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HomeMy WebLinkAboutEHPR-08-2016-24594.TIF �A G THIS IS NOT A PERMIT Case # EHPR-08-2016-24594 t ! G CATAWBA COUNTY HEALTH DEPARTMENT �� • .o r� f� ltUtItt'!!' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES :51 ti i Ig42 sM Environmental Health Plan Review - OSWP o ges.9 a.. pi.:;sir. .. IMPROVEMENT - AUTH CONST- EXPANSION 0 ■ Contractor LEATHERMAN SEPTIC TANK SVC INC (HARVEY LEATHERMAN), 8420 REEPSVILLE RD RD, LINCOLTON NC 28092 H:8282444409B:7044622194 C:8284612985 HOME:8282444409F:7044622636 Owner CAROLE ELLIOTT REVOCABLE TRUST,20510 BETHELWOOD LN, CORNELIUS NC 28031 C:7049060467 NAME TO APPEAR ON PERMIT Carole Elliott Revocable Trust SITE ADDRESS: 2094 CLAREMONT RD, NEWTON NC 28658 PIN # 365905088385 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 290,545.20 Acres 6.67 DIRECTIONS: Hwy 16 South, Left onto Claremont Rd, House is on the Left back off the road. PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: Septic Expansion for sale of home. Home has 4 bedrooms currently with a 3 bedroom septic permit. 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, Garage EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: House 60x40, Garage 26x28 NUMBER OF EXISTING BEDROOMS: 4 #OF OCCUPANTS: 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: E9-ehappl'cat ton 08/25/2016 1 127 Page 1 of d Kg 26 16 07:19a Leatherman's Septic Tank 704 462 2636 p.1 Aug. 25. 2016 11 : 26AM Mo. 0448 P. 2 eYe 1 CATAWBACOUNTY Case HYK-08-2016-24594 . 7�� PublioHealth Department Subdivision Environmental Health Division PIN# 365905088385 � PO Box 389. 100-A Southwest Blvd,Newton,NC 28658 NAME ON PERM1Tt (CAROLE ELLIOTT REVOCABLE TRUST),20510 BETHELWOOD LN,CORNELIUS NC 28031 ( Carole Elliott Revocable Trust) Site Address: 2094 CLAREMONT RD,NEWTON NC 28658 • Property Size? Square Feet 290,54520 Acres 6.67 Directions: Hwy 16 South, Left onto Claremont Rd.House is on the Left back off the road_ Improvement Permits issued as a result o't this information am valid for 5 yeas or may be non-eepiring under certain spedfied conditions.An Authorization to Construct Issued by Uls department is valid for(5)five years from the date issued and is not transferable; Improvement Permts and Well Permits are transferrable. Permits may be revoked if the information on this application,site plans or intended use changes for the proposed fecfry. I have read this application and certify that the information provided herein is True,complete and correct. Authorized county and stale officiate era granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand chat I am solely responsible for the proper idenlifIcationgnd labeling of all property lines and corners and making the site acne le so that comolet ile evaluation can be performed. Date: ' — /(o Signature of Applicant or Agent iwrit+� An Environmental Health Specialist will contact you within 5�rking days of application date. If you need further information or assistance please call 828-466-7291 AREA1 jc _i Authorization to Construct Fee(New/Expansion) • 08/252016 5500.00 Fee Improvement Permit Fee 08/25/2016 $150.00 •� s ��. ' t`L� X4$008 :� �C :Ihr a•t .:ett."s u > .E'EC' FEES ARE NON—REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN ANDIOR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) • • • Ea-diapplicitinn 08252016 n27 Page 2 of4 CATAWBA THIS IS NOT A PERMIT COUNTY ar' ijr�J.4 CATAWBA COUNTY HEALTH DEPARTMENT , �. „�Mo Application for Environmental Services Page 1 Improvement Permit