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HomeMy WebLinkAboutEHPR-04-2018-28975.TIF 4' • THIS IS NOTA PERMIT Case# EHPR-04-2018-28975 r� rr_v CATAWBA COUNTY HEALTH DEPARTMENT ••� �0 � �f '• / PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES # T`• :3� / 42 sm Environmental Health Plan Review- OSWP Z EXS_SYSTEM Applicant ANDREA CALDERON,8565 W NC 10 HWY, VALE NC 28168 C:8287347187 Paid By FABIOLO CALDERON.. C:8284002223 NAME TO APPEAR ON PERMIT Andrea Calderon SITE ADDRESS: 6822 WESTLEE DR,VALE NC 28168 PIN# 268701159696 NAME of SUI3D I V ISI ON: Lot tl Section/Block PROPERTY SIZE: Square Feet 0.00 Acres DIRECTIONS: West Hwy 10,approximately 12 miles turn left at Banoak Elementary School,house is on left at intersection of Banoak and Westlee PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: Existing system check for migrant housing for 4 people 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: 48x33 NUMBER OF EXISTING BEDROOMS: 3 It OF OCCUPANTS: 4 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: ehapplicatiun 04/24/2018 11:58 Page I of4 �H: e ••CVlAWBACOUNTY Cased EHPR-04-2018-28975 C ht.9n , Public Health Department Subdivision \j5®T a Environmental He;dth Division PINd 268701159696 ' 1 PO Bos 389,100-A Southwest Blvd,Newton,NC 28658 NAME ON PERMIT: (ANDREA CALDERON).8565 W NC It) HWY.VALE NC 28168 (Andrea Calderon) Site Address: 6822 WESTLEE DR. VALE NC 28168 Property Size: Square Feet 0.00 Acres Directions: West Hwy 10,approximately 12 miles turn left at Banoak Elementary School,house is on left at intersection of Banoak and Westlee 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 the property or legal agent of the owner. //////�/7� Date: -/R 2,--4)-- CI �/{��/��� � Signature ofApplic:mt or Agent ' If you need further information or assistance please call 828-466-7291 AREA2 444444 5*t4444444444444444444**54444**kit ii4iii5i4444455********55i4444**44444444i 44444Y444444444444i 544 44444 1 FI.ENA,\IE DME I'l'.I'.A\IOUN I Existing Tank Check Fee 04/24/2018 580.00 . . .. T • O I AL FEES 580.00 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) thappl icatiun 11.1/242018 11:58 Page 2 of v r` T / THIS 18 NOT A PERMIT COUNTY � COUNTY . .. CATAWBA COUNTY '.IIEAg,TH DEPARTMENT Application for Environmental Services Application is for: ] New Construction S Existing Facility Improvement Permit Authorization to Construct New Septic I I Septic Repair/Malfunction Septic Relocation I I Septic Expansion [ Existing System inspection or Reconnection I I New Well n Replacement Well Well Abandonment �{ Well Repair Property Address 6StZZ (QJ2 s4� e_e Dr. Subdivision C�i1BF. �ill?SI(� Lick L'C ,2 a-161 Lot Acres Driving Directions to Property We5�_*eJ�� 10 1�vv jI e..5 0lp r O)< fro (yr r`o cz k F I -e✓Vi L t'l'{-et.VU S 0 0 I Applicant Contact Information t bid°, Calderon `62%--4o02-22.3- Paid by Name An.6,teck Gat rQrt'n _ Address 35G5 k) Flwy lO \I al-e NC ',1St (0q • Phone ( ) 7 3LI - 7I g7 Cell Phone Owner ContactInformation Name Address Phone Cell Phone Contractor Contact Information Nance License# Address Phone Cell Phone Name to Appear on Permit? ❑ Owner Applicant f1 Contractor Who will be the Primary Contact? ❑ Owner Applicant Contractor Existing Structures on Site? ® Yes ❑ No If yes; describe # of Bedrooms * 3 '#of Occupants t Structure Dimensions Basement ❑ Yes No Basement Plumbing Yes X No 1`J Existing Water Supply? ❑ Individual Well _ Community Well LA, County/Cityrrownship Water Line Is a public water supply available? ** Yes ❑ No Well Construction/Abandonment/Repair • Proposed Well Type ❑ Individual Well n Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled Bored I I Dug ❑ Unknown Well Repair Requested Yes ❑No Describe Will Certified Well Contractor install Water Line or Electrical Line from Well Head to Pressure Tank? Yes ❑No N---7TTA, A\ THIS IS NOT A PERMIT CO NTv .. '1 CATAWBA COUNTY HEAILTH DEPARTMENT Application for Environmental Services Proposed New Construction - Residential Primary Residence n New Residence n Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement El Yes n No Basement Plumbing ❑ Yes [1 No Accessory Structure(s) Describe Structure Dimensions Plumbing ❑ Yes P No Describe Plumbing Needed Accessory Dwelling ❑ Yes ❑No # of New Bedrooms *t #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 Seals Commercial Kitchen ❑ Yes No if Daycare, # of Children If Multi-Family Residence, # of Apartments #Bedrooms per Apartment*t 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. If the answer to any question is"yes''; applicant must attach supporting documentation. 