Loading...
HomeMy WebLinkAboutEHPR-04-2018-28968.TIF A • THIS IS NOTA PERMIT Case# EHPR-04-2018-28968 Q � t 2 rQ CATAWI3A COUNTY HEALTH DEPARTMENT ❑' i' . PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ;: � `�•* :{ 18. 2 sM Environmental Health Plan Review- Septic Malfunction 'k`• �:{� AUTH_CONST- SEPTIC_MALFUNCTION � , rti , ler Applicant RACHEL PARLIER. 1210%E3 HAYNES RD.MAIDEN NC 28650 118284288171 C:7044724773 IIOME:8284288171 NAME TO APPEAR ON PERMIT Rachel Parlier SITE ADDRESS: 1210 7.2213 HAYNES RD,MAIDEN NC 28650 PIN # 363708883470 SAME of SUBDIVISION: Lot S HAYNES PROPERTY p 18-19 Section/Block I'14o1'ERrY SIZE: Square Feet 379,407.60 Acres 8.71 DIRECTIONS: 321 S, right Zeb Haynes lot on right 1/2 mile PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Water on ground 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 residence EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 105 x 77 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 2 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: eliappliea ion 04/23/2018 13:40 Page I of7 SNA CATAWBA COUNTY Casey EHPR-04-2018-28968 • Public Health Department Subdivision NELLIE S HAYNES PROPERTY G : �r�j � Environmental Health Division PIN/ 363708883470 -4" PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 is is NAME ON PERMIT: ( RACHEL PARLIER), 1210 ZEI3 HAYNES RD.MAIDEN NC 28650 ( Rachel Parlier) Site Address: 1210 ZEH HAYNES RD.MAIDEN NC 28650 Property Size: Square Feet 379,407.60 Acres 8.71 Directions: 321 S, right Zeb Haynes lot on right 1/2 mile 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 the owner of thepropertyor legal agent of the owner. /L�/jQ p //��// q Date: —��— /c3 Signature of Applicant or Agent � X / , ALA If you need further information or assistance please call 828-466-7291 AREAI ff♦it1Y*Y*YY11**44!44?**4♦4*4*4*4**+******4***********4f}4*44........*44*4*4+*4*****4*4*oft}*444445!#inti** [4FEENANIC, ..._.,a.,a..�a_A-1E 1I:F-AMOUNT_a Authorization to Construct(Repair)Fee 04/23/2018 $300.00 I . r 'CO'I'r1L FEES 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) ehnpplic:aion 04/23/2018 I3:10 Page 2 of 7 Ar ,���V j Cg THIS IS NOT A PERMIT t y ✓' iLdiriL. amity COUNTY HEHEALTHIDEPARTMYENI' :arae:7,;S, Application for Environmental Services Application is fon ] New Construction I�Existing Facility Improvement Permit Authorization to Construct INew Septic VSeptic Repair/Malfunction Septic Relocation I I Septic Expansion Existing System Inspection or Reconnection New Well I I Replacement Well I F Well Abandonment Weill Repair Property Address 42. /0 G-GG, lieS Subdivision /116 /7 ('-- 4 g./.45-6 Lot# Acres Driving Directions to Property Q4til ?a-/ S 7/6 Z." Nathe4LI 1MPh i i7A/ — C0 arouncl SLar_y� Lur ve_ cJc hos o n //r4 , Applicant ontact Information • Name L t / /Z , Address 9 Z Phone c y(, gy '7 / �� Cell Phone 78 SG 4L702 4L773 Owner Contact Information Name jefCh / P%r//ef Address zd at, - se-( e. / • /)/�i Phone • 2 2; • / Cell Phone V V 7 577,3 Contractor Contact Information Name 21— rearY__I Leo%endt -h License# Address �/ Phone Cell Phone Name to Appear on Permit? IVl Owner fl Applicant I I Contractor Who will be the Primary Contact? R 0 vner U Applicant Contractor Existing Structures on Site? • l Yes U No If yes, describe 6 h #of Bedrooms * 3 # o Occupants Structure Dimensions P.4 7 Basement g--Yes ❑ No Basement Plumbing Yes No Existing Water Supply? Individual Well 7 Community Well County/City/Township Water Line Is a public water supply available? ** Yes — No Well Construction/Abandonment/Repair Proposed Well Type iv-Individual Well in Semi-Public Well I Community Well Abandonment Type Drilled Bored I Dug Unknown Well Repair Requested I Yes Li No Describe Will Certified Well Contractor Install Wafer Line or Electrical Line from Well Bead to Pressure Tank? Li Yes U No trmi Air� 7\` L/\ THIS IS NOT A PERMIT ark coCur t, CATiAWBA COUNTY HEALTH EPARTMTi+IN T' the o Application for Environmental Services Proposed New Construction - Residential Primary Residence n New Residence LJ Addition to Residence # of New Bedrooms *j Project Description Structure Dimensions #/ of Occupants Basement Yes ❑ No Basement Plumbing n Yes H No Accessory Structure(s) Describe Structure Dimensions Plumbing [1 Yes ❑No Describe Plumbing Needed Accessory Dwelling ❑ Yes ❑No # of New Bedrooms *j #of Occupants Proposed New Construction - Commercial Food Service Specify Type #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 [ Yes No If Daycare,#of Children 1f Multi-Family Residence;# of Apartments #Bedrooms per Apartment*t Total #Bedrooms It Other hrformation Calculated Design Flow, Commercial 1' (This value will be determined by EII 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. If the answer to any question is"yes", applicant must attach supporting documentation. ❑ Yes VizNo Does the site contain any