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HomeMy WebLinkAboutEHPR-05-2018-29048.TIF y SiN ,, THIS IS NOT A PERMIT Case if EHPR-05-2018-29048 t ® "i CATAWBA COUNTY HEALTH DEPARTMENT 0 i •10 a „� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ' Ig._2 S. Environmental Health Plan Review-Septic Malfunction .'un I f AUTH_CONST- SEPTIC_MALFUNCTION ? o�'L ° • Owner ERNEST BOWMAN.3930 DELLINGER RD,VALE NC 28168-8909 NAME TO APPEAR ON PERMIT ERNEST BOWMAN SITE ADDRESS: 3930 DELLINGER RD. VALE NC 28168 PIN# 268704738811 NAME of SUBDIVISION: IurN Sccnon/Block PROPERTY SIZE: Square Feet 158,122.80 Acres 3.63 DIRECTIONS: Hwy 10 to Smith Rd,right on Dellinger Rd,last house on left PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: Tank Only-Tank collapsed 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: 44x41 NUMBER OF EXISTING BEDROOMS: 2 #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. Other described: .:bnVl`Iv.ouu„ 05.02,2018 09 53 Page 1 ut Q: CATAWBA coIINIV Case EHPR-05-2018-29048 U,y Public I Iealth Department Subdivision CcG t , M Environmental Health Division PIN 268]04]38811 PO Box 389.100-A Southwest BI'J.Newton,NC 28658 NAME ON PERMIT: ( ERNEST BOWMAN).3930 DELLINGER RD,VALE NC 28168-8909 (ERNEST BOWMAN) Site Address: 3930 DELLINGER RD,VALE NC 28168 Property Size: Square Peet 158,122.80 Acres 3.63 Directions: Hwy 10 to Smith Rd,right on Dellinger Rd,last house 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 Authonzation to Construct will remain valid as long as the Improvement Permit is valid.An Authorization to Construct issuedfor septic repair is valid for 60 months(5 years).Permits may be revoked if the information on this application/site plan changes or it 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. //�� Date: 5 — 2- - /8 Signature of Applicant or Agent EA .wYt C CI6C5Az✓vA„, If you need further information or ass'umnce please call 828-466-7291 AREA2 FEENAME DATE FEE.AMOUNT_. Authorization to Construct(Repair)Fee 05/02/2018 6150.00 TOTAL FEES $150.00 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) Alpo yaw), 09152,2201 e 0915 prise 2 on THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH IDEA Tl MENTI Nor Application for Environmental Services —._...� C�roltn A y lication is for: New Construction Existin �'acili ❑Improvement Permit ❑ Authorization to Construct ['New Septic WSeptic Repair/Malfunction ❑ Septic Relocation ❑ Septic Expansion ❑Existing System Inspection or Reconnection ❑New Well ❑Replacement Well n Well Abandonment ❑Well Repair Property Address 3 613b `DEt.411/1 (0417 Subdivision vats, t1/'6, 'L 8/Ce— Ret 09 Lot# Acres Driving Directions to Property 14 W ' lb -re 5 m /7 ' ° P P16r`- b nt cLL- ZX red Pia 1 ST /f6Uf V ti 2 ± '` T Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name '11U r `96 w e1-7144, Address 3cf 30 V ie. L/ 6 4 6>q VW LIS 11/4r 'Z4) ?G Phone ce7 �q_ 2C� / 7 I Cell Phone Contractor Contact Information Name License# Address Phone Cell Phone Name to Appear on Permit? A Owner ❑Applicant ❑ Contractor Who will be the Primary Contact? [Owner ❑Applicant ❑ Contractor Existing Structures on Site? [ Yes ❑ No If yes, describe #of Bedrooms * �. #of Occupants Structure Dimensions `'1 ,\,t4( Basement q4Yes El Basement Plumbing ( f{Yes ❑ No Existing Water Supply? 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 Head to Pressure Tank? ❑ Yes ❑No 9A 'T1';. JJ71. THIS IS NOT A PERMIT COUNTY CATAW(:;A COUNTY HEALTH DEPARTMENT T S,onh—Cor Application for Environmental Services Proposed New Construction - Residential Primary Residence ❑ New Residence ❑ Addition to Residence #of New Bedrooms *1. Project Description Structure Dimensions # of Occupants Basement ❑Yes .