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HomeMy WebLinkAboutEHPR-09-2016-24691.TIF C A4C.:itja�G THIS IS NOT A PERMIT Case # EHPR-09-2016-24691 CATAWBA COUNTY HEALTH DEPARTMENT 0 {. .0 nasi `�. Y�-' �, ��:._ PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 42 sM Environmental Health Plan Review - Septic Malfunction .-P. 0 .o - J yr AUTH CONST- SEPTIC_MALFUNCTION • • T Owner DRUMS PARTNERSHIP# I (LARRY DRUM),411 E 20TH ST,NEWTON NC 28658 B:828-465-6259 C:8283813253 NAME TO APPEAR ON PERMIT Drums Partnership #1 (Larry Drum) SITE ADDRESS: 1943 SOUTH PARK DR,NEWTON NC 28658 PIN # 365915720707 NAME of SUBDIVISION: Lot4 8 Section/Block PROPERTY SIZE: Square Feet 499,197.60 Acres 11.46 DIRECTIONS: Hwy 16 South, South Park Mobile Home Park, Lot#8 PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Community Well DESCRIBE WORK: Open Complaint - EH-07-2016-6250 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: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF SW EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 12x60 NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 1 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 understand that I am solely responsible for the proper identification and la eling of all property lines and corners and making the site acces ib e so that a co pie e sit(e"aluation can be performed. Date: "7,/, ' Signature of Applicant or Agent /�'�J ��et/t�y� 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 19-ehapplicat ion 09/08/2016 14:13 Page 1 of7 • CATAWBA COUNTY Case e EHPR-09-2016-24691 fit.�' la .z Public Health Department Subdivision 6 ; e: 4 Environmental Health Division PIN# 365915720707 NC PO Box 389, 100-A Southwest Blvd,Newton, NC 28658 lg.2 S. NAME ON PERMIT: DRUMS PARTNERSHIP#1 ( LARRY DRUM),411 E 20TH ST, NEWTON NC 28658 Drums Partnership#1 ( Larry Drum) Site Address: 1943 SOUTH PARK DR,NEWTON NC 28658 Property Size: Square Feet 499,197.60 Acres 11.46 Directions: Hwy 16 South, South Park Mobile Home Park, Lot#8 7�mo. py il0ll➢1„nl j'll"I � i ' ",,,t, •._, hi rRI�Ilflp.r11rfjr,p, rGl� F_.1 glnfl illll� � f(; L FEENAMEIV�tI `�I�I U�,yi •,.412.1119. ATEulk� ', EEIAMOUNT „y Authorization to Construct (Repair) Fee 09/08/2016 $300.00 14 i pPi -litOTALIFEES 111RIPiriail i MIMISid+Y" ,11ilflIflhtt 111111nIllll 91$3001O6 . 1w� 1 r y� h Ilibl' 41''JJirU fli,.. ;d ' .. , tin j 9!INN:�p�6ru4LNilu'L`-` Jl➢tJIAr, dr�r;166k ^di111NIL tmn! .F5 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) 19-ehapplical ion 09/08/2016 14:13 Page 2 of 7 CATAWBA THIS IS NOT A PERMIT \ NT CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permit❑ Authorization to Construct Septic Repair n Septic Malfunction Septic Expansion ❑ New Well Permit❑ Replacement Well n Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction 5 Existing Facility Property AddressMa JoF 4 Subdivision -�vc�fA p,�'"•�- Lot# Acres J Section/Block/Phase Driving Directions to Property NAME TO APPEAR ON PERMIT? gi Owner n Applicant ❑ Contractor . Applicant Contact Information Name A &y i V R Address t47-3-4. 4f,H�( 5.6 w SAN 7-771wk-J ri Phone,92_r_3Fy ,- ±s-3 Cell Phone Owner Contact Information Name nl,M s ' F��TCw, % / Address A// I �,5,_5?- Phone 2 p ? /._ 5.y.)3 Cell Phone 5'".k- Y fj' 3 Zcf Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? 5 Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site se, E Le)/ / j2 W #of Bedrooms *t Z- Structure Dimensions /J 9f ti #of Occupants Basement ❑ Yes 71 No Basement Fixtures 0 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. a Yes ;#No Does the site contain any jurisdictional wetlands? Yes ® No Does the site contain any existing wastewater systems? C3 Yes 'No Is any wastewater going to be generated on the site other than domestic sewage? a Yes a No Is the site subject to approval by any other public agency? ® Yes ieNo Are there any easements or right of ways on this property? Describe Existing water supply in use 5 Individual Well Community Well H Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** 5 Yes E 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) �❑ Accepted 0 Alternative ❑ Conventional ❑ Innovative ❑ Other ® Any CATAWBA THIS IS NOT A PERMIT COUNTY �. ., CATAWBA COUNTY HEALTH DEPARTMENT rill Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *f Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ® Yes ® No ❑ Accessory Structure(s) Describe # of New Bedrooms *1. if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed Multi-Family Residence#Units #Bedrooms per Unit*j' Total# Bedrooms *t Structure Dimensions ❑ 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 r I 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 ❑ 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. 