jurisdictional wetlands? lines Ltif No Does the site contain any existing wastewater systems? ❑ Yes 11(1/No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes 1No Is the site subject to approval by any other public agency? O Yes �No 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) O Accepted 0 Alternative ❑ Conventional El Innovative 0 Other IK-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. j 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 TO THE PROPERTY AND/OR SYSTEM REDESIGN WILL INCUR AN ADDITIONAL CHARGE(SEE FEE SCII LDUt,E) Completed applications are valid for a period ol'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 envy 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 snaking the site accessible so that a complete site evaluation can be performed. The undersigned is the owner of the prop� ty or legal agent .f the owner. Signature of Owner or Legal Agent f— i . c4 , _ Date '02J ' /8) Printed Name of Owner or Legal Agent__ .,p� qrl/tel Catawba County Environmental Health \_ =X55 V,""---\\N-7/ \-- � y 7 �� 845 4 �a of g50 IS46 rc 055 jiir CP0 \ ip co A, 1 t lilt ) ,‘,477 Ln • „, • of , , ....., /r1) i co • / 1101111' I C .4 v# Q / /O ^ \ Parcel: 36370888347`0, 1210 ZEB HAYNES RD 1 in=150ft MAIDEN, 28650 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 04/23/2018 Parcel Report Page 1 of 1 • Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 363708883470 Owner: PARLIER RACHEL L Parcel Address: 1210 ZEB HAYNES RD Owner2: City: MAIDEN, 28650 Address: 1210 ZEB HAYNES RD LRK(REID): 900420 Address2: Deed Book/Page: 1908/0815 City: MAIDEN Subdivision: NELLIE S HAYNES PROPERTY State/Zip: NC 28650-9327 Lots/Block: 18-19/ School Information: Last Sale: Plat Book/Page: 36/109 School District: COUNTY Legal: LOT 18-19 PL 36-109 Elementary School: MAIDEN Middle School: MAIDEN Calculated Acreage: 8.710 Tax Map: 065N 01050 High School: MAIDEN School Map Township: NEWTON State Road it: 2010 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: MAIDEN County Fire District: MAIDEN RURAL Zoning1: R-15 Building(s) Value: $395,800 Zoning2: Land Value: $56,900 Zoning3: Assessed Total Value: $452,700 Zoning Overlay: Year Built/Remodeled: 1997/ 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 #: 3710363700J Building Details 2010 Census Block: 3020 WaterShed: 2010 Census Tract: 011702 Voter Precinct: P20 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 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=363708883470&typ=P 4/23/2018 • CATAWBA COUNTY HEALTH DEPARTMENT ,. Telephone: (704) 465 270 TDD: (704) 465-8200 : 1 3 :: ifImprove. Permit Authorization to Construct Repair Permit_Oper. Permit stem Type Owner/Agent�Lt1[ ^F ( - tc..•1 rs '11rr t f-ene Phone L/ 2k- 817/ Address dQ/ ,(J Ids ASubdivision X4/4.140.1./ Se tion/Block/Phase Lot# Lot Size Fr, ?fr. ,.q- Directions: / SCffrz--7-,%Z, 5 Cf7 o) , r /bp/ AI(II Facility: House Mobile Home Business . Other: Tax Map # 4r54..) - / - 1/, # Se) Multi-family Other _ Zoning Approval # (P/7? cf.,j # Bedrooms 34 Seats 4 Employees . Application Rate ,q/ GPD Flow 36.a Hot Tub or Spa yes/rte Special Fixtures . 100% Repair Area es/no Basement /no Basement Plumbing Qes 'no Water Supply: Private Well O( Public Type of System: Trench Y., Bed Pump Pump/Panel Panel LPP Other Tank Size: Septic Tank Size lertin 2�.-/ Pump Tank Size Nitrification Field: Total Square Feet %/--i, Depth of Stone 1€ Bed Size Trench Width . ,C Total Length of All Trenches ereo Number of Trenches 3 Individual Trench Length/n //V //op/ / Feet on Center / Maximum Trench Depth Z li Distance of Nearest Well /D O *DO NOT INST L WHEN WET* Topo 6' -2 % Slope \ N. 'l/y�c9 �` ��\ Ite A. )1(tOL)Texture / t Structure A6lerk y r Clay Min. / % I n!` Soil Wetness /75 " Soil Depth :5 Restric. Hoz, at -').1 F„ Available space 4W/no Overall Class ITP U `�6 comments: 1S Z a" <S i/ i // j Z35`y i • tem TC p /T7%y ,c net **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 plane 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. Permit Date / - 3 - 92 r �- Owner/Agent Sanit rian�l/ ,(,�,(7IS'`"l"�rlr Installed By� tir .Date e/_ ./t- Sanitari n f M��" p,A Co CATAWBA COUNTY ��G 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT d "",,a0 PHONE: 828.465.8399 \C���p'5 j F 1 Monday,April 23, 2018 N. /842 sm www.catawbacoungmc.gov PAYOR: Parlier. Rachel PAYMENTS TRANSACTION NUMBER: "IRC-3467460-23-04-2018 PAYMENT DATE: 04/23/2018 PAYMENT TYPE: Check 8991 NCDL 5387999 dob 8/30/1941 exp/8/30/2024 INVOICE NUMBER FEE NAME FEE AMOUNT 04-18-352091 Authorization to Construct(Repair) $300.00 Fee TOTAL PAY M E NTS: 5300.00 EHPR-04-2018-28968 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 1210 ZIB HAYNES RD,MAIDEN NC 28650 Applicant RACHEL I'ARLIER, 1210 ZEI3 HAYNES RD,MAIDEN NC 28650 11:8284288171C:7044724773 ** NO PEOPLESOET ACCOUNT ASSIGNED** receipt 04/232018 13:38 Page I of I