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HomeMy WebLinkAboutEHPR-08-2022-42091.tif $ �G THIS IS NOT A PERMIT Case# EHPR-08-2022-42091 CATAWBA COUNTY HEALTH DEPARTMENT 0 7 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES \842 SM Environmental Health Plan Review-Septic Malfunction AUTH CONST- SEPTIC MALFUNCTION Applicant MARK DOLPHENS SR,2802 ROSEWOOD LN,NEWTON NC 28658 C:828-514-9924 OTHER:828-514-9975 NAME TO APPEAR ON PERMIT Mark Dolphens Sr SITE ADDRESS: 2802 ROSEWOOD LN,NEWTON NC 28658 PIN# 372017220281 NAME of SUBDIVISION: Loth 3 Section/Block PROPERTY SIZE: Square Feet 35,283.60 Acres 0.81 DIRECTIONS: Startown Rd,Sandy Ford Rd,left Chestnut Dr,right Rosewood Ln,on right PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: Tank only replacement, cracked 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 DESCRIPTION OF 53 x 49 residence, 25x25 attached garage, 30 x 40 detached garage EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: 4 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION BASEMENT? No 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: c6an�li ;dnu 08/26/2022 16:58 Page 1 of6 R' g. CATAWBA COUNTY Case# EHPR-08-2022-42091 • .t. �2 Public Health Department �., Subdivision Q Environmental Health Division PIN# 372017220281 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 NAME ON PERMIT: (MARK DOLPHENS SR),2802 ROSEWOOD LN,NEWTON NC 28658 ( Mark Dolphens Sr) Site Address: 2802 ROSEWOOD LN,NEWTON NC 28658 Property Size: Square Feet 35,283.60 Acres 0.81 Directions: Startown Rd,Sandy Ford Rd,left Chestnut Dr,right Rosewood Ln,on right 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 AREA1 FEENAME DATE FEE AMOUNT Authorization to Construct(Repair) Fee 08/26/2022 $150.00 TOTAL FEES S150.00 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) �Iapplic:ai•:: 08/26/2022 16:58 Page 2 of6 dotloop signature verification: catawba county pualic health Application for Environmental Health Services gjL' i I THIS IS NOT A PERMIT 4 1 Application is for: ❑New Construction ❑ Existing Facility ❑ Improvement Permit ❑ Authorization to Construct ['New Septic ® Septic Repair/Malfunction ❑ Septic Relocation ❑ Septic Expansion ❑ Existing System Inspection or Reconnection ❑ New Well ❑ Replacement Well ❑Well Abandonment ❑Well Repair Property Address 2802 Rosewood Ln, Newton NC 28658 Acres .81 Subdivision Rosewood Subdivision Plat 15/ 131 Lot# Driving Directions to Property Highway 321 traveling south from Hickory, take exit 41 - River Rd. Turn left onto River Rd. At stop sign, turn left onto Sandy Ford Rd. Turn right onto Chestnut Dr. Turn right onto Rosewood. Home is on the right. Describe work Replace cracked tank only. Applicant Name Mark A. Dolphens, Sr. CALL 828-514-9924 or 828-514-9975 for application payment. Applicant Address 2802 Rosewood Ln, Newton NC 28658 Phone 828-514-9924 or 828-514-9975 Email mdolphenssr@yahoo.com Owner Name Mark A. Dolphens, Sr. Owner Address 2802 Rosewood Ln, Newton NC 28658 Phone 828-514-9924 or 828-514-9975 Email mdolphenssr@yahoo.com Contractor Name K&M Grading, Kevin Bowles License#1697 Contractor Address 284 Old Vashti Rd, Taylorsville NC 28681 Phone 828-234-3758 Email kevmik429@gmail.com Name to Appear on Permit? ❑Owner ®Applicant ❑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 Description Structure Dimensions,also specify dimensions of decks&porches (Choose One) ❑Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' ❑ Yes ❑ No Accessory Dwelling #of New Bedrooms*t #of Occupants Structure Dimensions (Choose