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HomeMy WebLinkAboutEHPR-06-2022-41460.TIF $A �G THIS IS NOT A PERMIT Case# EHPR-06-2022-4 1460 CATAWBA COUNTY HEALTH DEPARTMENT rt 0 4C PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES \842 su Environmental Health Plan Review-Septic Malfunction AUTH CONST- SEPTIC MALFUNCTION Applicant *FOOTHILLS SEPTIC&GRADING LLC (BRANDON JANYSSEK),2819 SIGMON DAIRY RD, NEWTON NC 28658 C:8283085994 FOOTHILLSSEPTICGRADING gGMAIL.COM Owner REBECCA SMITH,3332 47TH AVE PL NE,HICKORY NC 28601-9713 C:8285140680 NAME TO APPEAR ON PERMIT Rebecca Smith SITE ADDRESS: 3332 47TH AVE PI,NE,I IICKORY NC 28601 PIN # 372520929114 NAME of SUBDIVISION: CATAWBA FOREST Lot#_ 80 Section/Block PROPERTY SIZE: Square Feet 30,056.40 Acres 0.69 DIRECTIONS: Springs Rd,Sulphur Sprins Rd NE,left 47th Ave PI NE,on left PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: collapsed pump tank 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: 52x 42 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: PROPOSED CONSTRUCTION BASEMENT? Yes BASEMENT FIXTURES? No PLUMBING REQUIRED? EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES: SEATING CAPACITY: TOTAL FLOOR SPACE(SQ FT): Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: tLn;phi:nn; 06/23/2022 13:10 Page 1 of6 „• CATAWBA COUNTY Case# EHPR-06-2022-41460 .t.li Public Health Department Subdivision CATAVVBA FOREST 4 '-4 Environmental Health Division ”t , PIN# 372520929114 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 NAME ON PERMIT: (REBECCA SMITI I),3332 47TH AVE PL NE,I IICKORY NC 28601-9713 ( Rebecca Smith) Site Address: 3332 47TH AVE PL NE,HICKORY NC 28601 Property Size: Square Feet 30,056.40 Acres 0.69 Directions: Springs Rd,Sulphur Sprins Rd NE,left 47th Ave PI NE,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 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: Signature of Applicant or Agent If you need further information or assistance please call 828-465-8270 AREA2 ******************************************************************************$***************************** FEENAME DATE FEE AMOUNT Authorization to Construct(Repair) Fee 06/23/2022 S150.00 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) ek ,pli :ni„n 06/23/2022 13:05 Page 2 of6 i !` '11-ff ' ':' 7 7 . ' V .\-v^ {!- puoli.c health , VI K&O Application for Environmental Health Services ; f)Sb THIS IS NOT A PERMIT i Application is for: ❑New Construction ❑Existing Faci]. ❑Improvement Permit ❑Aytltorization to Construct ❑New Septic }.Septic Repair/Malfunction 0 Septic Relocation ' ❑Septic Expa tan ❑Existing System Inspection or Reconnection ❑New Well ❑ Replacement Well ❑Well Abandonment 0 Well Repair Property Address '.� '� 2. ( l a' ✓ f g J L C L. IV tr 1 f.•. c.!{�r-7 Acres . Subdivision Driving Directions to Property Lot# 11 A licant Contact Information jZ Name �.in 19 cill :\:^'1 1 H.',Address , 7 /f x )7L /liC-- Phone I Cell Phone I Owner Contact Information Name Address ;I Phone I Cell Phone Contractor Contact formation Name •'u, a �-► ,• ,' �t r lt! u:�l�,� )i S { Address 7 f :, ':,�(•/ ; 11 J Phone S- z-a_ `10S r J t�, I Cell Phone I Name to Appear on Permit?: caner ❑Applicant D Contractor Who will be the Primary Contact?❑ Owner ❑Applicant ❑Contractor Existi5g Structures on Site?j I I es ❑ No If yes,describe #of Bedroo * 1 #of Occupants S ture Dimensions SLR l Basement Yes ❑ No Basement Plumbing 0 Yes• No p i r Existing Water Supply? �r t'A "n ❑ Individual Well 0 Community Well [County/City/Township Water Line Is a public water supply available?