11/Yes IY'No Does the site contain any jurisdictional wetlands? • Yes . No Does the site contain any existing wastewater systems? ❑ Yes friNo Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes 0/No Is the site subject to approval by any other public agency? O Yes CINo 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) ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other ❑ 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 bun has no bedrooms, calculated design flow will be determined by EH Staff. **IfNo, a well permit must he issued with the Authorization to Construct. RETRII'TO THE 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 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 malting the site accessible so that a complete site evaluation can be performed. The undersigned is the owner of the properly legal agent the owner. Signature of Owner or Legal Agent • //2cAtp Date -2*L Printed Name of Owner or Legal Agent ?a /c ( Ctigaic. Catawba County Environmental Health 60 / i Q5- 314.87 . . / r / 181.88 / 100.00 / / v a / ::93 t $ V / a r / 192.88 / 6 7 l 10 �p�IG PIczo I � ,, . . :64 LL' t I ♦ 7 37 .7 I 23 I to I vr ti- I WESTLEE DR I I 1 D 108.38 I 69.95 111.00 I N 1 O I NI I I I k 111\1\ 0 I Parcel: 268701159696, 6822 WESTLEE DR 1in=50ft VALE, 28168 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 04/24/2018 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 268701159696 Owner: CALDERON MIGUEL Parcel Address: 6822 WESTLEE DR Owner2: CALDERON JANET City: VALE, 28168 Address: 6822 WESTLEE DR LRK(REID): 100573 Address2: Deed Book/Page: 3382/0214 City: VALE Subdivision: DOUGLAS CORNERS State/Zip: NC 28168-7103 Lots/Block: 2/ Last Sale: $40,000 on 2017-01-20 School Information: School District: COUNTY Plat Book/Page: 45/145 Legal: LOT 2 PLAT 45-145 Elementary School: BANOAK Calculated Acreage: .490 Middle School: JACOBS FORK High School: FRED T FOARD Tax Map: School Map Township: BANDYS State Road #: 2043 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: PROPST Zoningl: R-40 Building(s) Value: $43,800 Zoning2: Land Value: $10,000 Zoning3: Assessed Total Value: $53,800 Zoning Overlay: Year Built/Remodeled: 1999/ Small Area: PLATEAU Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710268600J Building Details 2010 Census Block: 3016 WaterShed: 2010 Census Tract: 011802 Voter Precinct: P2 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared born 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. ©2017, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=268701159696&typ=P 4/24/2018 VI Iv s • . . /-,ma c" " CATAWBA COUNTY HAALTH DEPARTMENT N° 6 4 0 8 I elephone: (828)465-8270 TDD- 828)465-82 /�� Imp. Pnnt._ Auth. o Const. l/ Rpr. Print. Opr. Prmt. Sys. Type • Well Print `�Well Rpr, Prmt, Owner/Agent '0- Phone 77a0 Address 71f y, / [f ' Subdivision C�y7.v�-+0.. ha-� s Lot# SecuanlBlock/P `� Lot Size ., - Directions: 16 44J „„, .: �'lrti;; z. ' 37415{galley/k Rd Facility: House Mobile Home Business Multi-family . Other: Tax Map or Pin Number6 pf—IS— 7, 2/ i Other . Zoning Approval it ,..7.-9,9 12 / # Bedrooms # Seats #Employees . Application Rate t ; GPD Flow _2 6 Hot Tub or Spa yes/no Special Fixtures Basement yes/no . 100% Repair Area�Ano �� Basement Plumbing yes/no Water Supply: Private Well !/Public Semi-Public **************************** ********************************************************************************************** Type of System: Trench Bed Pump Pump/Panel Panel LPP Other` L, Septic Tank Size /606 v Pump Tank Size f _ Nitrification Field: Total Square Feet f 0 Depth of Stone lot 1/ Bed Size Trench Width J Total Length of All Trenches yd D Number of Trenches S Trench Length /WI /Rd / ) _17 I_Feet on Center 9 i Maximum Trench Depth 3 !/Distance of Nearest Well 'o /j *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* Topo 1 <J :lope 11 tJ�/1 Texture Structure 9 I - Clay Min. Soil Wetness Jr Fir 0 f Soil Depth r f ��01 Restric. Hoz. at ” rCI '�t� Available space no (�� Overall Class S U Comments: --d It/ Pe-r._ ' I1 ir 0.-1. 1---- isj/ /6 Iliji / ACIiLl—q Filter Re uired Riser required when c / tank is more than 6 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 sources of contamination. No volume of water is guaranteed at a site b the Health Department. —Cf Permit Date 77'?4 EHSe / Date 71 Owner/Aunt „yam _. '� Septic Tank Installed By "4a.. . ' EHS r .�"�"���=Well Installed By �` ' k Well Grout Approval Date r O/ Well Head Approval Date -RI-a j Date Sample Collected Date of Results - Results EHS /8 White-Office Blue-Building Inspection Operation Permit Yellow-Owneiitigent Green-Building Inspection Authorization to Construct CATAWBA COUNTY h OG, IOOA SOUTHWEST BLVD (#. + v NEWTON,NORTH CAROLINA 28658 RECEIPT .... e�P y PHONE:828.465.8399 K �j�:� S Tuesday,April 24,2018 V 4� SM 5aww.catawbacounl}'nc.gov PAYOR: Calderon,Andrea PAYMENTS TRANSACTION NUMBER: TRC-3473987-24-04-2018 PAYMENT DATE: 04/24/2018 PAYMENT TYPE: Check 357 NCD L-36902720 DOB-6/11/70 EXP-6/11/19 INVOICE NUMBER FEE NAME FEE AMOUNT 04-18-352142 Existing Tank Check Fee 580.00 TOTAL PAYMENTS: $80.00 EH PR-04-2018-28975 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 6822 WESTLEE DR, VALE NC 28168 Applicant ANDREA CALDERON,8565 \V NC 10 HWY,VALE NC 28168 C:8287347187 ** NO PEOPLESOFT ACCOUNT ASSIGNED** 1'aid By FABIOLO CALDERON,, 0:8284002223 receipt 04/21/2018 11:54 Page I of I