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HomeMy WebLinkAboutEHPR-05-2018-29039.TIF �ti'A Tilts IS NOTA PERMIT Case# EHPR-O5-2018-29039 1:1. .;-' '.:113 Jtri y CAfAWBA COUNTY HEALTH DF.PAIYfMENT � PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICESt1 18. 2 ss Environmental Health Plan Review-OSWP ?n 'I o -,fti i zttia ..., 4. ill c2ii '_� REPLACE WELL O '�f? Owner MICIIAEL HAYWORTI 1, 1842 STONEIIAVFN ST,CONOVER NC 28613 11'82825624I1 0:82885081155 IIOME:8282362411 NAME TO APPEAR ON PERMIT Michael Hayworth SITE ADDRESS: 1842 STONE]IAVEN Si.CONOVER NC 28613 PIN# 314516834167 NAME of SUBDIVISION: GERALD LAIL UNREC Lula PT 11 Section/Block PROPERTY SIZE: Square Peet 27,44280 Acres 063 DIRECTIONS: N NC 1rprings Rd,right Wnebarger St,on right at corner of Stonehaven PRIMARY CONTACT: r Owner SEWER TYPE: Septic Tank GALLONS PER DAY: -. 960- WATER SUPPLY: Privale Well DESCRIBE WORK: REPLACEMENT WELL ONLY 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 CIF ANY) DIM EXISTING STRUCTURE: 82 x52 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types(Improvement Permit or Authonzation to Construct): ACCEPTED: ALTERNATIVE. CONVENTIONAL: OTHER: INNOVATIVE. ANY: Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: YES (I54)`21118 11900 Pagc I oro web. THIS IS NOT A PERMIT Case# EIIPR-05-2018-29039 G r t CA"CAWBA COUNTY I IF,AL'Pl1 DEPARTMENT 1;1. 4.�,0., *0 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ci X 78. 2 aEnvironmental Health Plan Review-OSWP 'rY,' REPLACE_WELL ty 'ou .o' Applicant MICIIAFI.IIAYWORIFI, 1842 SIONCI IAVPN til,CONOVER NC 28613 11.8282562411 C8288508055 HOME:828256241I NAME TO APPEAR ON PERMIT Michael Hayworth SITE ADDRESS: 1842 STONEIIAVEN S"1-,CONOVER NC 28613 PIN# 374518834167 NAME of SUBDIVISION: GERALD LAIL UNREC Iof11 PT 11 Section/Block PROPERTY SIZE: Square Feet 27,442 80 Amos 0.63 DIRECTIONS: N NC 16 Hwy,let Springs Rd,right Wnebarger St,on right at corner of Stonehaven PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: REPLACEMENT WELL ONLY 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 properly? 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: 82 x52 NUMBER OF EXISTING BEDROOMS: 3 #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. APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: YES II ,E.p 06e11..2iir 0951 rain 1ord • 46: CATAWBA COUNTY Case= EHYR-05-2018-29039 r 4Q'I ■2 Public HealthmentDepartment Subdivleien GERALD8 411E UNREC dl/\, 1 PO Box 389,a1 - thDiheist YINg 3]451683416] VO Box 389,100-A Somhwcxl Hlvd Newlon,NC 28658 R4T NAME ON PERMIT: (MICHAEL DAYWORTH), 1842 STONIFIIAVEN S'I.CONOVER NC 28613 (Michael Hayworth) Site Address: 1842 S'IONEHAVEN Sl.CONOVER NC 28613 Property Size: Square Peet 27.442.80 Acres 063 Directions: N NC 16 Hwy,left Springs Rd,fight Winebarger St,on right at corner of Stonehaven 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 he 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, efteC S' (- l ').. signmun ofApplicam nrngem k -('_ 7�(0`v4/6-/-54 If you need further in lomat lin or assistance please toll 828-466-7291 AREA2 ..............................................................t............................................. FEENAME DATE FEE AMOUNT. Well Permit& Inspection Fee 05/01/2018 5300.00 TOTAL FEES - $300.00 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) =6'4nll.aua+ e5014n1 ti ay£I page 2 ata ' . T+ ,vv v. :' , THIS IS NOT A PERMIT