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HomeMy WebLinkAboutEHPR-07-2022-41611.TIF THIS IS NOT A PERMIT Case# EHPR-07-2022-41611 CATAWBA COUNTY HEALTH DEPARTMENT L*111 •' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 84 sM Environmental Health Plan Review-Septic Malfunction AUTH CONST- SEPTIC MALFUNCTION Applicant WILLIAM LAZARUS,3553 TEE ST,SHERRILLS FORD NC 28673 C:704-491-1378 BLAZARUS@CHARTER.NET CHARTER.NET NAME TO APPEAR ON PERMIT William Lazarus SITE ADDRESS: 3553 TEE ST,SHERRILLS FORD NC 28673 PIN# 460701078459 NAME of SUBDIVISION: RALPH N DRUM Lot# 6 Section/Block PROPERTY SIZE: Square Feet 20,908.80 Acres 0.48 DIRECTIONS: Hwy 150 E,left Mt Pleasant Rd,left Tee St, PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Tank has collapsed,TANK ONLY IF THERE APPEARS TO BE SPACE MAY WANT TO REVISE TO SEPTIC EXPANSION.ADDITIONAL FEES WILL BE DUE IF REVISE TO EXPANSION. well is located on 3592 Tee St with 6 connections 3579, 3569,3561, 3553,455,and 3559 Tee St 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, bath house with sink,toilet,shower only no living quarters EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 70 x 32 and 4x6 bath house NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION BASEMENT? Yes BASEMENT FIXTURES? Yes 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: •_6a�gih::wu 07/11/2022 11:50 Page 1 of • CATAWBA COUNTY rCase# EHPR-07-2022-4 1 6 1 1 Public Health Department Subdivision RALPH N DRUM Environmental Health Division PIN# 460701078459 • PO Box 389,100-A Southwest Blvd,Newton,NC 28658 SM NAME ON PERMIT: (WILLIAM LAZARUS),3553 TEE ST,SHERRILLS FORD NC 28673 (William Lazarus) Site Address: 3553 TEE ST,SHERRILLS FORD NC 28673 Property Size: Square Feet 20,908.80 Acres 0.48 Directions: Hwy 150 E,left Mt Pleasant Rd,left Tee St, 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: f t I"7 1 �- " \/ �� Signature of Applicant or Agent / / If you need further information or assistance please call 828-46 lc 70 AREA3 FEENAME DATE FEE AMOUNT Authorization to Construct(Repair)Fee 07/11/2022 $150.00 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) • cliapplication 07/11/2022 11:45 Page 2 of 6 catawba county public health Application for Environmental Health Services THIS IS NOT A PERMIT A' 'licatlon is for: 0 New Construction 122 Existing Facility _ XImprovement Permit ► Authorization to Construct :New Septic eptic Repair/Malfunction ❑ Septic Relocation Septic Expansion ❑Existing System Inspection or Reconnection ❑New Well ❑ Replacement Well ❑ Well Abandonment ❑Well Repair Property Address 3 S 6 3 TEE Sir A1.0. a rG 73 Acres . 75-140/Es Subdivision Lot# Driving Directions to Property FQgM AJE'To,l : 8US 3. l RT. ,0. R`I/0 TO RTlG ti .Z R/SD RT /So ro L,rrr.c nOu,.IT ,,.i r's Ta NOWT P4e4cnw7 runt) 7LE S7; Describe work Re PAIR 0,2 RFP&.46.--lr S ePT,c T4 i I(. Applicant Name WILL/Rh LA44QuE Applicant Address 3 SS 3 7 EE sr, ,s-deR ILLS Fa,��, Al C. oZ 8G 7 3 Phone 70`/- 79/ -/3 71' Email 8442-,4Rv s tp C M+QTE2,A/Ei— Owner Name Owner Address 5441 e Xs ,*6Q VE Phone Email Contractor Name Contractor Address Phone Email Name to Appear on Permit? ®Owner D 1pplicant El Contractor Who will be the Primary Contact? ®Owner ❑Applicant ❑Contractor Proposed New Construction-Residential Primary Residence ❑ New Residence ❑ Addition to Residence #of New Bedrooms*t #of Occupants Project Descriptioi Structure Dimensions,also specify dimensions of decks&porches (Choose One) 0 Basement 0 Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes 0 No Retaining Wall>2' ❑ Yes ❑ No Accessory Dwelling #of New Bedrooms*t #of Occupants Structure Dimensions (Choose One) 0 Basement 0 Crawl Space 0 Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes 0 No Retaining Wall>2' ❑ Yes ❑ No Accessory Structure(s)Describe Structure(s)Dimensions Plumbing ❑ Yes ❑No Describe Plumbing Needed (Choose One) 0 Basement 0 Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes ❑ No Retaining Wall>2' 0 Yes ❑ No Multi-Family Residence #of Apartments #Bedrooms per Apartment*t