One) ❑Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes 0 No Retaining Wall>2' ❑ Yes ❑ No Accessory Structure(s)Describe Structure(s)Dimensions Plumbing ❑Yes ❑No Describe Plumbing Needed (Choose One) ❑ Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes 0 No Retaining Wall>2' ❑ Yes ❑ No Multi-Family Residence #of Apartments #Bedrooms per Apartment*t Total#Bedrooms in Structure*t #of Occupants Structure Dimensions (Choose One) ❑ Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' ❑ 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 Environmental 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 dotloop signature verification: Existing Structures on Site Describe 1.5 Story House with attached 2 car garage and detached garage Structure Dimensions House: 53' X 49' 4 Attached garage: * #of Bedrooms #of Occupants 2 25' X 25' Basement [' Yes IN No Basement Plumbing ❑Yes ® No Detached garage: 30' x 40' Existing Water Supply ® Individual Well ❑ Shared Well—Number of Connections ❑Community Well ❑County/City/Township Water Line Is a public water supply available? ** ❑ Yes ©No Commercial ❑ Proposed New Construction ❑ Existing/Change of Use ❑ Repair Food Service Specify Type #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 ❑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. ❑Yes ®No Does the site contain any jurisdictional wetlands? ®Yes 0 No Does the site contain any existing wastewater systems? Permit#7387 attached. ❑Yes ll No Is any wastewater going to be generated on the site other than domestic sewage? ❑Yes 6c1 No Is the site subject to approval by any other public agency? ❑Yes F7 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) 0 Accepted ❑Alternative 0 Conventional ❑ Innovative ®Other Replace cracked tank❑ 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,augering,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 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. dotloop verified ��Ee .oc4: t 08/26/22 9:24 AM CDT Signature of Owner or Legal Agent GCQL-PVLH-VI9Z-LAND — Date 08/25/2022 Printed Name of Owner or Legal Agent Mark A. Dolphens, Sr. Y C ra I-- u 185.00 a. ar V1 ar Y u ea -D > v v a, _c m 3 U U ro a) 1 cu o L9 o a, re a 1 i i u h a, In 12 fI g ppO t12 -a N 0 O O u o0 vi ! JH O 3 ar I' ! I I I 11l O — I CU O 184.85 CC N i 0 00 N ba C .0 Y Y o Q ro •X N I— W //;v0 . **;Op. Permit and/Or Cert. Op. Required (Must be completed prior to final) C A T A W I3 A COUNTY HEALTH DE P A R T M E N T - diL (704) 465-8270 Lot Eval. N Impr ve. Permit Repair Permit Cert. of Comp. Permit xOper. Permit Owner/Agent 2:( Y d C(c) 145 Phone 091"- -23 6 Address 2 SOe 2(156.&JOOA CA) Subdivision /ZdScwOvd New f-Tr.., Section/Block/Phase Lot# . . Lot Size r V ,ate Directions: ,5/b7-14hI /vV-Q /Z/ J477P1►t 5171,-1 •..ti 0 Ckes•4'Ja.. 3 re IC C1q-, 12/Z4 -T P4 - rL Oetrev—e r0 � i iZ Ze t,.JOo,O G'J Facility: House N Mobile Home Business . Other: Tax'Hap # 1f1fYV -/ -KS Multi-family Other . Zoning Approval # e-9/O Z 3 O Bedrooms S Seats Employees . Application Rate . 11 GPD Flow �� Hot Tub or pa e Special Fixtures . 100% Repair Area yes/no REPAIR NOTICE: Basement yes/f:% Basement Plumbing yes/no . REPAIRS MUST BE WITHIN 30 DAYS OR Water Supply: Private )C Public . DAYS FROM DATE OF PERMIT. **********************************************************************************,******** Type of System: Trench )( Bed Pump Pump/Panel Panel LPP Other Tank Size: Septic Tank /COO1 5,1-1 Pump Tank Nitrification Field: Total Square Feet /2-C O Depth of Stone / 2 Bed Size Trench Width c 6 Total Length of All Trenches I/427 Number of Trenches y Individual Trench Length/Q.)