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HomeMy WebLinkAboutEHPR-04-2018-29014.TIF (.\-?,A-7:-;\. 'PHIS IS NOTA PERMIT Case# EHPR-04-2018-29014 ,. . � CATAWBA COUNTY HEALTH DEPARTMENT _❑�eA ,El��?` 7PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 0: .F ti• 842 I" Environmental Health Plan Review- Septic Malfunction o o t AUTH CONST- SEPTIC MALFUNCTION • y+Gr ,_ ti. Owner ARACELI ADAMIi.2367 11111 AVE NE.HICKORY NC 28601 C:8282386631 NAME TO APPEAR ON PERMIT Araceli Adame SITE ADDRESS: 2367 lin]AVE NE,HICKORY NC 28601 PIN # 372313024830 NAME of SUBDIVISION: PATRICIA ERASURE&NATHAN CLARK Lot 4 2&3 Section/Block PROPERTY SIZE: Square Feet 54,014.40 Acres 1.24 DIRECTIONS: Springs Rd,turn sight on 23rd St NE,turn into 11th Ave NE,and lot is on left PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water 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 68x35 house EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: 3 4 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: • ehapplication 04/26/2018 16:40 Page I of] d CA AWBA COUNTY Case# EHPR-04-2018-290!4 ^f' Ltat., Public Health Department Subdivision PATRICIA FRASURE&NATHAN < :�lr " Environmental health Division PIN# 372313024830 '`ti PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 • to NAME ON PERMIT: (ARACELI ADAMS),2367 I ITI-I AVE NE,HICKORY NC 28601 (Araceli Mame) Site Address: 2367 11TH AVE_NE.HICKORY NC 28601 Property Size: Square Feet 54,014.40 Acres 1.24 Directions: Springs Rd,turn right on 23rd St NE.turn into 11th Ave NE,and lot is on left 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 slate 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 cornets 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. • Date: LI 6 - ] Signature of Applicant or Agent ( race I f TA9lakwe LCM q If you need further information or assistance please call 828-466-7291 AREA2 4fi###i##44#######44#44##444#4####rt##4trt####tknt4ti4t4i iRt#####4####t#4####4#44##4t###44f4#t#trtt#rt#t#ttt#44ti FEENANIE DATE FEE AYIOUNT.a Authorization to Construct(Repair) Fee 04/26/2018 5300.00 TOTAL 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) • ehapplicwion 04/262018 16:38 Pa8e 2 of 7 c AF'T8. `\/ LI A TI-IIS IS NOT A PERMIT s`c'o nil t . CATAWBA COUNTY HEALTH DEPARTMENT -- Application for Environmental Services Application is for: New Construction Existing Facility Improvement Permit I I Authorization to Construct New Septic Qj Septic Repair/D4alfunction Septic Relocation I I Septic Expansion Existing System Inspection or Reconnection New Well I I Replacement Well I Well Abandonment I I Well Repair Property Address 736 ? // 'ti (Lite_ /.' Subdivision 1l ( kavY IUC / 2 0( Lot# Acres_(, Zs Driving Directions to Propertyer ' -{- g � e' � S �c Gr� �e� v ti �3 Sf /✓E Turn in /itCftn A) � Ir1- is o... (teff Applicant ContactInformation • • Name Address Phone Cell Phone Owner Contact Information Name tq ec ( ' Aar.