 ' P ,�I l n I�1�� Ill I,. PI n i l�'1(i llim'i11hd.. i 1{$11'1 `l ENAMEL.11:::: ''�j�;'I�I�IIAIui!�IIL�lliu�� ul1��I' i�{I(lf 'DATE �Iilill�. FEErAMOUNTI� Authorization to Construct(Repair) Fee 07/29/2016 $300.00 11(111 11I,1OTnLiFE i i„i;+l111111 . i , il i1ss0000a7 01 maw. +Sasiumn i i!1 ai' w'UiLusta ''l'sema_ 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) F9-eliapplication 07/29/2016 11:17 Page 2 of 7 CATAWBA THIS IS NOT A PERMIT COUNT CATAWBA COUNTY HEALTH DEPARTMENT - wy „ Application for Environmental Services Page I Improvement Permit❑ Authorization to Construct D Septic Repair ❑ Septic Malfunction' Septic Expansion ❑ New Well Permit E Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility Property Address 2 t S 'j't rvdg , land ft 1\s 13r Subdivision 14. Nein NC 21S(PS Lot# Acres Section/Block/Phase Driving Directions to Property act 0 oh,n snn ILA , ',near i7 iclts Stn�rii f--ti c S Can/01Py! 1))o\rhnc1 wln\+-t- C,ikv rch acr 0 SS c-run'l Old en fr nee t 4 Ltt v111oS1-r- I Ie r :Inas, c NAME TO APPEAR ON PERMIT? ZrOwner ❑ Applicant ❑ Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name &\.% lbs-s- v4, 1^n.JJS Address 2� - Tinnbe 14nd t4-as 1'f NeAtisn NC- 7' s-00St Phone X7,5 '3t o - 1Z\S Cell Phone n:3 3(.0 — I cAS Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site y Ot YtoM?. Vs\'Vit. C c r- V pr-(- C,nd nnce_ ,n+ dun N4 # of Bedrooms *t 2 Structure Dimension(4 X S� #of Occupants 3 is‘Slra Basement Z.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. ® Yes MNo Does the site contain any jurisdictional wetlands? r-Yes ® No Does the site contain any existing wastewater systems? O Yes EiNo Is any wastewater going to be generated on the site other than domestic sewage? CI Yes OCNo Is the site subject to approval by any other public agency? ® Yes "RENo Are there any easements or right of ways on this property? Describe Existing water supply in use jj, Individual Well ❑ Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes ❑ No D -V- S*-e. 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) \.....44Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other 0 Any CATAWBA THIS IS NOT A PERMIT COUNTt CATAWBA COUNTY HEALTH DEPARTMENT -. . •„„„�„•„�• 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 fl No • ❑ Accessory Structure(s) Describe # of New Bedrooms *`i if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence # Units #Bedrooms per Unit*t Total # Bedrooms *t Structure Dimensions fl Food Service Specify Type #Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift #of Shifts Dining Area(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 ❑ Individual Well ❑ Semi-Public Well E Community Well Abandonment Type ❑ Drilled n 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 be performed. Signature of Owner or Agent 9 t`,,,O,43,5\c oz-ak\c --) Date (,t 2� } zoi(p Printed Name of Owner or Agent `?t*c Q� a l�q �{ L CAWS Catawba County Environmental Health - - _ - - - - 200.18 - - - I — — — - - I— - - - — — I ._ - 00.00 - — — — • —1 — --- 170.87 - — • ; -4 IS • 71I ' i — ——4 mor Y - — -174.g0 / • ---<- - iii % _ I I 207 42 Y - - cm -- • (1\1\H Parcel: 371106287077, 2505 TIMBERLAND 1 in=50ft HILLS DR NEWTON, 28658 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 07/29/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 371106287077 Owner: RINEHARDT BETSY ANN Parcel Address: 2505 TIMBERLAND HILLS DR Owner2: LAWS DAVID ALLEN City: NEWTON, 28658 Address: 2505 TIMBERLAND HILLS DR LRK(REID): 43033 Address2: Deed Book/Page: 3273/1585 City: NEWTON Subdivision: TIMBERLAND HILLS State/Zip: NC 28658-9518 Lots/Block: 71-78/ C Last Sale: School Information: School District: COUNTY Plat Book/Page: 11/50 Legal: LOT 71-78 PLAT 11-50 Elementary School: BLACKBURN Middle School: JACOBS FORK Calculated Acreage: .930 High School: FRED T FOARD Tax Map: 091 H 07004 School Map Township: HICKORY State Road #: 1287 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: HICKORY County Fire District: HICKORY RURAL Zoningl: R-2 Building(s) Value: $80,800 Zoning2: Land Value: $14,800 Zoning3: Assessed Total Value: $95,600 Zoning Overlay: Year Built/Remodeled: 1963/ Small Area: Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel it: 3710371100J Building Details 2010 Census Block: 2000 WaterShed: 2010 Census Tract: 011102 Voter Precinct: P35 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. ret,M isenheur orayi2,11) http://gis.catawbacountync.gov/nomap/parcel_report.php?key=371106287077&typ=P 7/29/2016 y�)3A CATAWBA COUNTY � 100A SOUTHWEST BLVD RECEIPT r1k{A a NEWTON,NORTH CAROLINA 28658 ,,,,-47;P " PHONE: 828.465.8399 4 .)(\c,. ,[0, C Friday, July 29, 2016 /842 sM www.catawbacountync.gov PAYOR Laws, Betsey& David PAYMENTS TRANSACTION NUMBER: TRC-756443-29-07-2016 PAYMENT DATE : 07/29/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 07-16-331036 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-07-2016-24396 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 2505 TIMBERLAND HILLS DR,NEWTON NC 28658 Owner BETSEY& DAVID LAWS, 2505 TIMBERLAND HILLS DR,NEWTON NC 28658 C:8283101018 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 07/29/2016 11:17 Page 1 of I