*• ❑ Yes ❑No Well Construction/Abandon{neat/Repair f Proposed Well Type YP ❑ Individual Well ❑ Semi-Public Well ❑Community Well I Abandonment Type ❑ Drilled ❑ Bored 0 Dug❑ Unknown Well Repair Requested ❑Yes ❑No Describe • Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank?❑Vies ❑No Eliviromreaiol HeuuOil8 Cotowbo County Government Center 25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8276 1 Proposed New Construction-Residential Primary Residence ❑ Ilew Residence ❑ Addition to Residence #of New Bedrooms'Ct Project Description Structure Dimensions #of Occupants Basement ❑Yes ❑ No Basement Plumbing ❑Yes ❑ No Accessory Structure(s)Describe Structure Dimensions Plumbing ❑Yes [I]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 Arca(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#Bedrlooms*t Other Information Calculated Design Flow,Conunercial 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 folloi ing apply to the property in question. If a answer to any question is`yes",applicant must attach supporting documentation. ❑Yes Does the site contain any jurisdictional wetlands? ❑Yes Does the site contain any existing wastewater systems? ❑Yes Is any wastewater going to be generated on the site other than domestic sewage? ❑Yes Is the site subject to approval by any other public agency? ❑Yes Cleo 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 Systei Type(s): (systems can be ranked in order of your preference) l - ccepted 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 tie 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 butjhas 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 HARGE (SEE FEE SCIEDULEI 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 f the information on this application/site plan changes or if the intended use for the proposed facility changes.Permits may be revoke 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 appli able laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines an is corners and making the site accessible so that a complete:site evaluation can be performed. The undersigned is the owner of the property fir,legal agent of the v er. Signature of Owner or Legal Agent ��` �� Date �1 Printed Name of Owner or Legal Agent fir, �r�, 1 S el( i li 1 r •�, T �_ Catawba County Environmental Health 79,46 67.52 48.9 411 AVE,pL,NE •3312 (120) 1- 100 r 120.00 f! •3322 • F •3332 •33421 ti • ui o> 145,41 79 145.35 200,00 113.86 120.00 86.12 73.85 rn N 225.59 99.21 •4725 �__----" r.-- •4722 Parcel: 372520929114, 3332 47TH AVE PL NE 1 in=50ft 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 2021 Catawba County NC 06/23/2022 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 372520929114 Owner: SMITH REBECCA ANN Parcel Address: 3332 47TH AVE PL NE Owner2: City: HICKORY, 28601 Address: 3332 47TH AVENUE PL NE LRK(REID): 37147 Address2: Deed Book/Page: 2289/1425 City: HICKORY Subdivision: CATAWBA FOREST State/Zip: NC 28601-9713 Lots/Block: 80/ School Information: Last Sale: $90,000 on 1997-01-01 Plat Book/Page: 16/261 School District: COUNTY Legal: LOT 80 80 PL16-261 CAT FOREST PL 16- Elementary School: SNOW CREEK Middle School: ARNDT 261 Calculated Acreage: .690 High School: ST STEPHENS Tax Map: 0701 02017 School Map Township: CLINES State Road #: TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: ST STEPHENS Zoningl: R-20 Building(s) Value: $124,100 Zoning2: Land Value: $15,600 Zoning3: Assessed Total Value: $139,700 Zoning Overlay: Year Built/Remodeled: 1979/ Small Area: ST STEPHENS/OXFORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-12-18 Building Permit Address Search for this parcel. Firm Panel #: 3710372500K If available, Building Permits for this parcel. Septic 2010 Census Block: 1022 links are not permits. 