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HomeMy WebLinkAboutEHPR-04-2018-28943.TIF THIS IS NOTA PERMIT Case# EHPR-04-20I 8-28943 r CATAWBA COUNTY 1-IEALTI-1 DEPARTMENT ❑' : 0 -1-414:9 y PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 3 til 1842 sM Environmental Health Plan Review - Septic Malfunction ? r .c }, AUTH CONST- SEPTIC MALFUNCTION rd. 1074 Applicant ERIC GALES.3167 PINKIE LN.NEWTON NC 28658-8141 C:8282342774 Owner KIMBERLY DRUM-GALES.3167 PINKIE LN,NEWTON NC 28658 NAME TO APPEAR ON PERMIT Kimberly Drum-Gales SITE ADDRESS: 2669 BUFFALO SHOALS RD,NEWTON NC 28658 PIN # 367803247232 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feel 42,253.20 Acres 0.97 DIRECTIONS: 16 S,left Buffalo Shoals Rd on left before Little Mountain Rd PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Sewage on ground. Current tank and drain field is either over property line or very close. Would need new tank and drain field installed on property as it exists. If a pump would be required owners would like to change property line and install new drain field on property to left. Would need system laid out and survey to create new plat and deed to add additional property. 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: 26 x 68 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: cltapplicaGwi 04/192018 13:46 Page I of vA\yA CA AWBA COUNTY Case# EHPR-04-2018-28943 < � : Public Health Department Subdivision �i�9�0• ,� Environmental Health Division P119# 367803247232 ' PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 84 s. NAME ON PERMIT: (KIMBERLY DRUM-GALES).3167 PINKIE LN,NEWTON NC 28658 ( Kimberly Drum-Gales) Site Address: 2669 BUFFALO SHOALS RD.NEWTON NC 28658 Property Size: Square Feet 42,253.20 Acres 0.97 Directions: 16 S,left Buffalo Shoals Rd on left before Little Mountain Rd Completed applications are valid for a period of 2 years.Improvement Permits are valid:with complete site plan=60 months(5 years);with complete plat =without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid.An Authorization to Construct issued for septic repair is valid for 60 months(5 years).Permits may be revoked if the information on this application/site plan changes or if the intended use for the proposed facility changes. Permits may be revoked if site conditions are altered such that they effect permit conditions or installation requirements 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. The undersigned is'thhe owner of the property or legal agent of the owner. �,(/ Date: y// / )1 U Signature of Applicant or Agent ��?/4/ '� If you need Further information or assistance please call 828-466-7291 AREAI iiitii******iietii******************ittiititiiiiiiiiiiiiiiiiiiiiii************?'i?tiitit}tiiitiiittiitiit it* r-1" 7-7ff”".— -.r.�..�� _-......]�... ....� Irl..., ..--..I FIINA\IF. DATE FII.AMOUNT Authorization to Construct(Repair) Fee 04/19/2018 $300.00 IOTAS'IllEES S300.00, 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) • chapplicwion 04/19/2018 13:46 Page 2 of 7 Afl AwB 4j '['HIS IS NOTA PERMIT ceurrr �v i�1 �1 CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Application is for: New Construction X Existing Facility Improvement Permit n Authorization to Construct ❑New Septic Septic Repair/Malfunction Septic Relocation I Septic Expansion Existing System Inspection or Reconnection New Well Replacement Well Well Abandonment Well Repair Property Address 2 QEE Lo s-40ALs Subdivision _NEvropz, NC nGS3 Lot # Acres Driving Directions to Property Huoi I/o Snuz4-v TJL 0 Ng. 'Bo Emu, $i-bAc5 I' D Applicant Contact Information Name ERic &AL-E3 Address 3167 Pei* - [ Ar tT Phone o - - /356 Cell Phone . 2 8- 234-Z77cf Owner Contact Information Name Ica r,-Pip 2I Y Lar. 3d - RLSs Address 3107 PINKIE Last Phone 828-944, y35 Co Cell Phone 828- 4o4 - 1n310 Contractor Contact Information Name License # Address Phone Cell Phone Name to Appear on Permit? ® Owner D Applicant ❑ Contractor • Who will be the Primary Contact? ❑ Owner IX Applicant ❑ Contractor Existing Structures on Site? VI Yes ❑ No It yes, describe #of Bedrooms * # of Occupants 3 Structure Dimensions Z(o 7C (o(i Basement ❑ Yes -g- No Basement Plumbing ❑ Yes No Existing Water Supply? Ej Individual Well ❑ Community Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes ❑No 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 Will Certified Well Contractor Install Water Line or Electrical Line from Well L-lead to Pressure Tank? Yes I I No cArAv 7a TI-HS IS NOT A PERMIT • • COUNTY = CATAWBA COUNTY HEALTH DEPARTMENT No,«C„oI Application fo Environmental Services Proposed New Construction - Residential Primary Residence n New Residence n Addition to Residence # of New Bedrooms `'j Project Description Structure