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Home My WebLink AboutEHPR-03-2023-43896.tif A �$ THIS IS NOT A PERMIT Case# EHPR-03-2023-43896 CATAWBA COUNTY HEALTH DEPARTMENT i O '61 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 18 2 SM Environmental Health Plan Review- Septic Malfunction AUTH CONST- SEPTIC MALFUNCTION Applicant SANDRA SHOOK,4830 RALEIGI-I ST,CONOVER NC 28613 H:828-261-5134 HOME:828-261-5134 SANDRASHOOK271@GMAIL.COM NAME TO APPEAR ON PERMIT Sandra Shook SITE ADDRESS: 4830 RALEIGI I ST,CONOVER NC 28613 PIN# 373417113323 NAME of SUBDIVISION: _ Lot u Section/Block PROPERTY SIZE: Square Feet 17,859.60 Acres 0.41 DIRECTIONS: Springs Rd,turn right Raleigh St before County Home Rd,on left PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: Replace septic tank only collapsed. Per installer Bryan Miller replace in same location 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 and garage EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 67 x 34home, 100 x 28garage NUMBER OF EXISTING BEDROOMS: 2 #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: dhn�gilic,tn,n 03/31/2023 10:27 Page 1 of6 " . CATAWBA COUNTY Caself EHPR-03-2023-43896 .t. Public Health Department Subdivision ,� Environmental Health Division PINM 373417113323 Ilikkroik PO Box 389,100-A Southwest Blvd,Newton,NC 28658 NAME ON PERMIT: (SANDRA SHOOK),4830 RALEIGH ST,CONOVER NC 28613 (Sandra Shook) Site Address: 4830 RALEIGH ST,CONOVER NC 28613 Property Size: Square Feet 17,659.60 Acres 0.41 Directions: Springs Rd,turn light Raleigh St before County Home Rd,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 ).2 owner of the property or legal agent of the owner JJ,, L Date: 3 3 t 3 Signature of Applicant or Agent � 61c • J Ledi..............._If you need further information or assistance please call 828-465-8270 AREA2 FEENAME DATE FEE AMOUNT Authorization to Construct(Repair)Fee 03/31/2023 $I50.00 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) chapplicauun 03/31/2023 10:27 Page 2 of6 catawba county public health Application for Environmental Health Services THIS IS NOT A PERMIT Application is for: ❑New Construction ❑Existing Facility ❑ Improvement Permit uthorization to Construct ❑New Septic Septic Repair/Malfunction ❑ Septic Relocation ❑ Septic Expansion ❑ Existing System Inspection or Reconnection ❑New Well ❑Re lacement Well 0 Well Abandonment 0 Well Repair Property Address 3 D a- e ' 9 44. o n o V e r I ,C . .,2g6 Acres Subdivision Lot# Driving Directions to Property Describe work R e.p 10.-e_ 5,e ;c To, h/1. 5frtg, ieati pn. u t� Applicant Name 5 a.►krct S h.co�. e0 ha/, J Applicant Address yg 3 d 7k_o_( e; cS k ono ye r IV' - lei 3 Phone gag - a 6 f- 5/3 `r Email Sa taro... SA oo>! 2 71 @ 5 fl ( . c a►n- Owner Name _S ct n 9,r Owner Address ye 3 o Kcvi t i 3 k , . Conover >il. C • ..2BG/3 Phone gig - 2la /- )3 U Email Contractor Name Contractor Address Phone Email Name to Appear on Permit? L ' weer ❑Applicant ❑Contractor Who will be the Primary Contact? gOwner El 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 El Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' 0 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 ❑ No Retaining Wall>2' ❑ Yes ❑ No Accessory Structure(s)Describe Structure(s)Dimensions Plumbing ❑Yes 0 No Describe Plumbing Needed (Choose One) ❑Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement El Yes Cl 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' D 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 s=Existing Structures on Site Describe __Structure Dimensions #of Bedrooms* 2 #of Occupants I Basement I:1' cs ❑ No Basement Plumbing [✓(Yes ❑ No Existing Water Supply ¢ E/Individual Well ElShared Well—Number of Connections 0 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 tl,a-answer to any question is"yes",applicant must attach supporting documentation. ❑Yes allo Does the site contain any jurisdictional wetlands? ❑Yes (24 Does the site contain any existing wastewater systems? 