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HomeMy WebLinkAboutEHPR-02-2023-43401.tif catawba county public health AUTHORIZATION OF REFUND Date: 2/15/2023 Case tt: EHPR-02-2023-43401 Applicant: Peter Courchesne Refund Amount: $300.00 Refund Reason: Clog found in line to tank. No repair permit needed Authorizing Signature: Received By Staff: L)-fiukit_ Date: -i1 ?' 1)3 catawbacountync.gov Environmental Health Cotcwbc County Government Center 25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270 MAKING. LIVING. BETTER. Catawba County, North Carolina - Disbursement Voucher Vendor No. A Date: 2/15/2023 Make Payment To: �' CQ Voucher No(s) Peter Courchesne Q' t 1140 34th St Ln NE Q „ ,4 Conover, NC 28613 v 1b ATTACHMENT Prepared by: Julia English Description Amount Clog found in line to tank. No repair permit needed 5300.00 r Sub-Total Food Tax Sales Tax Total $ 300.00 For Accounting Use Fund Cost Center Object Project Amount Only 110 580200 663000 Total The undersigned hereby certifies that the goods or services specified above have been received or performed. Payment has not been previously authorized and this expenditure is a proper charge to the appropriation indicated. The above charge is certified to you for payment. (SIGNATURE-APPROPRIATE OFFICIAL) $A � CATAWBA COUNTY Q" INA SOUTHWEST 13LVD �` NEWTON,NORTH CAROLINA 28658 PHONE:828.465.8399 RECEIPT V C,)_J Wednesday, February 15,2023 18 Z SM www.catawbacountync gov PAYOR: COURCHESNE,PETER PAYMENTS TRANSACTION NUMBER: TRC-57741602-15-02-2023 PAYMENT DATE; 02/15/2023 PAYMENT TYPE: DV INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 02-23-418311 110.580200-663000 Authorization to Construct(Repair) (S300.00) Fee TOTAL PAYMENTS: ($300.00) EHPR-02-2023-43401 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 1140 34TH ST LN NE,CONOVER NC 28613 Owner PETER COURCHESNE, 1140 34TH ST LN NE,CONOVER NC 28613-8650 C:8283246972 **NO PEOPLESOFTACCOUNTASSIGNED** receipt 02/15/2023 15:41 Page 1 of 1 II • THIS IS NOTA PERMIT Case# EHPR-02-2023-43401 t CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 51A Environmental Health Plan Review -Septic Malfunction AUTH CONS?- SEPTIC MALFUNCTION viti4 kelmetio, rut 561f f1.4f t/t'/ Owner PETER COURCI IFSNF, 1140 34TH ST LN NE,CONOVER NC 28613-8650 C:8283246972 NAME TO APPEAR ON PERMIT PETER COURCHESNE SITE ADDRESS: 1 140 34TH ST LN NE,CONOVER NC 28613 PIN# 372320812420 NAME of SUBDIVISION: BOWMAN ACRES Lot>y 1 Section/Block A PROPERTY SIZE: Square Feet 23,086.80 Acres 0.53 DIRECTIONS: Highland Ave NE, right onto Spence Rd NE,right onto 34th St Ln NE,property on the right PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: New leach field. Toliet in basement is not flushing. 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 home, 2 outbuildings EXISTING STRUCTURES ON SITE OF ANY) DIM EXISTING STRUCTURE: 44x36,8x12,12x16 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED? EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES: SEATING CAPACITY: TOTAL FLOOR SPACE(SD FT): Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: ehapplication 02/14/2023 09:41 r , CATAWBA COUNTY Case# EHPR-02-2023-43401 .(1.7.7.11,.. Public Health Department Subdivision BOWMAN ACRES Environmental Health Division PWN liklitift PO Box 384,100-A Southwest Blvd,Newton,NC 28658 372320812420 14 NAME ON PERMIT: (PETER COURCHESNE), 1140 34TH ST LN NE,CONOVER NC 28613-8650 (PETER COURCHESNE) Site Address: 1140 34TH ST LN NE,CONOVER NC 28613 Property Size: square Felt 23,086.80 Acres 0.53 Directions: Highland Ave NE,right onto Spence Rd NE,right onto 34th St La NE,property on the 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 80 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: , I Gi- L-, 3 Signature of Applicant or Agentrc dtitiva..., If you need further information or assistance please call 828-465-8270 AREA2 FEENAME DATE FEE AMOUNT Authorization to Construct(Repair) Fee 02/14/2023 $300.00 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) ehapplication 02/14/2023 09:41 Page 2 of 6 , a catawba county public health Application for Environmental Health Services THIS IS NOT A PERMIT Application is for: ❑New Construction IV,Existing Facility ❑Improvement Permit ❑Authorization to Construct ❑New Septic .Septic Repair/Malfunction El Septic Relocation El Septic Expansion ❑ Existing System Inspection or Reconnection ❑New Well ❑Replacement Well ❑ Well Abandonment ❑Well Repair I Property Address /1 E{a '3 .