COUNTk �, CATAW' A COUNTY HEALTH DEPA ,TMENJL ,1 � * Application for Environmental Services A lication is for: (l New Construction Existing Facility [] Improvement Permit ❑ Authorization to Construct ENew Septic ❑ Septic Repair/Malfunction ❑ Septic Relocation ❑ Septic Expansion ❑Existing System Inspection or Reconnection ❑ New Well t"Replacement Well ❑Well Abandonment Well Repair Property Address / - ((? $7tdn/< //i vL- ry S " Subdivision C v. VeR - -Lot# Acres friving Directions to Property Lgi _ 4 . I Ca\l(0 �s t( `frh O)CQj r� txsf < Ji uzh ��F( c16@J"ry', 5 �—f— ti ye' i- -di. .., .... •I 'I.At( ok`6�ehla�-'- — i — znc,,4;g"-- Applicant G° (Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name (�'),G wae/Address lgl"}z �Y><t J I (' - Phone c i,,— Cell Phone -evx-i‘o , 106- Contractor Contact Information Name License# Address Phone Cell Phone Name to Appear on Permit? [Owner ❑Applicant ❑ Contractor Who will be the Primary Contact? ner ❑Applicant ❑ Contractor Existing Structures on Site? u/Yes ❑ No If yes, describe #of Bedrooms * 3 #of Occupants Structure Dimensions 521C 6-2 Basement ❑Yes I No Basement Plumbing ❑ Yes g 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 X] 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?1 Yes c)No lr�� 4a 9 THIS IS NOT A PERMIT covt�=rr LiV COUNTY HEALTH DEPARTMENT • North ryo„ZO-' 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 ❑ No Basement Plumbing n Yes ❑ No Accessory Structure(s) Describe Structure Dimensions Plumbing ❑Yes ❑No Describe Plumbing Needed Accessory Dwelling n 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*t 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 property in question. If the answer to any question is"yes", applicant must attach supporting documentation. ❑ Yes A No Does the site contain any jurisdictional wetlands? Yes 0 No Does the site contain any existing wastewater systems? ❑ Yes No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes )C No 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 apply ng 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 ❑Innovative ❑ 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 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. 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 ently 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 7'24:4_.,.,! 7� wow- Date 5/ /, Printed Name of Owner or Legal Agent /p? r`C AEG /7tl-t-y‘,./ 6 lT.f!Z Catawba County Environmental Health eft a*II" st..... I ti■ if 100 I c 30 (150) (140) O En c Q ,.‘ i2 I- )Ct L ) tib (t g W z E ihk lith (13s) O 0 0.1 50 EN SToN yg) P O` Parcel: 374516834167, 1842 STONEHAVEN ST lin=50ft CONOVER, 28613 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 05/01/2018 Parcel Report Page I of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 374516834167 Owner: HAYWORTH MICHAEL EUGENE Parcel Address: 1842 STONEHAVEN ST Owner2: HAYWORTH PAMELA C City: CONOVER, 28613 Address: 1842 STONEHAVEN ST LRK(REID): 43128 Address2: Deed Book/Page: 2122/0543 City: CONOVER Subdivision: GERALD LAIL UNREC State/Zip: NC 28613-7768 Lots/Block: PT 11/ School Information: Last Sale: School District: COUNTY Plat Book/Page: Elementary School: OXFORD Legal: LOT PT 11 1842 STONEHAVEN ST Middle School: RIVER BEND Calculated Acreage: M30 High School: BUNKER HILL Tax Map: 0910 01024A School Map Township: CLINES State Road #: 1557 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: OXFORD