❑ No Basement Plumbing ❑ Yes ❑ No Accessory Structure(s)Describe Structure Dimensions Plumbing ❑Yes ❑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 Seats Commercial Kitchen ❑ 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 j (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 propertyin question. If the answer to any question is"yes", applicant must attach supporting documentation. ❑ Yes l Nti Does the site contain any jurisdictional wetlands? 01 Yes 0 No Does the site contain any existing wastewater systems? 0 Yes if No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes lfl No Is the site subject to approval by any other public agency? Yes h No Are there any easements or right of ways on this property? Describe. _ - If applyi g for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) ❑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 confined 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 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 property or legal agent of the owner. Signature of Owner or Legal Agent ." _ Date 7 — - •–3 e Printed Name of Owner or Legal Agent A.41-.IL/ r i, '13 W /c9„ Catawba County Environmental Health \\\N? J /// EZ2 / /fr kr,./7/ 0,P ((i i ' \.:\\ -- \EL"' ///./A �_/ P 'c> v\ v �� \ k\ \ ' \\ 7 . t ' ��/, \ \\ \,/ a32yfr Lf 'i 73(rt ----------111/ t78) /� /!,",t; / z )a) 4R )pyo f -`, �/ � V — ,/, rru�g 45 ,�, ' / NN 401)3 / • CI? / 1.95 %: / >0:41/ , :U / 7... -- -",,❑ 1°. 45 \ II f / // i i . 1 ^ 073) 1 pyo 95 /pf �i a;e ' , / IF—ipr co ' / 1 ( `D -' ' /' 45 / / // / /,' ok r'` \NS 1i Parcel: 268704738811, 3930 DELLINGER RD 1in=150ft 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 liabilitywhether 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 05/02/2018 Parcel Report Page of I Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 268704738811 Owner: BOWMAN ERNEST LORENZO Parcel Address: 3930 DELLINGER RD Owner2: BOWMAN BRONNIE SMITH City: VALE, 28168 Address: 3930 DELLINGER RD LRK(REID): 13771 Address2: Deed Book/Page: 0442/0359 City: VALE Subdivision: State/Zip: NC 28168-8909 Lots/Block: / School Information: Last Sale: School District: COUNTY Plat Book/Page Legal: Elementary School: BANOAK Middle School: JACOBS FORK Calculated Acreage: 3.630 High School: FRED T FOARD Tax Map: 013 B 05035 School Map Township: BANDYS State Road#: 2060 TaxNalue 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: $60,400 Zoning2: Land Value: $18,800 Zoning3: Assessed Total Value: $79,200 Zoning Overlay: DWMH-O Year Built/Remodeled: 1953/ 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: 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=268704738811&typ=P 5/2/2018 ***Op. Permit aid/or Cert. Op. Required_ (Must be completed prior to final) - / Q 0 7 A q 1• CATA WSA CZ1'J-N TY HEALTH DEPA,R TMENT, r (704) 465-8270 Lot Eval._Improve. Permit Repair Permit )( Cert. of Comp. Permit V Oper. Permit Owner/Agent k/ S ¶ iSaWMA,J Phone u6 2_ 'I9 S A Address 3`/30 •D &Lc- I".IC-,G2 —O. Subdivision VPrLC /QC_ Z8'I/o( Section/Block/Phase Lot# Lo(�,S�ize D' tions: lO w GS--C r . 2d 2 oD _I+,m 5 �/ SMlilrr 2D/ Q)4 `7(rC( ISI ) :Z ,eut/ccS ^n woocc ch..( di-_ --di-_ ---7-€F Facility: House N Mobile Home_ Business_ . Other: Tax'Map II Multi-family Other . Zoning Approval P Bedrooms p� Seats Employees . Application Rate GPD Flow Hot Tub or Spa yes/no Special Fixtures . 