-,-,1(- Address Address Z36 7 /i rh Ac N6 H ( ; NL i Z ?6o Phone Cell Phone($Z%) 23 8- L 6 3 I Contractor Contact information Name License # Address Phone Cell Phone Name to Appear on Permit? rWowner I Applicant Contractor Who will be the Primary Contact? Owner Applicant H Contractor Existing Structures on Site? [ Yes No 11'yes, describe # of Bedrooms * 3 # of Occupants 'a Structure Dimensions rlj% 3 Basement n Yes 4-No Basement Plumbing H Yes L-1—No Existing Water Supply? ❑ Individual Well I I Community Well ❑County/City/Township Water Line Is a public water supply available? ** Yes n No Well Construction/Abandonment/Repair • Proposed Well Type LI Individual Well ❑ Semi-Public Well Community Well Abandonment Type Drilled LI Bored ___ Dug ❑ Unknown Well Repair Requested ❑ Yes n No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank? Yes No A` tTia ° THIS IS NOT A PERMIT Courry (CATAW[[oA COUNTY HEALTH DEPARTMENT ;o.,„ ? Application for Environmental Services Proposed New Construction - Residential Primary Residence _ New Residence Addition to Residence #of New Bedrooms 'T Project Description - Structure Dimensions #of Occupants Basement ❑ Yes n No Basement Plumbing ❑ Yes P1 No Accessory Structures)Describe Structure Dimensions Plumbing n Yes 9 No Describe Plumbing Needed Accessory Dwelling n Yes _ No #of New Bedrooms *-1- # 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 Arca (Sq.Ft.) Business/Other Specify Type Structure Dimensions Retail Floor Space #of Employees per Shift # of Shifts If Church#of Seats Commercial Kitchen H Yes n No If Daycare,#of Children If Multi-Family Residence,#o1Apartments #Bedrooms per Apartment*I' Total #Bedrooms 11- Other jOther 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. ❑�yes Flo Does the site contain any jurisdictional wetlands? I� 'es 0 NoDoes the site contain any existing wastewater systems? Yes o Ts any wastewater going to be generated on the site other than domestic sewage? LI Yes so Is the site subject to approval by any other public agency? ❑ Yes No Are there any easements or right of ways on this property? Describe If applying for an huprovernent 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 El 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 continued 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. I. 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. RETRII'TO THE PROPERTY AND/OR SYSTEM REDESIGN WILL INCUR AN ADDITIONAL CHARGE(SEF,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. I have read this application and certify thatthe 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 1 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 property or legal agent of the owner. Signature of Owner or Legal Agent_ ace /, Q o&c 1--col tzS Date Printed Name of Owner or Legal Agent_A re t.' Adante �erKvs Catawba County Environmental Health i `F 7 (191 � I $ j4 L co 60 X 92 203 l , c4 g.= id v III .41G co Z, T 42.16 r O \ "Nir Nirtel\ v 4 ,,,i: t ill ' ..08 h 6s� 2 4. soo.0 Ili ..it 39.15, Q O r o • ry.' / J 1-3CP v\,, 145.9 i \ i i \ V \ i C i \ .0 / \ .1 i • V \ N tri ----#.--..---------.7 :&\\., , , " 71 • / / Parcel: 372313024830, 2367 11TH AVE NE 1in=80ft HICKORY, 28601 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 04/26/2018 Parcel Report Page 1 of 1 • Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 372313024830 Owner: SAUCEDO ROBERTO Parcel Address: 2367 11TH AVE NE Owner2: ADAME-LEMUS ARACELI City: HICKORY, 28601 Address: 2367 11TH AVE NE LRK(REID): 604306 Address2: Deed Book/Page: 3255/0722 City: HICKORY Subdivision: PATRICIA FRASURE & NATHAN State/Zip: NC 28601-3005 CLARK Lots/Block: 2 & 3/ School Information: School District: COUNTY Last Sale: $62,000 on 2014-08-29 Elementary School: ST STEPHENS Plat Book/Page: 70/116 Middle School: ARNDT Legal: LOT 2 & 3 PLAT 70-116 Calculated Acreage: 1.240 High School: ST STEPHENS Tax Map: School Map