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HomeMy WebLinkAboutEHPR-05-2018-29045.TIF �$A THIS IS NOT A PERMIT Case# F.HPR-05-2018-29045 fO II;(:!!" CA'fAWRA COUNTY HEALTH DEPARTMENT vr#�O:If PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES y� I yo as I k Ig. 'L s� Environmental Health Plan Review-Septic Malfunction qV {{. AUTH_CONST- SEPTIC MALFUNCTION r, o� •?!o' . ••.•• -4 - Applicant CAROLYN DOCKEY. 164 GARDNER POINT DR.STONY POINT NC 28618 11004-585-9683 C..828-310-5752 I IOML?04-585-9683 NAME TO APPEAR ON PERMIT Carolyn Dockey SITE ADDRESS: 2680 GLENN ST,NEWTON NC 28658 PIN# 362910351695 NAME of SUBDIVISION: STAR RIDGE SUBDIV Lot 11 Seaton/Block PROPERTY SIZE: square Feet 19,602.00 Acres 045 DIRECTIONS: Hwy 10 W,left Duke St, right on Glenn 4th on right PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well 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 house and storage building EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 58 x39 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 3 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: 05.01,1oix 11n Peuc l m'9 c rA U4A COUNTY25" Case r. EHPR-05-2018-29045 .t,■ Public Health Department Subdlrision STAR RIDGE SUBDIV 2 I.`_� Ti Environmental l'leant)Division PINN 362910351695 w PO Box 389,100-A Southwest Blvd.Neaten.NC 28658 NAME ON PERMIT: (CAROLYN DOCKET). 164 GARDNER POINT DR,STONY PO1N f NC 28678 (Carolyn Dockey) Site Address: 2680 GLENN S'I,NEWTON NC 28658 Property Size: Square Peet 19,602.00 Acres 045 Directions: Hwy 10 W,left Duke St.right on Glenn 4th on right Completed applications are valid for a period ol 2 years Improvement Permits are validwith complete site plan=60 months(5 years),with complete plat =without expiration. An Autbonzation 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 II the information on this applicationlsite plan changes or if the intended use for the proposed facility changes.Permits may be revoked II 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. C/7-7-7Y Signature of Applicant or Agent 0 -' `' cipiet_— Ifyou need further information or assistance please call 82g-466-7291 AREA2 «,,.,,««««,,,,,,,.««.«„«,,,.«.«.«.,,,,,.«.«,,.....,.«,«.,,,.„.«.««,,,...,«.„„,,,.„,««.,«,«,.,.«.«.,.,„ FEENAME DATE FEE AMOUNT Authorization to Construct(Repair) Fee 05/012018 .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) m.., i5,01,2018 1227 Paue 2 ntr CATAWBA THIS IS NOT A PERMIT ` rn My CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services A 'Haitian is for: n New Construction Existin s Facili ❑ Improvement Permit ❑ Authorization to Construct ['New Septic 'Septic Repair/Malfunction ❑ Septic Relocation ❑ Septic Expansion • ❑ Existing System Inspection or Reconnection H New Well (l Replacement Well ❑Well Abandonment ❑Well Repair Property Address 24 c5(J Glen ri 5+' Subdivision _ wPcV to r±C _ 25((a 4 5? Lot # Acres . ri 0 Driving Directions to Property i • _5 • u + tv. • e fjn or+ le- t (.D 10,75+ �hPn ijh r 4a-r• hI� „o. orLrii.,r_L 46th k) to Applicant nContact Information Name ( ilk r i S or C 4 r•] i I r.. Do G k ey Address . i e '• •t t of, . C 2� ' Phone Toy - S-ys— y (pSS3 Cell Phone gag - 3/ o - 5 -7Sa- Owner Contact Information Name 5a nit a 4l pIle4ri Address Phone Cell Phone Contractor Contact Information Name License# Address Phone Cell Phone Name to Appear on Permit? ❑✓ Owner ❑Applicant ❑Contractor Who will be the Primary Contact? J Owner ❑ Applicant ❑Contractor Existing Structures on Site? ,C IlYes ❑ No if yes.describe JU,D€ Cloy 61 JFpf C 1231 . ._. d of Bedrooms * 3 it of Occupants 3 _ Structure Dimensions S v 34 Basement ❑Yes to Basement Plumbing ❑Yes ❑ No C f et pl/I S pq e e, Existing Water Supply? _ii UV lndicidual Well ❑Community Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Ycs ❑No Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well El 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 CATABA THIS IS NOT A PERMIT court VV-� CATAWBA COUNTY HEALTH DEPARTMENT -.,C Application for Environmental Services Proposed New Construction - Residential Primary Residence ❑ Ncw Residence ❑ Addition to Residence #of New Bedrooms *t Project Description Structure Dimensions #of Occupants Basement ❑ Yes ❑ No Basement Plumbing ❑Yes ❑ No Accessory Structure(s)Describe Swcture 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 Shill #of Shifts _ Dining Arca(Sq. Ft.) Business/Other Specify Type Structure Dimensions _ Retail Floor Space _ #of Employees per Shill #of Shifts if Church ft of Seats Commercial Kitchen ❑ Yes ❑No If Daycare.