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HomeMy WebLinkAboutEHPR-04-2018-29029.TIF �V F THIS IS NOTA PERMIT Case# EHPR-04-2018-29029 -1 CATAWBA COUNTY HEALTH DEPARTMENT 0 El� �4O� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES �•= \ ' + I8A 2 94 Environmental Health Plan Review- Septic Malfunction tir".....\0.-",,T.-" AUTH_CONST- SEPTIC_MALFUNCTION Owner JARED NIEDERMEYER.2843 W NC 10 HWY.NEWTON NC 28658 H:8289944774 C:828-455-5055 HOME:8289944774 NAME TO APPEAR ON PERMIT Jared Niedermeyer SITE ADDRESS: 2843 W NC 10 HWY.NEWTON NC 28658 PIN # 362909251058 NAME of SUBDIVISION: Lot# Section/Block PROPER'T'Y SIZE: Square Feet 93,654.00 Acres 2.15 DIRECTIONS: 321 Bus,right on Hwy 10 5 miles down,house 100 yards past Robinson Rd on right PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: System failing SITE INFORMATION Do any of the following apply to the properly 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: 61x42 NUMBER OF EXISTING BEDROOMS: 2 tt OF OCCUPANTS: 2 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: ehapplicnion 0427/2018 1648 Page I of7 • CAi\WBA COUNTY Case a EHPR-04-2018-29029 Public Health Department Subdivision < j %t H Environmental Health Division P1184 362909251058 °'a PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 •. NAME ON PERMIT: (JARED NIEDERMEYER).2843 W NC 10 HWY,NEWTON NC 28658 (Jared Niedermeyer) Site Address: 2843 W NC 10 HWY.NEWTON NC 28658 Property Size: Square Feet 93,654.00 Acres 2.15 Directions: 321 Bus,right on Hwy 10 5 miles down,house 100 yards past Robinson Rd on right 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 Thee prop-rty or legal agent of the owner. Date: 0C/l Signature of Applicant or Agent If you need further information or assistance p1, se call 828-466-7291 AREA2 #4#4#44#4#44#44#44444444#444444#444444#4#4#4#444#4####4##44444#44##4444#44444444444#444##444444#4444#4#44444 LFEENANIE DATE 1 FEE EAMo11N'F , Authorization to Construct(Repair) Fee 04/27/2018 S300.00 TOTAL FEES • 5300.00 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) chayplicatiun 04/27/2018 16:48 Page 2 of'7 r� ,,V\j Lp A THIS IS NOT A PERMITL'1 �.� it lb,' couNTY CATAWBA COUNTY HEALTH DEPARTMENT ho:we,:4Application for Environmental Services Application is for: New Construction K Existing Facility Improvement Permit Authorization to Construct New Septic N optic Repair/Malfunction Septic Relocation Septic Expansion Lf Existing System I spection or Reconnection n New Well Replacement Well ❑ Well Abandonment Well Repair cr / 7 'INNSdam Property Address A o Lf S I'Tt�l� . b Subdivision A/ to a!14 rW Lot# Acres Driving Directions to Property 31---1 6✓I 01-vtal 0 r✓ (-1 f.+lS b r✓ /� zj Po LA)w Y � /o o 1� KCS Ps i 71—orifi WJLr+ /Z0 • Applicant Contact Information Name A/' COE2P7 c- Address FEL-A-1'7 /0 Lvezr /I/ Tow, /tic i4LX Phone / / - ( ?? , Cell Phone 7- y5 J —sms-- Owner Contact Information 7' Name Address Phone Cell Phone Contractor Contact Information Name License # Address Phone Cell Phone Name to Appear on Permit? Owner n Applicant ❑ Contractor Who will be the Primary Contact? weer n Applicant LI Contractor Existing Structures on Site? Yes LI No If yes, describe #of Ocrnnanis Structure Dimensions_�o__� $asP+«z o* 1-Yes 7.No L r,u. ,uing YesA No Existing Water Supply? Individual Well H Community Well ❑ County/City/Township Water Line s a public water supply available? ** ❑ Yes n No Well Construction/Abandonment/Repair • Proposed Well Type , Individual Well Lf Semi-Public Well n Community Well Abandonment Type 11 Drilled ❑ Bored ❑ Dug n Unknown Well Repair Requested Yes n No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank? 0 Yes ❑No in A ; ,\ it . THIS IS NOT A PERMIT r'\ it.I �,'/' n • . cout.n CATAWBA COUNTY HEAL Hf DEPARTMENT - ,,,o,n� � Application forEnvironmentaIServices Proposed New Construction -- Residential Primary