Zoningl'. R-20 Building(s) Value: $67,600 Zoning2: Land Value: $12,400 Zoning3: Assessed Total Value: $80,000 Zoning Overlay: DWMH-O Year Built/Remodeled: 1987/ Small Area: ST STEPHENS/OXFORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-12-18 Building Permits for this parcel. Firm Panel#: 3710374500K Building Details 2010 Census Block: 1013 WaterShed: 2010 Census Tract: 010201 Voter Precinct: P33 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 mapfrepon 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=374516834167&typ=P 5/1/2018 CATAWBA COUNTY HEALTH DEPARTMENT T11 NEWTON , NORTH CAROLINA pIa COMPLETION PERMIT FOR SEPTIC TANKS PERMIT N! 4221 WIC y� DATE : 7/SAz OWNER I Z45/NWICI ADDRESS BUILDING CONTRACTOR/ SUBDIVISION j LOCATION Au !!�p -4wush W//4i- dm k✓ c $/-R6T 4n- OT( L 4 �� LOT SIZE BLOCK OR SECTION HOUSE ( ) MOBILE HOME (y) BUSINESS .( ) OTHER ( ) FHA-VA LOAN ( ) , .SEPTIC TANK: (SIZE /000 GALS) WATER SUPPLY: NO. BEDROOMS 2- NO FIXTURES / INDIVIDUAL f PUBLIC GARBAGE .DISPEL UNIT :YES (-7-1710 (K) IF WELL, TYPE: BORED DRILLED DUG AUTO WASHING MACHINE : YU (C) NO ( ) DISTANCE FROM SEPTIC TANK OR NEAREST NITRIFICATION FIELD: yapSQ..ET. POLLUTION : _ f FT. 1) NUMBER, OF LINES 3 SEPTIC TAN N T D �YSIi���) 2) LENGTH AND WIDTH OF LINES 2 -aa1.� 2. 550 ERI4IT E -.--CERTIEICATE-SE,, LET .,ABY b) TRENCH SYSTEM ( ) 4•^-sa. 3) DEPTH OF STONE IN LINES (U REMARKS : ADEQUATE FALL (GRADE) OF: 1) BUILDING (HOUSE) SEWER LINE : YES ( C) NO ( ) ` 2) NITRIFICATION LINES : DATE INSTALLED: 7 /S/d_` YES (%) NO ( ) SEPTIC TANK LAYOUT H O P. 6 �lQ MO O 0 1^ a F-I 4)TH DEPARTMENT COPY 1 Y F� _- CATAWBA CTY HEALTH DEPARTMENT // N° qR? r ERMIT FOR SEPTICTANKS 1itDATEDDRESS OF OWNER . PHONE AME. OF CONTRACTOR ADDRESS )CATION oh,, G 4C2 ! # / "-itl� N � '/ • &I rm _ Al itd dy e S , '- /srz me r n V IBDIVISION LOT NO. , - SECTION OR BLOCK )T SIZE FH41 VA LOAN )USE ( ) MOBILE HOME Og BUSINESS ( ) OTHER ( ) SEPTIC TANK LAYOUT ). BEDROOMS ( ) NO. FIXTURES ( ) SRBAGE DISPOSAL UNIT: YES ( ) NO ( ) LUKStNG UNDER BASEMENT FLOOR: YES ( ) NO ( ) • IZE OF TANK /D0?) LIQUID GALLONS ITRIFICATION FIELD:, . 1. Number of lines 3 2. Length and width of lines: ' ' a. Bed System f j. � X J D ft. 11.1 b. Trench system ft. 3. Total Depth of stone /D _inches . � j ROUNDWATER INTERCEPTOR DRAIN: F (IF REQUIRED) ATER SURELY.:__.ERIVATE_QC)-PUBLIG, (_) .-.. ___-..--. ._--- ;JEER NOTIFIED TO CHECK ZONING: YES ( ) NO ( L ( - , J.or r7NER AGREES WITH LAYOUT: YES ( ) NO ( ) - 7�a ------T --) 1 ATER AGREES WITH SPECIAL INSTRUCTIONS: YES ( ) NO (' ) e..-.---> qqO ! �`^� /,��•',',�` ERMIT FEE $ D dNER OR CONTRACTOR SIGNATURE a 5" Bi 0 �_,'��`°,� 0 ERMIT VOID AFTER 36 MONTH bPROVEMENT PERMIT ISSUED B SEPTIC TANK CONTRACTOR. MUST FOLLOW ALL DETAILS OF. THIS PERMIT (LAYOUT) MITARIAN HE TH- DEPARTMENT COPY )IL CLASSIFICATION: SUITABLE ( ) PROVISIONALLY SUITABLE ( ) UNSUITABLE ( ) , LTE FACTORS: . SLOPE (%) - S .- PS - U 7. SOIL PERMEABILITY S - PS = I . SOIL TEXTURE (12-48- IN.) S - PS - U UNDER 60 MIN. - OVER 60 MIN.,. SANDY, LOAMY, CLAYEY 8. OTHER - S PS - . SOIL. STRUCTURE (12-48 IN-.) S - PS - U (SPECIFY) . SOIL DEPTH ('IN.). S - PS U 9'. SOIL SERIES: . RESTRICTIVE HORIZONS (IN.) S - PS - U A. CECIL ( ) J . HIWASSEE ( ) (IMPERVIOUS STRATA, ROCK) - C. MADISON ( ) D. APPLING ( ) . SOIL. DRAINAGE GROUNDWATER S '- PS - U E. PACOLET ( ) .F. FLOOD PLAIN ( ) (EXTERNAL - INTERNAL) . G. ' 2-1 CLAY SOIL H. OTHER-SPECIFY r