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 7 - 4212014;7-7 Date?—e'–/‘ Printed Name of Owner or Agent/, a Ny 9, p7, L,,,S Catawba County Environmental Health • • tlittiliegla Q ' . 1' - . " r\_/-- r1914, V I • a C? _ •..`_•..\ 111s Parcel: 365915720707, 1928 SOUTH PARK DR 1 in=300ft 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 09/08/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 365915720707 Owner: DRUMS PARTNERSHIP #1 Parcel Address: 1928 SOUTH PARK DR Owner2: City: NEWTON, 28658 Address: 411 EAST 20TH ST LRK(REID): 508 Address2: Deed Book/Page: 1917/0273 City: NEWTON Subdivision: State/Zip: NC 28658-2004 Lots/Block: 4/ Last Sale: School Information: Plat Book/Page: 6/134 School District: COUNTY Legal: LOT 4 TR 4-5 PT 6 PL 6-134 PL 6-134 Elementary School: BALLS CREEK Middle School: MILL CREEK Calculated Acreage: 11.460 Tax Map: 001 K 02004 High School: BANDYS Township: CALDWELL School Map State Road #: Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: NEWTON RURAL Zoningl: R-40 Building(s) Value: $43,200 Zoning2: Land Value: $175,200 Zoning3: Assessed Total Value: $218,400 Zoning Overlay: RP-O Year Built/Remodeled: / Small Area: BALLS CREEK Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710365900J Building Details 2010 Census Block: 1000 WaterShed: 2010 Census Tract: 011601 Voter Precinct: P20 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 hem 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=365915720707&typ=P 9/8/2016 Po' -wwwW1111111111 —.wwwwwmplIMMillwi, e0 0,0 No 3030 C A 'T'A. W/31N. COUNTY HEALTH D E P A R T M E N T (704) 465-1c270 / Lot Eval. Improve. Permit Repair Permit �r/Cert. of Comp. Permit per. Permit Owner/Agent IlU\ ldA IMP) % 4 I Phone 46 4 - / ti k 7 Address -v1box ISO Subdivision feAititzt/u4-1 Milt. ,,i AI etii• Section/Block t* Vd-9 Lot Size Directions: /4 - l Se-n.1714_ , sem CLnn� d b 4/ ri'). itif i4 ,AF - /n4-P) ,_ - 7,eix. A /Eo Facility: House `Mobile Home..5 ✓ 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 . 00 DAYS OP) DAYS FROM DATE OF Water Supply: Private Public . Pte; Type of System: Trench Bedump Pump/Panel Panel LPP Other Tank Size: Septic Tank r4 /1)4/v11{ Pump Tank Nitrification Field: Total Square Fee 6( C) Depth of Stone /j if Bed Size /6444)/ Trench Width •-r Total Length of All Trenches Number of Trenches Individual Trench Length_/_/J/_/_ Feet on Center Maximum Trench Depth ,3( J Distance of Nearest Well /470 Lot Evaluation: Approved yes/no (Void After 24 months) Topo % Slope Sketch of lot Evaluation Site - System Design - Final Texture /Ve b, ,�44;7 t. ,--) Kiev! 01 , ,t- 3- ii ilzeid ..,.'t A4s. Structure Clay Min. / 1 exiS Soil Wetness Soil Depth " Q.rop, I�n4 vsecl " Restric. Hoz. at " �� I �Available space yes/no ` Overall Class S PS Ulex/ A�� 1JComments: ro y E:y cid , ii.a-ri, frrZA- au& 1111,44 i. Iv, **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN THROUGH THE ISSUANCE OF THIS PERMIT** Permit Date /off d /CI / (Improvement Permit void /after 60 months) (4,- .-,L. Owner/Agent L'ii -- .-.- -n tarian , 444!4i '- t_/ /5;5- Installed By -= y1�-'! T:.,,�L. Date /S 4 Sanitarian�`�wyli'.( ,.<4.-41(44.. (Note any change- information in ,red or by sketc on back) White-Office Blue-Bldg. Insp. Comp. Yellow-Owner/Agent Green-Bldg. Insp.I.P. 3.A Cp CATAWBA COUNTY ick// I OOA SOUTHWEST BLVD w y NEWTON, NORTH CAROLINA 28658 RECEIPT �n��� � ie�Ve" U U1i .0 PHONE: 828.465.8399 Thursday, September 8, 2016 �� ( � 1842 snt www.catawbacountync.gov PAYOR: Drums Partnership#1 Drums Partnership#1 (Drum, Larry) PAYMENTS TRANSACTION NUMBER: TRC-823382-08-09-2016 PAYMENT DATE: 09/08/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 09-16-332468 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-09-2016-24691 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 1943 SOUTH PARK DR,NEWTON NC 28658 Owner DRUMS PARTNERSHIP# 1,411 E 20TH ST,NEWTON NC 28658 B:828-465-6259C:8283813253 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 09/08/2016 14:12 Page 1 of I