Township: HICKORY State Road #: 1442 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: HICKORY County Fire District: ST STEPHENS Zoning1: R-4 Building(s) Value: $37,400 Zoning2: Land Value: $15,500 Zoning3: Assessed Total Value: $52,900 Zoning Overlay: Year Built/Remodeled: 1996/ 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 #: 3710372300J Building Details 2010 Census Block: 2002 WaterShed: 2010 Census Tract: 010304 Voter Precinct: P28 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,arid 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=372313024830&typ=P 4/26/2018 CATAWBA COUNt LALTH DEPARTMENT No 8 41 6 r , • Tele hone: (828)465-827 D: (828)4 r p � 5� Imp. Prmt, __ Auth. to Cortsi. Rpr. Prmt. � Opr. Prmt, Sys. Type r'[ Well Prmt. Well Rpr. P int. Owner/Agent I 0c e _ 1-614" Phone 2 ,i(, -jt`) Address 2_73.70 I 1 Th 11,E Subdivision Section/Block/Phase Lot# Lot Size t 2— Directions: 5 pct 5 a 0 ) S T ex 3.Z rn S-r lug" 7 - T 4T() j1i* jkv /VE I r4n -r c r t--7- -2370 T-2370 it6 Piot. WE Facility: House Mobile Home Business Multi-family . Other: Tax Map or Pin Number -37?.-5 l—AD 2,4 7 L1 S Other . Zoning Approval# 1 It C C‘,,,-„a #Bedrooms #Seats #Employees . Application Rate .3 7 i GPD Flow --Z(,O Hot Tub or Spa yes/ SpeOal Fixtures Basement yes . 100% Repair Area} s no Basement Plumbing yes/ o Water Supply: Private Well Public.X Semi-Public Type of System: !P~K Bed Pump Pump/Panel Panel LPP Other Septic Tank Size )C10 U Pump Tank Size Nitrification Field: Total Square Feet /0 Depth of Stone /.�` Bed Size Trench Width �� Total Length of All Trenches 3 Lid.' Number of Trenches Li Trench LengthW/ lSr>/ / / Feet on Center � Maximum Trench Depth ' Di ; stance of Nearest Well ! *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION" Topa % Slope Jf) 6/9_c Texture `/E: Structure 1L j/Lt -I'r � �� Clay Min. r Soil Wetness Lie/ " 1 (_ Ni ' I i . Soil Depth tic(' " y yr Restric. Hoz. at 4* Available space no Overall Class S _ Comments: rP5 .. r P Arl :4" Q4. P rcit1 1 Q ei-,5 ��•>• t) r 1 3 NO �-# Lo4-- r� cA rcAd A (W e(kr, �� 5.ep r t t Gr{M1C) Ult. t. Filter Required 70 Riser required when tank is more than 6 9 lad inches deep. 4{1 **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE P - I • - • H OF TIME TRIS 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 guarantee atsite by the Health Department. Permit Date — —D EHS 12 ., s. Owner/Agent - �-- Septic Tank Installed By /7/;----7:___'_ Date ,/1-IX 1.,,- EHS t� Y� Well Installed By Well Grout Approval Date Well Head Approval Date Date// Sample Collecte,d, . , Date of Results Results EHS White-Office Blue-Building Inspection Operation Permit Yellow-Owner/Agent Green-Building Inspection Authorization to Construct `rti�A CATAWBA COUNTY �' � 100A SOUTHWEST BLVD �� NEWTON,NORTH CAROLINA 28658 RECEIPT eaP® PHONE:828A65.8399 C..) vdsv, /'C� Thursday,April 26,2018 13L� 1 SM \\ww.catawbacoWnV0e.6ov PAYOR: D Adame,Araceli PAYMENTS TRANSACTION NUMBER: TRC-3491791-26-04-2018 PAYMENT DATE: 04/26/2018 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 04-18-352284 Authorization to Construct(Repair) $300.00 Fee TOTAL PAYMENTS: S300.00 El-1112-04-2018-29014 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 2367 I ITH AVE NE,HICKORY NC 28601 Owner ARACELI ADAME.2367 I um AVE NE. HICKORY NC 28601 C:828238663I **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 04/26/2018 16:37 Page 1 of 1