2010 Census Tract: 010301 Septic Final Permits prior to 08/2018, contact Agricultural District: Environmental Health. Building Details WaterShed: Voter Precinct: P29/ Voting Map 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. ©2022, Catawba County Government, North Carolina.All rights reserved. • ., CAI AWBA COUNTY El t o R, ■n Case u OP-05 2018-099279 • I4,,",53,_ll Public Health Department s Subdivisiou CATAWBA FOREST • �EE.), { Environmental Health Division I••1,...a4!:17.6% YINH372520929114 I'0 Oox 384,100-A Southwest[3hd,Nev�7on,NC 28G58 Tvs. : `�r� LOTH 80 oJka4 NAME ON PERMIT: REBECCA SMITH, 3332 47TH AVE PL NE, HICKORY NC 28601-9713 Site Address: 3332 47TH AVE PL NE, HICKORY NC 28601 Property Size: Square Feet:29,620.80 Acres:0.68 Directions: SPRING RD TO SULPHER SPRINGS RD,TURN LEFT ON TO SULPHER SPRINGS RD, GO 1.9 MI TURN LEFT ON TO 47TH AV PL,4TH HOUSE ON LEFT Catawba County Health Department Operation Permit System Type: IIIB-SYSTEM W/SINGLE EFFLUENT PUMP (In accordance with Table Va) • Description: 25%REDUCTION System Code: IQ4PS System Code Description: Infiltrator Quick 4 Plus Standard Types V and VI systems expire in 5 years. Owner must contact health department 6 months prior to expiration for permit renewal. System Installation Comments: PERMIT CONDITIONS: 1.All maintenance,monitoring,and performance requirements shall be in accordance with 15A NCAC 18.1900, Rule .1961 2. Operation&Maintenance Specifics: Subsurface system operator required? Yes NoX, If yes, see attached sheet for additional operation conditions, maintenance and reporting. This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal,and All conditions of the Improvement Permit and Construction Authorization. Buck Smith 3476 05/09/2018 SYSTEM INSTALLER INSTALLATION DATE 05/09/2018 AUTHORIZED STATE AGENT DATE OF OPERATION PERMIT ISSUANCE Form I' dyer+pi i 05,09/2619 09:33 Page 1 of I S 7� M / Catawba County Environmental Health ALIT4-05-)011-1, 71+r,A c --_,0 5#‘119 55.95 OP— O5aO ) 4.._.__ ..98 T9.46 oq9 f ql 67. 48.9 / 4 a fk / / (120) / / 100 / / / 120 �y / 'I / luf- .:7 / p) ti tiJ en L-iPra — ecil 145.4; 0 79 145.35 86 88 12 120 ;'. rJ ? ,. it �.r 7 t :t 1 rr i' f'" f'7 rrt r » •� 'St :? en 48.27 5.59 $NUJ t,_ 99.21 .r,J'. .4 R T1i}7 ti;',k 1' \ rs7 `-.? 52.36 30 11 Parcel: 372520929114, 3332 47TH AVE PL NE 1in=60ft HICKORY, 28601 This map/report product was prepared from the Catawba County,NC Geospatlal 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 d personnel,disaim,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 05/09/2018 g'A CATAWBA COUNTY T�� 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT PHONE:828.465.8399 \ / Thursday,June 23,2022 \Ig 4'L/ SM www.catawbacountync.gov PAYOR: *Foothills Septic&Grading LLC *Foothills Septic&Grading LLC(Janyssek,Brandon) PAYMENTS TRANSACTION NUMBER: TRC-42170569-23-06-2022 PAYMENT DATE: 06/23/2022 PAYMENT TYPE: Credit Card 291576422 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 06-22-408326 110-580200-663000 Authorization to Construct(Repair) S150.00 Fee TOTAL PAYMENTS: $150.00 EH PR-06-2022-41460 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 3332 47TH AVE PL NE,HICKORY NC 28601 Applicant *FOOTHILLS SEPTIC&GRADING LLC,2819 SIGMON DAIRY RD,NEWTON NC 28658 C:8283085994 FOOTHILL SSEPTICGRADING@GMAIL.COM **NO PEOPLESOFT ACCOUNT ASSIGNED** Owner REBECCA SMITII,3332 47T11 AVE PL NE, HICKORY NC 28601-9713 C:8285140680 receipt 06/23/2022 13:05 Page 1 of I