#of Children If Multi-Family Residence,#of Apartments #Bedrooms per Apartment*t Total #Bedrooms st 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 VI question. If the answer to any question is"yes applicant must attach supporting documentation. ❑YesNo Does the site contain any jurisdictional wetlands'? dYes IitNo Docs the site contain any existing wastewater systems? ❑ Yes ®-No Is any wastewater going to be generated on die site other than domestic sewage? ❑Yes fLYSTo Is the site subject to approval by any other public agency? ❑ Yes [4N6 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 0 Alternative ❑Conventional 0 Innovative 0 Other ❑ Any *Any room that will be intended for sleeping at the time of construction or for future consideration should he noted as a bedroom and counted on all applications.The number of bedrooms w ill he confirmed by rooms identified on floor plans as a bedroom at the time of building permit issuance. This may prevent the need fir septic system expansion in the future. t If structure is plumbed hut has no bedrooms_calculated design flow will he determined by El I Stall. if No.a well permit must he issued with the Authorization to Construct. RETRIP TOT THE PROPERTY AND/OR SYSTEM REDESIGN WILL[NOIR 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 Penn it is valid. Permits may he revoked if the information on this application,site plan changes or if the intended use for the proposed facility changes. Permit may he revoked if site conditions are altered such that they effect pennit conditions or installation requirements. I have read this application and certify that the information provided herein is true,complete and conectL Authored county and state otlicials 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 I accessible so that a complete site evaluation can he performed_ The undersigned is the owner of the property or legal agent of the owner. Signature of Owner or Legal Agent � c tie C -n.'_ Date --/-167 g g � D� IK e \ Printed Name of Owner or Legal Agent CO YO Catawba County Environmental Health 02 o0 •2741 $ 1d�� 5 9 ii 00� 4 10 00 ill ‘� i°s 31 4,., 71 S 10000 C �� „+� g V1f1 L \2 N S likla S 01\ 111. 00 100 4_g •2690 Wr VJ p000 *2700 100I. p0 G�0SS Is co 8100 ry O co- ni N 100' 1 Ilk ?e 60 ms\ Parcel: 362910351695, 2680 GLENN ST 1in=50ft 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/repod product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 05/01/2018 Parcel Report Page I of I Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 362910351695 Owner: DOCKEY CHRISTOPHER G Parcel Address: 2680 GLENN ST REVOCABLE LIVING TRUST City: NEWTON, 28658 Owner2: DOCKEY CAROLYN W REVOCABLE LRK(REID): 3868 LIVING TRUST Deed Book/Page: 3439/1823 Address: 164 GARDNER POINT DR Subdivision: STAR RIDGE SUBDIV Address2: Lots/Block: 11/A City: STONY POINT Last Sale: $50,500 on 1987-08-01 State/Zip: NC 28678-9015 Plat Book/Page: 15/63 School Information: Legal: LOT 11 PL 15-63 School District: COUNTY Calculated Acreage: A50 Tax Map: 004AJ 01011 Elementary School: STARTOWN Middle School: MAIDEN Township: JACOBS FORK State Road #: 2081 High School: MAIDEN School Map TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: NEWTON RURAL Zonings: R-20 Building(s)Value: $97,000 Zoning2: Land Value: $11,700 Zoning3: Assessed Total Value: $108,700 Zoning Overlay: ED-O Year Built/Remodeled: 1976/ 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#: 3710362900J Building Details 2010 Census Block: 1006 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. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=362910351695&typ=P 5/1/2018 . � . .. . . / trN. 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