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HomeMy WebLinkAboutEHPR-08-2016-24492.TIF �Y3A c- THIS IS NOT A PERMIT Case # EHPR-08-2016-24492 A o CATAWBA COUNTY HEALTH DEPARTMENT � ' o J41:1 WAS Cr.r. - l0` PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES s • f ti /842 sM Environmental Health Plan Review - Septic Malfunction 13 • c + r.o • AUTH CONST - SEPTIC_MALFUNCTION?� o{" j Owner TONI SMITH, 1961 VILLA DR, NEWTON NC 28658 C:8283587296 NAME TO APPEAR ON PERMIT Toni Smith SITE ADDRESS: 1961 VILLA DR,NEWTON NC 28658 PIN # 363909053526 NAME of SUBDIVISION: STARMONT VILLAGE Lot# 4 Section/Block E PROPERTY SIZE: Square Feet 20,037.60Acres 0.46 DIRECTIONS: Hwy 10 West, Left onto Sigmon Dairy Rd, Right onto Shady Ln, Right onto Villa Dr, 6th house on the Left. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: Sewage is backing up in the sink, toilets & showers in the 1st floor bathroom. Tank last pumped a few months ago. 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, Out Bldg EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: House 54x37, Out Bldg 20x20 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 4 PROPOSED CONSTRUCTION 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: 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 understanc'that I am solel responsible for the proper identification and labeling of all property lines and corners and making the site accessible s that a coff"" lete s e evaluatio n be performed. Date: - // - f (o Signature of Applicant or Agent" , U- VJ /net . 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 E9-ehapplication 08/I1/2016 08:50 Page I of 7 CATAWBA COUNTY Case it EHPR-08-2016-24492 • ,%- rr'} 1. Public Health Department Subdivision STARMONT VILLAGE Environmental Health Division "��" ^� PIN# 363909053526 ' PO Box 389, 100-A Southwest Blvd,Newton. NC 28658 /842 ,. NAME ON PERMIT: ("TNI SMITH), 1961 VILLA DR, NEWTON NC 28658 ( Toni Smith) Site Address: 1961 VILLA DR, NEWTON NC 28658 Property Size: Square Feet 20,037.60 Acres 0.46 Directions: Hwy 10 West, Left ontoppSigmon Dairy Rd, Right onto Shady Ln, Right onto Villa Dr, 6th house on the Left. LFEEN�AM 4y}t.�1 • !,'0,;IJV"s 4ltlyVl'oill6�,'il�w',uM�!"��yp rr011 I.�ii�1�hrr,7•9..f DATE• I�tth:.�IIiFEEtAMOUINIT til. Authorization to Construct (Repair) Fee 08/11/2016 5300.00 S300.00 �It����l����� 1 8:' dad 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-ehapplHai nn 08/I1/2016 08:50 Page 2 of7 CATAY VTHIS IS NOT A PERMIT Cot N t � �..,A. CATAWBA COUNTY HEALTH DEPARTMENT `vi „on,,;„ Application for Environmental Services Page 1 Improvement Permit 1 ] Authorization to Construct ❑ Septic RepairSeptic Malfunction K Septic Expansion ❑ New Well Permit❑ Replacement Well D Well Abandonment❑ Well Repair n Existing System Inspection (Pre-Approval Required) ❑ Application is fore New Construction ❑ Existing Facility S] Property Address 19 (el \I. I I& `){; VL Subdivision S+Igr 1'yl p i t 10 N PAn h 0 Ned J-e%? c8 Lot# Acres I Section/Block/Phase Driving Directions to Property 2 , i 4 • i' • a ; a • .I 11 = z -_ —/ ; - .: k • . Sherd N �, 1 , . • i1J e., NAME TO APPEAR ON PERMIT? ® Owner I I Applicant ❑ Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name ON 1 C, cnn 4-1A. Address 19 (e 1 V; H - Dv; ve NP W 1 Oki id C4- ) R Ce Se) Phone Cell Phone eize_ 3 Am _7 2,9 Contractor Contact Information Y Name Address Phone ._/ Cell Phone WHO WILL BE THE PRIMARY CONTACT? I`�1 Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site 'r-bUQ / l_ b 48, • ?Cx 2C) # of Bedrooms 11 3 Structure Dimensions #of Occupants Li- Basement ❑ Yes rigl No Basement Fixtures Q 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. O Yes XNo Does the site contain any jurisdictional wetlands? Yes ® No Does the site contain any existing wastewater systems? O Ycs )(No Is any wastewater going to be generated on the site other than domestic sewage? 