Residence I I New Residence _ Addition to Residence #of New Bedrooms *I' Project Description Structure Dimensions #of Occupants Basement _Yes ❑ No Basement Plumbing ❑ Yes No Accessory Structure(s)Describe Structure Dimensions Plumbing _ Yes n No Describe Plumbing Needed , , ._, Accessory Dwelling f Yes n No # of New Bedrooms *-i• # of Occupants Proposed New Construction - (CommerciaIl - 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 Jr of> mployees per_Shift #of Shifts 'A If Church #of Seats Commercial Kitchen n Yes n go • If Daycare, # of Children 1' y 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. If the answer to any question is "yes'', applicant must attach supporting documentation. ❑ Yes ikNo Does the site contain any jurisdictional wetlands? -_-,` Yes -go Does the site contain any existing wastewater systems? Yes gNo is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes ANo Is the site subject to approval by any other public agency? ❑ YesIF No Are there any easements or right of ways on this property? Describe If applyi g or 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 construct ion 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(he 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. RETRTP 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 making the site accessible so that a complete site evaluation can be performed. The undersigned is the owner of the n pert)/ore:. ant of me owner. Signature of Owner or Legal Agent_ testi / `j�, n Date Printed Name of Owner or Legal Ag tn _ C _ _ ��/ �Y'_ • • Catawba County Environmental Health / es N �t __ _ _ 0, t N.IJ 0t a5 \A ao Os 0 0 • GA 0 17 33 YPIV V. n) i 41* # .♦ /vsso� ,, o �lli it . 7 -o 114. a A • r Q .,,. 50,0 :. ;. `4 /l -:Jt 4„ .ft a .. ..� riiii•olor N \\....._ M1 _..... •.95 0 ,;„ 9@ fi fip .•t Parcel: 362909251058, 2843 W NC 10 HWY lin=150ft 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 • 04/27/2018 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 362909251058 Owner: NIEDERMEYER JARED H Parcel Address: 2843 W NC 10 HWY Owner2: NIEDERMEYER CATHERINE T City: NEWTON, 28658 Address: 2843 W NC 10 HWY LRK(REID): 2596 Address2: Deed Book/Page: 2119/0530 City: NEWTON Subdivision: State/Zip: NC 28658-8876 Lots/Block: / Last Sale: $94,500 on 1998-12-01 School Information: School District: COUNTY Plat Book/Page: Legal: 2843 W NC 10 HWY Elementary School: STARTOWN Middle School: MAIDEN Calculated Acreage: 2.150 Tax Map: 003 J 02021 High School: MAIDEN Township: JACOBS FORK School Map State Road it: 10 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: NEWTON RURAL Zoningl: R-20 Building(s) Value: $88,600 Zoning2: Land Value: $20,600 Zoning3: Assessed Total Value: $109,200 Zoning Overlay: ED-O Year Built/Remodeled: 1948/1979 Small Area: STARTOWN Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel it: 37103629003 Building Details 2010 Census Block: 1005 WaterShed: 2010 Census Tract: 011702 Voter Precinct: P34 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. No Dem/ --?oknir http://gis.catawbacountvnc.gov/nomap/parcel_reporLphp?key=362909251058&typ=P 4/27/2018 �4"� CATAWBA COUNTY �� IOOA SOUTHV VEST BLVD �' VV NEWTON.NORTH CAROLINA 28658 RECEIPT f.���es�► PHONE:828.465.8399 �C� +f]�'�v�w� `� Friday,April 27,2018 rr �SM vvww.c11taw hacountync.gov PAYOR: Niedermever,Jared PAYMENTS TRANSACTION NUMBER: TRC-3499454-27-04-2018 PAYMENT DATE: 04/27/2018 PAYMENT TYPE: Check 5658 NCDL-29549557 DOB-7/28/46 EXP-7/28/19 INVOICE NUMBER FEE NAME FEE AMOUNT 04-18-352335 Authorization to Construct(Repair) $300.00 Fee TOTAL PAYMENTS: $300.00 EHPR-04-2018-29029 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 2843 W NC 10 HWY,NEWTON NC 28658 Owner JARED NIEDERMBYER,2843 W NC 10 H WY,NEWTON NC 28658 41:8289944774C:828-455-5055 5-5055 "NO PEOPLESOFT ACCOUNT ASSIGNED" receipt 04/272018 16:46 Page 1 of I