( Si LAI )0 6 r d fi d l/C IZ Acres i ') 3 Subdivision Lot# Driving Directions to Property 5 p6AieG 2 f;2)Describe work /1)E va L. „4r I-1 t1 G 4 a Applicant Name j ca v 2-G //('S/tie Applicant Address C 4 mG Phone t71—L6-- 324( 6.97z Email Owner Name S A Ai E Owner Address 5444 Phone SiJIi Email Contractor Name Contractor Address Phone Email fName to Appear on Permit? [ ner ❑Applicant ❑Contractor ` Who will be the Primary Contact? ner ❑Applicant ❑Contractor Proposed New Construction-Residential Primary Residence ❑ New Residence ❑ Addition to Residence #of New Bedrooms*j. #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 0 No Accessory Dwelling #of New Bedrooms*f #of Occupants Structure Dimensions (Choose One) El Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' ❑ Yes 0 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 ❑ No Retaining Wall>2' ❑ Yes El No Multi-Family Residence #of Apartments #Bedrooms per Apartment*? Total#Bedrooms in Structure*j' #of Occupants Structure Dimensions (Choose One) 0 Basement 0 Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' ❑ Yes 0 No Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑Semi-Public Well ❑Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested El 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 P0. Box 389, Newton, NC 28658 Phone:(828) 465-8270 I Fax:(828)465-8276 I EHAdmin@CatawbaCountyNC.gov f Existing Structures on Site Describe T }5 I 01/ CDC S• Structure Dimensions #of Bedrooms* _ #of Occupants 3 • Basement [ Yes ❑ No Basement Plumbing LWes ❑ No Existing Water Supply 3dividual Well ❑Shared Well-Number of C•,.,,ections ❑Community Well ❑ County/City/Township Water Line Is a public water supply available?** ❑ Yes t! o 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 El 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 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 th swer to any question is"yes",applicant must attach supporting documentation. ❑ es D1� Does the site contain any jurisdictional wetlands? a. Yes l$lgo Does the site contain any existing wastewater systems? ❑Yes a ''• Is any wastewater going to be generated on the site other than domestic sewage? 0 Yes P Nam- Is the site subject to approval by any other public agency? 0 Yes EYNo 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) \ �d/ 0 Accepted 0 Alternative ElElh Conventional Innovative 0 Other '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. j 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. REIRIP 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 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. Signature of Owner or Legal Agent72 Date 2 "/9 -Z 3 Printed Name of Owner or Legal Agent P £ , G r Zc E/ ' Catawba County Environmental Health Cil cS) 3403 11 RP I A.... 211J4 35.87 r s (7 � Q 'If4 C'r 40 QV '4.: 1:(% ) 0 >>98 '* fJ Parcel: 372320812420, 1140 34TH ST LN NE 1 in=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 2021 Catawba County NC 02/14/2023 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 372320812420 Owner: BOSS TINA M Parcel Address: 1140 34TH ST LN NE Owner2: COURCHESNE PETER E City: CONOVER, 28613 Address: 1140 34TH STREET LN NE LRK(REID): 56935 Address2: Deed Book/Page: 2457/0915 City: CONOVER Subdivision: BOWMAN ACRES State/Zip: NC 28613-8650 Lots/Block: 1/A School Information: Last Sale: $102,000 on 2003-04-16 School District: COUNTY Plat Book/Page: 14/19 Elementary School: ST STEPHENS Legal: LOT 1 BOWMAN AC PL 14-19 Middle School: ARNDT Calculated Acreage: .530 High School: ST STEPHENS Tax Map: 166H 11010 Township: HICKORY School Map State Road #: Tax/Value Information: Tax Rates Zoning Information: City Tax