Dimensions #of Occupants Basement ❑ Yes _ No Basement Plumbing Li Yes n No Accessory Structure(s) Describe Structure Dimensions Plumbing ❑ Yes ❑ No Describe Plumbing Needed Accessory Dwelling ❑ Yes No #of New Bedrooms *1* #of Occupants Proposed New Construction - Commercial • Food Service SpeenyType #Seats Floor Space-Entire Food Service Facility(Sq. Ft.) #Employees per Shift # of Shifts Dining Area (Sq. Ft.) Business/Other Specify Type Structure Dimensions Retail Floor Space # of Employees per Shift #of Shifts If Church #of Seats Commercial Kitchen n Yes ❑No if Daycare,# of Children If Multi-Family Residence, #of Apartments #Bedrooms per Apartment*j' Total # Bedrooms *t Other Information Calculated Design Flow,Commercial t (This value will be determined by EH staff) The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in question. 1 f the answer to any question is "yes'', applicant must attach supporting documentation. ❑ Yes gNo Does the site contain any jurisdictional wetlands? Yes iallo Does the site contain any existing wastewater systems? 0 Yes gl-No Is any wastewater going to be generated on the site other than domestic sewage? ❑ YesC�rq No Is the site subject to approval by any other public agency? ❑ Yes 4No Are there any easements or right of ways on this property? Describe 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 0 Any *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 floor plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system expansion in the future. t If structure is plumbed but has no bedrooms, calculated design flow will be determined by EH Staff. ** If No, a well permit must be issued with the Authorization to Construct. RETRIP I'O TIIE PROPERTY AND/OR SYSTEM REDESIGN WILL INCUR AN ADDITIONAL CHARGE(SEE FEE SCHEDULE) Completed applications are valid for a period of 2 years. Improvement Permits are valid:with complete site plan=60 months(5 years); with complete plat=without expiration. An Authorization to Construct will remain valid as long as the improvement Permit is valid.An Authorization to Construct,issued for septic repair is valid for 60 months(5 years). Permits may be revoked if the information on this application/site plan changes or if the intended use for the proposed facility changes. Permits may be revolted if site conditions are altered such that they effect permit conditions or installation requirements. 1 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. The undersigned is the owner of the property or leo • ent of the owner. Signature of Owner or Legal Agent 8 Date Wi`k' Printed Name of Owner or Leal gAgentPRc & G a - Catawba County Environmental Health /6,6,�J 00 4) J J 4?e, -- \ r c. o , 09,-, /1") / / 0 fr5). cot P/ ,( o JO 47 � 0 Parcel: 367803247232, 2669 BUFFALO SHOALS 1 in=50ft RD 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 04/19/2018 CATAWBA COUNTY IOOA SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT c>\ Irnrati p l°1► PHONE: 828.465.8399 ,Svpv, Thursday,April 19, 2018 -484Su www.calawbacountync.goc PAYOR: GALES.ERIC PAYMENTS TRANSACTION NUMBER: IRC-3437456-19-04-2018 PAYMENT DATE: 04/19/2018 PAYMENT TYPE: Check 350 NCDL 5177177 dob 9/2/1960 exp 9/2/2018 INVOICE NUMBER FEE NAME FEE AMOUNT 04-18-351953 Authorization to Construct(Repair) 5300.00 Fee TOTAL PAYMENTS: 5300.00 EH PR-04-20 18-28943 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 2669 BUFFALO SHOALS RD-NEWTON NC 28658 Applicant ERIC GALES.3167 PINKIE LN.NEWTON NC 28658-8141 C:8282342774 ** NO PEOPLESOFT ACCOUNT ASSIGNED** Owner KIMBERLY DRUM-GALES,3167 PINKIE LN,NEWTON NC 28658 receipt 04/11/2018 13J2 Pace 1 of 1 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 367803247232 Owner: DRUM-GALES KIMBERLY LEE Parcel Address: 2669 BUFFALO SHOALS RD Owner2: City: NEWTON, 28658 Address: 3167 PINKIE LN LRK(REID): 4968 Address2: Deed Book/Page: 2170/0961 City: NEWTON Subdivision: State/Zip: NC 28658-8141 Lots/Block: / School Information: Last Sale: School District: COUNTY Plat Book/Page: Legal: 2669 BUFFALO SHOALS RD Elementary School: BALLS CREEK Middle School: MILL CREEK Calculated Acreage: .970 Tax Map: 005 K 04024 High School: BANDYS Township: CALDWELL School Map State Road #: 1003 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: BANDYS Zoningl: R-40 Building(s) Value: $133,600 Zoning2: Land Value: $12,700 Zoning3: Assessed Total Value: $146,300 Zoning Overlay: WP-O Year Built/Remodeled: 1946/1971 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 #: 3710367800J Building Details 2010 Census Block: 4017 WaterShed: WS-IV Protected Area 2010 Census Tract: 011402 Voter Precinct: P1 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. ©2018, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=367803247232&typ=p 4/19/2018