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HomeMy WebLinkAboutEHPR-08-2016-24525.TIF rg,A COG THIS IS NOT A PERMIT Case # EHPR-08-2016-24525 ,� ' CATAWBA COUNTY HEALTH DEPARTMENT Rpm - vsna t� ja p9 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 842 SM Environmental Health Plan Review - Septic Malfunction , n o n.e r. AUTH CONST - SEPTIC_MALFUNCTION ` d ' ct o Owner HOMER ABERNATHY JR., 5501 BOLICK RD, CLAREMONT NC 28610 C:8284597509 NAME TO APPEAR ON PERMIT Homer Abernathy Jr. SITE ADDRESS: 5595 BOLICK RD, CLAREMONT NC 28610 PIN # 376404541771 NAME of SUBDIVISION: Lott/ 1 Section/Block PROPERTY SIZE: Square Feet 120,225.60 Acres 2.76 DIRECTIONS: Rock Barn Rd, Left onto Oxford School Rd, Next Right onto River Bend, Next Right at Bethel Lutheran Church onto Bolick Rd, quarter mile down the road on the Right. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Tank has been pumped twice within the last 3 months. Starting to back up in the home. 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, 2 storage Bldgs, 2 Old Barns EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: House 59x48 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 4 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 I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so at a complete site aluation can be performed. Date: &/7-7 Signature of Applicant or Agent An Environmental Health Specialist will contact you within 5 working days o/application date. If you need further information or assistance please call 828-466'7291 AREA2 E9-ehapplication 08/17/2016 14:20 Page 1 of 7 CATAWBACOUNTY Case# EHPR-08-2016-24525 I".r.'1L\ Public Health Department Subdivision < life) Environmental Health Division PIN# 376404541771 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 Z M NAME ON PERMIT: ( HOMER ABERNATHY JR.), 5501 BOLICK RD, CLAREMONT NC 28610 ( Homer Abernathy Jr.) Site Address: 5595 BOLICK RD, CLAREMONT NC 28610 Property Size: Square Feet 120,225.60 Acres 2.76 Directions: Rock Barn Rd, Left onto Oxford School Rd, Next Right onto River Bend, Next Right at Bethel Lutheran Church onto Bolick Rd, quarter mile down the road on the Right. l�ISir itiul: , .I I('V(I� 1511i"li 11tf. (0a1Ig1 Y ' ,. ..'.77.7111.111110i ")I!lP 6({�q hIiiTHIgl s 1 �FEENAME'4,h t�1i,,11l1111I! PIiA dil1 , a.wai.id�Ola,ur�DTE,r -- bjNFEE.AMOUNT'i;II Authorization to Construct (Repair) Fee 08/17/2016 $300.00 1 t '� t -t 11x7 tl�4�i i I ti�i l£t i 1 �11iI1 R nU`II ilit'i� I �I���{111111 1� TOTAL�F,EESro1i91 i�,�l�(+u�7�tl° �1.11���11i111�C�hB � 5111 fl'n ��ial�!�ILS300 001 . dI(11u t d ii„ "e:xulI8U6✓FI�,II''WwW6L17fIItl{JU4 �,s;• ,.-_....9 ,..:c :711CINhw:._ iitiih. 4mWOWtlJiiulUl7rL.-."'i 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-&application 08/17/2016 14:20 Page 2 of 7 fl A A\\ ;A THIS IS NOTA PERMIT cou7--T— CATAWBA COUNTY HEALTH DEPARTMENT �— y-� =1 Application for Environmental Services Page 1 i/ Improvement Permit ❑ Authorization to Construct H Septic Repair❑ Septic Malfunction Septic Expansion [ New Well Permit ❑ Replacement Well ❑ Well Abandonment n Well Repair n Existing System Inspection (Pre-Approval Required)) ❑ Application is for New Construction ❑ Existing Facility I Property Address Cc 5 C Lit' k RI Subdivision 7/greyNo1n.t .tiC Zt/O Lot# Acres //�� n Li a n '4 Q Section/Block/Phase Driving Directions to7Property 4e AcA 4., UK I 5 W ./ iMt e I l.,fK K✓te/2 7Lalp-. ,ftie4 "P _ ' toe Mt-kt `f4,i, 72 / O,‘ 04h C 4C NAME TO APPEAR ON PERMIT? VOwner ❑ Applicant ❑ Contractor Applicant Contact Information Name Houa-12 APtw i' 7 . Tie Address ftccoI La ,1 Ll t,.c,✓ NC 296/0 Phone ezg- YS5- 75-0 9 Cell Phone Owner Contact Information Name 5a i/t(P Address Phone Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? Owner Applicant ❑ Contractor Description of Existing Structures on Site ,9,Q)c L , $ti,xi # of Bedrooms *1' 3 Structure Dimensions #of Occupants 4 Basement [Yes ❑ No Basement Fixtures '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. O Yes c-No Does the site contain any jurisdictional wetlands? "(Yes *go Does the site contain any existing wastewater systems? d Yes ®'No Is any wastewater going to be generated on the site other than domestic sewage? CI Yes laKo Is the site subject to approval by any other public agency? CI Yes 1:31 o Are there any easements or right of ways on this property? Describe Existing water supply in use [Individual Well ❑ Community Well ❑ Semi-Public Well / Li 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) 0 Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other MAny C ATA 7U A THIS IS NOTA PERMIT c un l �--� CATAWBA COUNTY HEALTH DEPARTMENT �� •-� �, Application for Environmental Services Page 2 Proposed Facility Type n Primary Residence n New Residence U Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions #of Occupants Basement n Yes n No Basement Fixtures ® Yes ® No n Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes U No Plumbing ❑ Yes n No Describe Plumbing Needed Multi-Family Residence#Units #Bedrooms per Unit*t Total# Bedrooms *t Structure Dimensions U 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 n Other Facility Type Specify If Church# of Seats Kitchen ❑ Yes n 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 ❑ Drilled ❑ Bored ❑ Dug n 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. 