District: All in County Zoning District: HICKORY County Fire District: ST STEPHENS Zoning1: R-1 Building(s) Value: $165,400 Zoning2: Land Value: $13,900 Zoning3: Assessed Total Value: $179,300 Zoning Overlay: Year Built/Remodeled: 1971/ Small Area: ST STEPHENS/OXFORD Tax Revaluation 2023: Info, COMPER Split Zoning Districts: / Online Appeals Zoning Agency Phone Numbers Comparable Sales (COMPER) for this parcel Contact Tax Dept. at 828-282-2009 Current Tax Bill Miscellaneous: Firm Panel Date: 2007-09-05 Building Permit Address Search for this parcel_ Firm Panel #: 3710372300J If available, Building Permits for this parcel. Septic 2010 Census Block: 1002 links are not permits. 2010 Census Tract: 010304 Septic Final Permits prior to 08/2018, contact Agricultural District: PROXIMITY Environmental Health. Building Details WaterShed: Voter Precinct: P28/ 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 Intormation 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. ©2023, Catawba County Government, North Carolina.All rights reserved. • . -4 IP CATAWBA COUNTY �" :1100A SOUTHWEST I3LVD '44NEWTON,NORTH CAROLINA 28658 RECEIPT *`) PHONE:828.465.8399 (.) Tuesday,February 14,2023 f g , sm www.catawbacountync.gov PAYOR: COURCHESNE,PETER PAYMENTS TRANSACTION NUMBER: TRC-57636843-14-02-2023 PAYMENT DATE: 02/14/2023 PAYMENT TYPE: Credit Card INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 02-23-418311 110.580200-663000 Authorization to Construct(Repair) $300.00 Fee TOTAL PAYMENTS: 5300.00 EHPR-02-2023-43401 CASE TYPE: Environmental IIealth Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 1140 34T1 I ST LN NE,CONOVER NC 28613 Owner PETER COURCHESNE, I140 34TH ST LN NE,CONOVER NC 28613-8650 C:8283246972 **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 02/14/2023 09:40 Page 1 of 1 � 0/CCATAWBA COUNTY I!EALTH DEPARTMENT t9Skd . Telephonj: (828)465-8270 TDD: (828)465-8200 WLS # 3-top Zdr IP AC Rpr. Print. )( Opr. Pr t 7C Sys. Type f -�" 1 Prmt, Replacement Well Well Rpr. Print. Owner/Agent it K )No ,_ eork f( Phone Address 10 34 " - 51 LAPIN 6.. f Subdivision 1 Section/Block/Phase Inimaste Lo Lot Size it ctions: .S N NF Property Address D LA-' T- Facility: House/S Mobile Home Business Multi-family _ Other: Pin Number 3773 Zp$/ Z¢ZO Other . Zoning Approval N #Bedrooms 3 #Seats #Employees . Application Rate GPD Flow Hot Tub or Spa yes/no Special Fixtures Basemen y :410 . 100% Repair Area yes/no Basement Plumb' •et,no Water Supply: Private Well )( Public Semi-Public Type of System: Trench Bed X[ Pump Pump/Panel Panel LPP Other c� Septic Tank Size t 7(!St_ Pump Tank Size Nitrification Field: Total Square Feet Depth of Stone 125 I d ei Bed Size 1D K 60 Trench Width Total Length of All Trenches Number of Trenches Trench Length / / I / / Feet on Center Maximum Trench Depth Distance of Nearest Well *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* Topo % Slope Texture Alls' k Structure Clay Min. Soil Wetness " Soil Depth 1 C.) `a Restric_ Hoz. at " Available space yes/no Overall Class S PS U Comments: ` S) 1_,,,,,/,_ 4440. -/-164 S ' tdttr - e_e 40 4tecO /54. b RA /"L 1*°)'1' Filter Required .O i-4.0 Riser required when tank is more than 6 inches deep. ,� C�)3j"� **NO GUARANTEE OR WARRANTY IS IMPLIED OR G N AS TO THE PERFORMANCE 0 LENGTH OF TIMETHIS SYSTEM WILL FUNCTION** *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility. An Authorization to Construct is valid for (5) five years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation,and protection must meet state and local regulations,and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. The siting of the well by the Health Department staff is to provide protects o kno possible sou s of contamination. No volume of water is guaranteed at any site by the Health Department. Permit Date —/3—Q�3 EHS - Owner/Agen Septic Tank Installed B Date -3 EHS , - ell Installed By It Grout Approval Date Well Head App val Date Date Sample Collected Date of Resul( Results EHS White-Office Yellow-OwnedAgenl Pink-Building Inspection Authorization to Construct