Authorization to Construct Septic Repair ❑ Septic Malfunction ❑ Septic Expansion1 New Well Permit❑ Replacement Well ❑ Well Abandonment 111Well Rep, it Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction/ , 111y Existing Facilit Property Address 20 cy4 C-L,el�cz no , - Subdivision 4 4vad-ro, _ /7/C .2 9455- Lot# Acres Section/Bloc d'has Driving Directions to Property Hui/ /6 ,S es -- --`-R -- on NAME TO APPEAR ON PERM' Owner ❑ Applicant igiContractor Applicant Contact Information Name ...,/y, cf_o,e z, Address ) 091[f aa,, -77'07d / /2 _„A e, Nc Phone 20 it 1/62 2 i ?5' Cell Phone 8' 5, ¼'! .2 713 Owner Contact InformatioXn Name 3 -ejt Yen�[c -- 4 Address Phone Cell Phone 90 y 706 094 7 Contractor Contact Information Name Cy /!/_ /J Address S Ctnnfa4_ '�. ca'l Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? H Owner dApplicant h% Contractor Description of Existing Structures on Site / # of Bedrooms *1. Li Structure Dimensions 6 0 Pia # of Occupants ea— / Basement ❑ Yes 1/-No Basement Fixtures 0 Yes ® No 3. ,froom hQua.e. Lt The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property inquestion. If the answer to any question is "yes", applicant must attach supporting documentation. a Y o Does the site contain any jurisdictional wetlands? l kkes �® N� Does the site contain any existing wastewater systems? a Yes re NIs any wastewater going to be generated on the site other than domestic sewage? a Yeso Is the site subject to approval by any other public agency? a Yes algo Are there any easements or right of ways on this property? Describe Existing water supply in use Vfldividual Well ❑ Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** H 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 ference) ❑ Accepted ❑ Alternative G3 Conventional 0 Innovative 0 Other Ir Any cATAVVBA THIS IS NOT A PERMIT COUNTY ,fie CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type ] Primary Residence [ New Residence ❑ Addition to Residence # of New Bedrooms *j Project Description Structure Dimensions # of Occupants Basement [ Yes ❑ No Basement Fixtures ® Yes fl No ❑ Accessory Structure(s) Describe # of New Bedrooms *7 if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ] Multi-Family Residence # Units #Bedrooms per Unittt Total#Bedrooms *1. Structure Dimensions n 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 ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug [ Unknown Well Repair Requested ❑ Yes ❑ 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. 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 comers and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent .8Ci.n-c/ 0 e,,r Date. 53— 2a —/ Printed Name of Owner or Agent &q r C 7L� f n Catawba County Environmental Health i---_______—ijel -354 ' \it, ... 05 O / . 05- /r I jr.. ...--------- -- ••.. . 0. o 0 Li � \ cr • / / 0 \ SL ` Vfr " \ \ • • \ N. V \ R y22. G� \ / Parcel: 365905088385, 2094 CLAREMONT RD lin=100ft 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 08/25/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 365905088385 Owner: ELLIOTT CAROLE I REVOCABLE Parcel Address: 2094 CLAREMONT RD TRUST City: NEWTON, 28658 Owner2: LRK(REID): 35032 Address: 20510 BETHELWOOD LN Deed Book/Page: 3238/0880 Address2: Subdivision: City: CORNELIUS Lots/Block: / State/Zip: NC 28031-7036 Last Sale: Plat Book/Page: School Information: School District: COUNTY Legal: Calculated Acreage: 6.670 Elementary School: BALLS CREEK Middle School: MILL CREEK Tax Map: 063N 01034 Township: NEWTON High School: BANDYS State Road #: 1801 School Map Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: NEWTON RURAL Zoningl: R-30 Building(s) Value: $118,600 Zoning2: Land Value: $56,300 Zoning3: Assessed Total Value: $134,700 Zoning Overlay: Use Land Value: $16,100 Small Area: BALLS CREEK Year Built/Remodeled: 1956/1992 Split Zoning Districts: / Current Tax Bill Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710365900J Building Details 2010 Census Block: 3008 WaterShed: 2010 Census Tract: 011300 Voter Precinct: P22 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 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=365905088385&typ=P 8/25/2016 ) �)a ` `=' /1 N2 3321 CATAWSA COUNTY HEALTH DE PARENT (704) 465-82 Lot Eval. Improve. Permit Repair Permit ' /Cert. of Comp. Permit t _-Oiler. Permit Owner/Agent 191--er1 7 U), 1_-SFA)l Ed412 Phone Address ,Q ,a A/ '7Q Subdivision 64.1/0A JAL. . 02Section/Block Lot* Lot Size ' Directions: /t `S LG/=7 6&771) c 4,eEhm4T dz) -2 &J7 iA“_cr` o,7) L EFT" Facility: House L--tiobile Home Business . Other: Zoning Approval yes/no # Multi-family, Other . 100% Repair Area yes/no Bedrooms Seats Employees . GPD Flow Application Rate Hot Tub or Spa yes/no Special Fixtures . REPAIR NOTICE: REPAIRS MUST BE WITHIN Basement yes/no Basement Plumbing yes/no . 30 DAYS OR DAYS FROM DATE OF Water Supply: Private c— Public . PERMIT. Type of System: Trench c,-Bed Pump Pump/Panel Panel LPP Other Tank Size: Septic Tank /646- Pump Tank Nitrification Field: Total Square Feet ?et,— Depth of Stone Jc ' Bed Size Trench Width 3 ' Total Length of All Trenches 346- - Number of Trenches : - Individual Trench Length1D0f/6//04V / Feet on Center 7 ' Maximum Trench Depth ,4• Distance of Nearest Well S) ' 4- Lot Evaluation: Approved yes/no (Void After 24 months) I Topo Slope Sketch of lot Evaluation Site - System Design diglab Textur. �— , 3 Tseex J,LE s St �-� . i_ loos JZ 3 ' , Clay Ir. Soil etnes Soil Dep s` Restri . Hoz. " ~ Available ce s/no __ �' - Overall a PS U r- �' - '~� •-- Comments. ,'''' ,'i i i _ , , 7 -14) -(7 I Fd2aArr **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN THROUGH THE ISSUANCE OF THIS PE iI ** Permit Date .12, 2L. /9'i ( (Improvement Permit void after 60 months) c:.•,•-• J Owner/Agent Sanitarian �'. f Installed By S�,•0��% v Date 7-//--91 Sanitarian s.�' �„„�,.,, (Note any c�{anges/information in red or by sketch on back) White-Office Blue-Bldg. Insp. Comp. Yellow-Owner/Agent Green-Bldg. Insp.I.P. IgA C\ CATAWBA COUNTY ION, SNORTH ALLVD INVOICE/RECEIPT � NEWTON, NORTH CAROLINA 28658 yw.—s..nruirkicR�a U 'it p�i'1�x�_`4�1vdsv; PHONE: 828.465.8399 Thursday, August 25, 2016 n fit . 1$42 snt www.catawbacountync.gov Invoice Number: 08-16-332014 Invoice Date: 08/25/2016 EHPR-08-2016-24594 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 2094 CLAREMONT RD, NEWTON NC 28658 Owner CAROLE ELLIOTT REVOCABLE TRUST, 20510 BETHELWOOD LN, CORNELIUS NC 28031 C:7049060467 Contractor LEATHERMAN SEPTIC TANK SVC INC, 8420 REEPSVILLE RD RD, LINCOLTON NC 28092 H:8282444409117044622194C:8284612985F:7044622636 ACCOUNT: 50131 PAYOR: LEATHERMAN SEPTIC TANK SVC INC FEES EHPR-08-2016-24594 FEE AMT DUE AMT Authorization to Construct Fee(New/Expansion) Fe®8/25/2016 $300.00 $300.00 i 01 Guilin ll I 4fA n.u?I'"" �� a IIS T I TT r , m. +nom �� "�o° 9" �� �� `I iC iliilaement+Pe nutlFee;a, ,,�1 Ll�l@ t E,c{�li ,��i!��II{���1;;;108%2e/2016,��1�a Illllf$.I'SO;OOaI it lipli _ $ISO400 1 FEES: $450.00 $450.00 TOTAL FEES : $450.00 5450.00 invoicereceipt 08/25/2016 11:26 Page 1 of 1