1P. Yes No Is the site subject to approval by any other public agency? O Yes No Are there any casements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well T Community Well E Semi-Public \ tell X] County/City/Township Water Line Is a public water supply available? ** Yes D 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 0 Conventional ❑ Innovative ❑ Other XAny THIS IS NOTA PERMIT ' coUN CATAWBA CATAWBA COUNTY HEALTH DEPARTMENT „o,„.,, , 4; Application for Environmental Services Page 2 Proposed Facility Type TPrimary Residence n New Residence I Addition to Residence # of New Bedrooms *t Project Description $ (9i1G �_i N t M1e Phi V Structure Dimensions #of Occupants Basement Yes n No Basement Fixtures ® Yes n No E Accessory Structure(s) Describe # of New Bedrooms *t if applicable 3 Structure Dimensions of Occupants Accessory Dwelling ❑ Yes n No Plumbing n Yes n No Describe Plumbing Needed n Multi-Family Residence # Units #Bedromns per Unit*t Total# Bedrooms *t Structure Dimensions ❑ Food Service Specify Type # Seats Floor Space -Entire Food Service Facility (Sq Ft) 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 ft of Seats Kitchen n Yes I No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type [ Individual Well H Semi-Public Well ❑ Community Well Abandonment Type n Drilled n Bored H Dug n Unknown Well Repair Requested n Yes n 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 wars 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 _LI - 1 /t Date fy/4 Printed Name of Owner or Agent Catawba County Environmental Health 10000 ,00.00 ,� 100.�.44 10000 ‘10-1--A OR I 200,00 10000 00-00k ali • 6IIIII'0 0 00 .. • 200.80 y III r-.) 1 0 b 0 o 1 0 1 g . ..20160 VI 100.00 1 10111" \ CP HOU} W114,19,01;... 308.30 'IN's.. Parcel: 363909053526, 1961 VILLA DR 1 in=50ft 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 08/11/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 363909053526 Owner: SMITH TONI Parcel Address: 1961 VILLA DR Owner2: City: NEWTON, 28658 Address: 1961 VILLA DR LRK(REID): 41325 Address2: Deed Book/Page: 1333/0273 City: NEWTON Subdivision: STARMONT VILLAGE State/Zip: NC 28658-9316 Lots/Block: 4/ E Last Sale: $43,000 on 1983-09-01 School Information: School District: COUNTY Plat Book/Page: 14/107 Legal: LOT 4 STARMONT PL 14-107 Elementary School: STARTOWN Middle School: MAIDEN Calculated Acreage: .460 High School: MAIDEN Tax Map: 084N 03007 Township: NEWTON School Map State Road #: Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: NEWTON Zoning District: NEWTON County Fire District: All in City Zoningl: R-20 Building(s) Value: $82,900 Zoning2: Land Value: $11,800 Zoning3: Assessed Total Value: $94,700 Zoning Overlay: Year Built/Remodeled: 1971/ 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 #: 3710363900J Building Details 2010 Census Block: 2013 WaterShed: 2010 Census Tract: 011702 Voter Precinct: P34 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 Geospalial 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. is - - Ute. SY,uY CP Cid . SpiQu•DiGfi- Or Neiduln , -Ht 2Q. L -` IlY tS �. NOL (ArrJ to G' l� http://gis.catawbacountync.gov/nomap/parcel_report.php?key=363909053526&typ=P 8/11/2016 (IA • CATAWBA COUNTY a IOOA SOUTI-IWEST BLVD NEWTON, NORTH CAROLINA 28658 RECEIPT p`ev►ev PHONE: 828.465.8399 �C) ' " `� Thursday, August 11, 2016 g42 sn+ www.calawbacountync.gov PAYOR: Smith,Toni PAYMENTS TRANSACTION NUMBER: TRC-776155-11-08-2016 PAYMENT DATE : 08/I 1/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-331461 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : S300.00 EHPR-08-2016-24492 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 1961 VILLA DR, NEWTON NC 28658 Owner TONT SMITH, 1961 VILLA DR, NEWTON NC 28658 C:8283587296 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 08/11/2016 08:50 Page 1 of 1