Total#Bedrooms in Structure*t #of Occupants Structure Dimensions (Choose One) 0 Basement 0 Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes 0 No Retaining Wall>2' 0 Yes 0 No Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑Semi-Public Well ❑Community Well Abandonment Type El 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 Envinnmental Health Catawba County Government Center,25 Government Drive I PO. Box 389, Newton, NC 28658 Phone: (828)465-8270 I Fax: (828)465-8276 I EHAdmin@CatawbaCountyNC.gov Existing Structures on Site Describe 5iA/Cc.e fi3-Nt IL 7 (4e w(_1 Structure Dimensions 74?3 IC 3 #of Bedrooms* f' 3 #of Occupants ! 7 V 14-talh `1 O U SC w, 6.1 t D 1 let 4-5110104 s' % / Basement (g(Yes ❑ No Basement Plumbing Yes ❑ No 00 W S Existing Water Supply (1 El Individual Well ® Shared Well—Number of Connections C. ❑Community Well ❑ County/City/Township Water Line Is a public water supply available? ** El Yes ®No W ett located rn 31,f l Si- 5ei es 3C7t ?T 1 Commercial ❑Proposed New Construction ❑ Existing/Change of Use ❑ Repair 3 r L,I, 3. 33 43 5S Food Service Specify Type 4- 3•%9 Tee 5t #Seats Dining Area(Sq. Ft.) #Employees per Shift #of Shifts Church #of Seats Daycare❑Yes ❑No #of Children #of Employees per Shift #of Shifts Commercial Kitchen ❑Yes 0 No Residential Kitchen ❑Yes ❑No Daycare#of Children #of Employees per Shift #of Shifts Business/Other Specify Type Structure Dimensions Retail Floor Space #of Employees per Shift #of Shifts 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. RYes NI No Does the site contain any jurisdictional wetlands? Yes WNo Does the site contain any existing wastewater systems? ❑Yes IN No Is any wastewater going to be generated on the site other than domestic sewage? ❑Yes IS No Is the site subject to approval by any other public agency? 0 Yes Et No 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 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 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) Environmental Health soil/site evaluations require digging,angering,and/or probing into the ground.Property owner/applicant is responsible for marking all underground utilities,including but not limited to:underground power,cable,telephone,gas,water lines,and irrigation systems/sprinkler systems.Catawba County Environmental Health is not responsible for damage to unmarked utilities. 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 the effect ermit conditions or installation re uirements. 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. .45 Signature of Owner or Legal Agent C — Date 7 ` - a 1— Printed Name of Owner or Legal Agent W ffrl L /4 a f(R U 5 Catawba County Environmental Health ii? \ � ;:, ,h' •I" . •3 ' 9 i 7 � �V ti 6 lv NO ,e,/st3t, /.\,, VI' ., 6) ® .s553► Av A 16.31 • .0 cr. k. / ".11 "ie A. •3569 cO �,�^ ' • 0 4::17 57.26 Parcel: 460701078459, 3553 TEE ST 1 in=50ft SHERRILLS FORD, 28673 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 07/11/2022 7/11/22, 10:53 AM Parcel Report Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 460701078459 Owner: LAZARUS WILLIAM R Parcel Address: 3553 TEE ST Owner2: City: SHERRILLS FORD, 28673 Address: 3553 TEE ST LRK(REID): 11843 Address2: Deed Book/Page: 2820/0694 City: SHERRILLS FORD Subdivision: RALPH N DRUM State/Zip: NC 28673-9764 Lots/Block: 6/ School Information: Last Sale: School District: COUNTY Plat Book/Page: 12/7 Elementary School: SHERRILLS FORD Legal: LOT 6 PLAT 12-7 Middle School: MILL CREEK Calculated Acreage: .480 High School: BANDYS Tax Map: 011BX 05012 Township: MOUNTAIN CREEK School Map State Road #: 2266 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoning1: R-30 Building(s) Value: $371,900 Zoning2: Land Value: $117,500 Zoning3: Assessed Total Value: $489,400 Zoning Overlay: CRC-O,WP-O,FPM-O Year Built/Remodeled: 1995/ Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permit Address Search for this parcel. Firm Panel #: 3710460700J If available, Building Permits for this parcel. Septic 2010 Census Block: 3008 links are not permits. 