100% Repair Area yes/no REPAIR NOTICE: Basement yes/no Basement Plumbing yes/no . REPAIRS MUST BE WITHIN 30 DAYS OR Water Supply: Private Public_ . DAYS FROM DATE OF PERMIT. Type of System: Trench Bed 7 Pump Pump/Panel Panel LPP Other Tank Size: Septic Tank F*-r s i/"`C` Pump Tank i Nitrification Field: Total Square Feet (,OZ) Depth of Stone (2 Bed Size 101-60 Trench Width Total Length of All Trenches Number of Trenches Individual Trench Length / / / / Feet on Center Maximum Trench Depth Distance of Nearest Well Lot Evaluation: Approved yes/no (Void After 24 months) ******* **** ***************************************************************************** Topo % Sl..e Sketch of lot Evaluation Site - System Design - Final Text DO NOT -- INSTALL S _- . - WHEN WET Clay in. -- So Wet.-ss — " < E-4_:- 11-1G-k-< (U) 7 ' all D- *th — " "esti' . nz. - _" Ava' abl: spa.- yes/no Ovral Cla S PS U Comme• s: j NS i(aLL NeW G 1 ,/to d HooS iGG/ -5 rTG0t.D -r" . 't RR+6 a Septic Tank Contractors I MUST contact the ) — Sanitarian BEFORE changing permit. ) ( '^_ **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN THROUGH THE ISSUANCE OF THIS*•ERMIT** Permit Date g(/ZV/ �D9' � " (Improvemen •e i�. //Am 60 months) Owner/Agent g�^r I l .n-w. — Sanitarian /a.gl'%�,��� I_S' Installed By /•' - vy42LSY (FA-Mc-Ste /0/0 1 sanitaria a%'��Y_ . (Note any changes/information in red or by sketc on'bac)) IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO T .PROPERTY, THERE******** IS AN ADDITIONAL $25 CHARGE. White-Office Blue-Bldg Insp.Comp. Yellow-Owner/Agent Green.Bldg.Imp.I.P. v -'CATAWBA COUNTY HEALTH DEPARTMENIVCOfO WLS# o a ai y o/ IP AC Rpr. Prmt. Opr. Pant. Sys.Type Well Prmt. Replacement WelICV Well Rpr. Prmt. Oent s�� grA gyre-v\ _Phone Addressddress 391 Wortizi. Subdivision Section/t lock/PhoW Lot Size Dir1riyns: - J_" , T . n ! r _ i F � _ tt. Property Address •y • —sr, Facility:House (/Mobile Home Business Multi-family . Other: Pin Number ,z6, 7-0 Li'73/ -- • I Other . Zoning Approval it k Bedrooms P� It Seats # Employees . Application Rate GPD Flow Hot Tub or SVC-yes/no Special Fixtures __ Basement yes/no . 100% Repair Area yes/no Basement Plumbing yes/no W ter Supply: Private Well //Pablic Semi-Publi _ ii*H+iriHiiri*i•i*i++4i4+++*+i4f++*r4+p4+ rv4 ++4+iq*+iH H44iq++++*+i+i4i*******+ *** 4 4irrr**+*Hii+***** Typem of System: Trench Bed Pum mp/Panel anel LPP Other r Septic Tank Size __[/� ze N' (kali n FAL Ina Sr .re ' Depth of Stone Bed Size nc -- llI Wid ir otal Length f i -riches Number of Trenches Trench Length 1 / /_/ / Feet on Center Maximum Trench Depth Distance of Nearest Well *DO OT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* rr ****************4*44*4***+***44*4*4**4*r*4*4**4***4*4*4***4********44*r*4********4***4*44*44**********r******4**r***4* Too % 'lope ?r 'reMi . M.Wetne• _" 37epic.- o . at / Availade pace y6/0no Overall lass S 'S U Comments: / - - • b � t ^ ' EiLv � V� iso Filter Required Riser required when 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** ilii**444*lir***4*4*4*ri*4**r*44+*44*4**44r********4*4***4*4****4i**4*4*4*****4*ii*i**44*4*44*i***irr*ri***r**4**4r4**4***4 *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 v site by(/hHealth Department. Pernik Date ./ I ) EHS 471.44....C—C.7 01-45/1-72—e7 /f' Owner/AgeniN f2,,,,,_4.mE 'e, es,-0-41.-777)76, Septic Tank Installed By Date EHS Well Installed By 4742-W Well Grout Approval Datep_1 zo Well Head Approval Date/a—_( 7-4 Date Sample Collected d" /�/�7 Date of Results Results EHS 6� ln� l'/t'Ced- —0.--e -- White-Office Yellow-Owner/Agent Pink-Building Inspection Authorization to Construct