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 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 iiLm c i , Date 8- 77/e Printed Name of Owner or Agentt'2 46,,,,e,„1 � Catawba County Environmental Health (1055) 101.78 BOLICK RD 164 780)_ -l- _ _ ^0 (254) 1 Li ,I ----� X ir • N O so4> 7tlL.y4 / l\ f I Parcel: 376404541771 , 5595 BOLICK RD 1 in=80ft CLAREMONT, 28610 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 08/17/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 376404541771 Owner: ABERNATHY HOMER C JR Parcel Address: 5595 BOLICK RD Owner2: ABERNATHY DORIS V City: CLAREMONT, 28610 Address: 5501 BOLICK RD LRK(REID): 403322 Address2: Deed Book/Page: 3157/1133 City: CLAREMONT Subdivision: State/Zip: NC 28610-8162 Lots/Block: 1/ School Information: Last Sale: $75,000 on 2012-11-15 Plat Book/Page: 56/99 School District: COUNTY Legal: LOT 1 PL 56-99 Elementary School: OXFORD Middle School: RIVER BEND Calculated Acreage: 2.760 High School: BUNKER HILL Tax Map: Township: CLINES School Map State Road #: 1706 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: OXFORD Zoning!: R-40 Building(s) Value: $64,000 Zoning2: Land Value: $21,800 Zoning3: Assessed Total Value: $85,800 Zoning Overlay: WP-O Year Built/Remodeled: 1947/1969 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 #: 3710376400K Building Details 2010 Census Block: 2000 WaterShed: WS-IV Protected Area 2010 Census Tract: 010101 Voter Precinct: P27 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 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 hold 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. Lir PSCce -- turlip 10,6e 01 (1a( 2313/42-7-: http://gis.catawbacountync.gov/nomap/parcet_report.php?key=376404541771&typ=P 8/17/2016 JL5 WO( - 00376 ,, CATAWBA COUNTY HEALTH DEPARTMENT 1 Telephone (828)465-8270 TDD• (828) 465-8200 0�5' 1`I4'-� IP AC Rpr Prmt Opr . mt. Sys Type Well Prmt._ Replacement Well x Well Rpr Prmt. Owner/Agent 7// -.0OPhone Address Subdivision _ Secti.n/Bloc: Phase a Lot Lot Si e�Directions :]���10},+ � flaterrtg ftJ 'tti,-� VS f ft- YV6 ew tt}+-, r - / Property Address .5.5s y-({C/G PetC/a OTfa Facility House X Mobile Home Business Multi-family Other- Pin Number 376 0 4-,SQ/3 / 0 _ Other Zoning Approval# #Bedrooms Z #Seats #Employees . Application Rate GPD Flow `_. Hot Tub or Spa yes/no Special Fixtures Baseent yes/no 100% Repair Area yes/no Q Basement Plumbing yes/no Water Supply- ` Private Well ./C- Public Semi-Public *******************vveve ************************************************W*********vvette ********************************** Type of System Trench BPump Pump/Panel , Panel LPP Other Septic Tan Size Pump nk Size Nitrificatio field: Total Square Feet Depth of Stone Bed Size Trench Width Total Length of All Tr hes Number o enches Trench Length / / / / / Feet on Center Maximum Tren Depth Distance of Nea t Well *DO NOT INSTALL SEPTIC WHEN WET* 2.7o*WELL RECORD REQUIRED AT COMPLETION* ***********************************************************s oeti********+k***I************ev***************** Topo % Slope Texture _ Structure I Clay Min. Soil Wetness ,, Soil Depth Restric Hoz at " ( We-a- +>- Available space yes/no Overall Class S PS U s Comments. kr)r) C Lt ti5D -t 1 . . ; ‘41, ilC Filter Required I330 Riser required when .._ tank is more than 6 "Td 0 RI coM3 inches deep. `� **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)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 so,iy es of con :mination. No volume of water is guaranteed at any site by the Health Department. / • Permit Date 2 -7,r / EH FPra flYw�� Owner/Ag & ,( ( Septic Tank tailed liy drDate EHS Well Installed By Inju.--/ Well Grout Approval Date 3-/ - I Well Head Approval Date Date Sample Collected Date of Results Results EHS White-Office Blue Building Inspection Operation Permit Yellow Owner(Agent Green-Building Inspection Authorization to Construct frACATAWBA COUNTY F 100A SOUTHWEST BLVD a 2 NEWTON,NORTH CAROLINA 28658 RECEIPT d ,...mi,r --; L.)17s�►e . PHONE: 828.465.8399 4 vow,: C Wednesday, August 17, 2016 842 sM www.catawbacountync.gov PAYOR: Abernathy Jr., Homer PAYMENTS TRANSACTION NUMBER: TRC-787069-17-08-2016 PAYMENT DATE : 08/17/2016 PAYMENT TYPE: Check 1526 INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-331726 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : S300.00 EHPR-08-2016-24525 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 5595 BOLICK RD, CLAREMONT NC 28610 Owner HOMER ABERNATHY JR., 5501 BOLICK RD, CLAREMONT NC 28610 C:8284597509 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receip[ 08/17/2016 14:19 Page 1 of I