2010 Census Tract: 011501 Septic Final Permits prior to 08/2018, contact Agricultural District: PROXIMITY Environmental Health. Building Details WaterShed: WS-IV Critical Area Voter Precinct: P31/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. gis.catawbacountync.gov/nomap/parcel_report.php?key=460701078459&type=u 1/1 :-3 ��05647 CATAWIBA CDUNTY HEALTH DEPARTMENT s (704) 465-8270 Lot Eval. Improve. Permit Repair Permit (-serf. of Comp. PermitPermit Owner/Agent 1,1t4yll/E re C-/}POu PIEcr /.0 1 Phone Address ? 7.7g 6/V6r„,2 Ofl-A Subdivision .i}/J'/-j .IIL(irl �tP Gr-AfT F V - F-j1) /-/9 . / 34,! Section/Block/Phase Lot#g Lot Size irections: GCP 0 v . frr— Pe Asl941]- G eb it 26)-D .41 LiICvg4- Facility: House Mobile Home Business . 0 er: Z 'ing Approval ,yes/no # Multi-family_- Other . Ta a Bedrooms � Seats Employees . App1 ation ate GPD'F ow Hot Tub or Spa es'special Fixtures . 1001,- Re it Are yes/n REP • ICE: Basement yes' Basement Plumbing yes( ). -REPAIRS MU$P BE WITHIN 3 AYS OR Water Supply: Private Public . DAYS FROM DATE OF PERMIT. Type of System: Trench Bedp Pump/Panel Panel LPP Other Tank Size: Septic Tank A")<1S774) Pump Tank • Nitrification Field: Total Square Feet Depth of Stone �.�-'=-" Bed Size () Trench Width /O-----~Total Length of All Trenches Number of Trenches Individual Trench Length / / / / Feet on Center Maximum Trench Depth Distance of Nearest Well ,5-6 /-4-- Lot Evaluation: A rove yes no (Void After 24 months) '` v***,� Topo % S ope ✓Sk !r� o of Evaluation Site - Sy- em Design - Fina J Textur—/ NVAMIIIIII.v w lam'+ -45 c,P Se_ET;M I/� / Clay , _ _ .S it p�5l� p FO/C ., — ! ' fl 3 a6 Eli QO 4+'4 So �1 �-• Restr-' . Hoz. at - - - - AO Lis I Available-0,ac: yes/n j pNT T<e ix) , Overall Clas S PS U J - AN1 so sick., 1.F rr o4E- 6EWDmr Comments: 2 SY�c'rr PE F tS F,,e,s-T- ct MUVI)K, /4 Mir- ,G lJ€-z p FD4 �bssiR�t i o E EP,gii, 6y,_s/F ' )la�cE 1 Ate pi dN�4c� 'I DPNf/CGS VILL I `nits RAy ci e reA0E(- j f)N.5,-,,at. - Septic Tank Contractors 44,c1L 51 -7-4,9/cC MUST contact the F 6D P. 7D a� 1-ts Ez Sanitarian BEFORE I changing pe Q-. j� rr **NO GU EE 0 WARRANTY IS IMPLIED OR GIVEN THR6'[ i-}� ANCE OF THIS PERMIT** Permit Dat /l ? /¢`7 3 (Improvement Permit void after 60 months) Owner/Agent X �/f� 2 � e � Sanitarian Installed By/// '/YN y D rc c',v4=F Date `f -/3 -5 Sanitarian - (Note any changes/information in red or by sketch on back) IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, IS AN ADDITIONAL $25 CHARGE. White-Office Blue-B1de. Tnsn. Comn. Ye11ow-Owner/Aeent Green-B1de. Tnsn. T.P. , , C Le(4,.xr..J OJT J/, 9 s . iiH . 1-1,,,;. (9-/qc) IN f 1.„..,(....... .,..7` 5.:i!. 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S—. ..,AN.",-1•Ate:Mvi.n•I 54,.R :'..?T 4 4411 '.MAn MPIP.al.!..ir.Lrfr...e....+'.r.w,n M...^'+.w+.re•..w....,w.r........wwr..+rw....w.w.•.......,............w.........,..»..... ,Y-...... -......_�......+.....--..�...�.... _.,..-.v�....,,w. .v.....,-.w —..w.»caavcwa..'.!+F'anrla}�D'.-(e: .,•.iM .•t- ..+?•!Y"tls�f+4a�e•...•...nv...«nwr.n v.•w....w• ...s..,. .ns.w..•...... w ..... �-.......... ._..�.., .»�.... ........,.... ........ ,-.... ...........,...............�..,.....w........v.-,..a.v.... ....w.. n a�....-.nra+w•..rvtvo+t...rf..rvc...t*Y�. �...,.v T i." 4'p' • CATAWBA COUNTY IOOA SOUTHWEST BLVD * 0-3 NEWTON,ONE?828.465 8399H A 28658 RECEIPT PHV 115 O Monday,July 11,2022 18 4 2 sM www.catawbacountync.gov PAYOR: Lazarus,William PAYMENTS TRANSACTION NUMBER: TRC-432 1 1 87 1-1 1-07-2022 PAYMENT DATE: 07/11/2022 PAYMENT TYPE: Credit Card 292279445 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 07-22-408931 1I0-580200-663000 Authorization to Construct(Repair) $150.00 Fee TOTAL PAYMENTS: $150.00 EHPR-07-2022-4 1 6 1 1 CASE TYPE: Environmental I lealth Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 3553 TEE ST,SHERRILLS FORD NC 28673 Applicant WILLIAM LAZARUS,3553 TEE ST,SHERRILLS FORD NC 28673 C:704-491-1378 BLAZARUS@CHARTER.NET **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 07/112022 11:43 Page 1 of 1