0 Yes 0-No Is any wastewater going to be generated on the site other than domestic sewage? \lt021 Yes Ella Is the site subject to approval by any other public agency? Yes Ca'f'lo 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 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. 1' 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 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 cessible so that a complete site evaluation can be performed. The undersigned is the owner of the property or legal agent of the owner. (at �a/• .— ,�;` . �`-t.v-v-� 3/� t /2 3 Signature of Owner or Legal Agent Date Printed Name of Owner or Legal Agent _ 7 e CL J r a— '. S 100 K Catawba County Environmental Health .aaa9 H LJ • Di a_ _._____ __________ __. _ ,....: �R Ilt� (711° [ (140) n L f _, ri-i 1-7 I- - $ = n •453Il T 0 - -- — _ _ W N i g —_ i L_J —---- - (140) 95.98 (113) 90 96 •482:1t o _. g �J!! •481a8 I I 14 13 _ _ _ _ _ nI 1 o �— J o ^ u- • co co co ------ (115) _ F. ,..... ______ 1- .1868 _ 15 I j .4810.-1 Parcel: 37341 71 1 3323, 4830 RALEIGH ST 1in=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 2023 Catawba County NC 03/31/2023 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 373417113323 Owner: SHOOK SANDRA DENISE Parcel Address: 4830 RALEIGH ST Owner2: City: CONOVER, 28613 Address: 4830 RALEIGH ST LRK(REID): 50674 Address2: Deed Book/Page: 2975/0875 City: CONOVER Subdivision: State/Zip: NC 28613-8548 Lots/Block: / School Information: Last Valid Sale: School District: COUNTY Plat Book/Page: Elementary School: SNOW CREEK Legal: Middle School: ARNDT Calculated Acreage: .410 High School: ST STEPHENS Tax Map: 1420 05001B Township: CLINES School Map State Road #: 1505 TaxNalue Information: Tax Rates Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: ST STEPHENS Zoning1: R-20 Building(s)Value: $215,800 Zoning2: Land Value: $9,400 Zoning3: Assessed Total Value: $225,200 Zoning Overlay: Year Built/Remodeled: 1956/ Small Area: ST STEPHENS/OXFORD Tax Revaluation 2023: Info, COMPER Split Zoning Districts: / Online Appeals Zoning Agency Phone Numbers Valid 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 #: 3710373400J If available, Building Permits for this parcel. Septic 2010 Census Block: 2000 links are not permits. 2010 Census Tract: 010303 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. 'A O CATAWBA COUNTY �'' �{+ 111- 1" 100A SOUTHWEST BLVD di NEWTON,NORTH CAROLINA 28658 RECEIPT V\\ PHONE:828.465.8399 Friday, March 31,2023 18 474 sM www.catawbacountync.gov PAYOR: Shook,Sandra PAYMENTS TRANSACTION NUMBER: TRC-60833929-31-03-2023 PAYMENT DATE: 03/31/2023 PAYMENT TYPE: Credit Card 303106182 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 03-23-420628 110-580200-663000 Authorization to Construct(Repair) S150.00 Fee TOTAL PAYMENTS: S150.00 EH PR-03-2023-43896 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 4830 RALEIGH ST,CONOVER NC 28613 Applicant SANDRA SHOOK,4830 RALEIGH ST,CONOVER NC 28613 H:828-261-5 134 SANDRASHOOK27I@GMAIL.COM GMAIL.COM **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 03/31/2023 10:27 Page 1 of 1