//QD/bOO//aO/ Feet on Center` Maximum Trench Depth 2 7 Distance of Nearest Well Lot Evaluation: Approve4Plo (Void After 24 months) Topo % Slope Sketch of lot Evaluation Site - System Design - Final Texture i, 6 DO NOT V INSTALL StActure C ��I HEN WET ca 111Wr, C1:1 '1 . Ali ,'S. 1 Dep.etra\r �►1 R-4:tric. 1 at Availableispace yes/no Overall Class S PS U . Comments: IP �� p,. \V rtu -- Septic Tank Contractors RUST contact the 1 /1 d Sanitarian BEFORE 1 changing permit. 1 /lo,.,E(4).610;0 -'PL ' - **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN THROUGH THE ISSUANCE OF THIS PERMIT** ***************************** ********************************************** "************** Permit Date 9-7%-9 nn __ � (Improveme ermit o'd • ter 60 ',•nths) Owner/Agent J r, �• vl`t" ► Sanitarian / 1/ Installed By nrr - r Date yl-3��s San tari ? / .rr�v�. /07 (No e any changes/information in red or by sketch on b ck) (l IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE IS AN ADDITIONAL $25 CHARGE. White-Office Blue-Bldg Insp.Comp. Yellow-Owner/Agent Green-Bldg.Insp.I.P. S , '-',-*$,t 7G.,5• .--I,; r ,'A l' C1� 1 w; ,t f y i 14' Yy . .au ,r ,r p••• '.,. '• 9r, \ •_ � '1, ,,*..___, '\ i` • C. D D v G (D. J .A Catawba County Environmental Health 9421 316.50 161.10 190.00 •2802 con 0281 190.00 ROSEWOOD LN 338.00 Parcel: 372017220281, 2802 ROSEWOOD LN 1 in=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/report product or the use thereof by any person or entity. Copyright 2021 Catawba County NC 08/26/2022 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 372017220281 Owner: DOLPHENS MARK A SR Parcel Address: 2802 ROSEWOOD LN Owner2: DOLPHENS ANNETTE JANE City: NEWTON, 28658 Address: 2802 ROSEWOOD LN LRK(REID): 30980 Address2: Deed Book/Page: 3561/1703 City: NEWTON Subdivision: State/Zip: NC 28658-8424 Lots/Block: 3/ Last Sale: $350,000 on 2018-08-02 School Information: School District: COUNTY Plat Book/Page: 15/131 Elementary School: STARTOWN Legal: LOT 3 PL 15-131 Middle School: MAIDEN Calculated Acreage: .810 Tax Map: 048N 01083 High School: MAIDEN Township: NEWTON School Map State Road #: 2532 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: NEWTON RURAL Zoning1: R-20 Building(s) Value: $306,000 Zoning2: Land Value: $24,900 Zoning3: Assessed Total Value: $330,900 Zoning Overlay: Year Built/Remodeled: 1995/ Small Area: STARTOWN 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 #: 3710372000J If available, Building Permits for this parcel. Septic 2010 Census Block: 2023 links are not permits. 2010 Census Tract: 011701 Septic Final Permits prior to 08/2018, contact Agricultural District: Environmental Health. Building Details WaterShed: Voter Precinct: P34/ 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. -, $A • CATAWBA COUNTY ��" 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT PHONE:828.465.8399 Friday,August 26,2022 I842 sM www.catawbacountync.gov PAYOR: Dolphens Sr,Mark PAYMENTS TRANSACTION NUMBER: TRC-46052782-26-08-2022 PAYMENT DATE: 08/26/2022 PAYMENT TYPE: Credit Card 294310795 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 08-22-411205 110-580200-663000 Authorization to Construct(Repair) $150.00 Fee TOTAL PAYMENTS: $150.00 EHPR-08-2022-42091 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 2802 ROSEWOOD LN,NEWTON NC 28658 Applicant MARK DOLPHENS SR,2802 ROSEWOOD LN,NEWTON NC 28658 C:828-514-9924 **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 08/26/2022 16:57 Page 1 of 1