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HomeMy WebLinkAboutEHPR-04-2023-44000.tif 83A • THIS IS NOTA PERMIT Case# EHPR-04-2023-44000 Q „ CATAWBA COUNTY HEALTH DEPARTMENT / PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Ig$2 sM Environmental Health Plan Review- OSWP EXS_SYSTEM- ABANDONMENT RohSec clLk. Applicant SCOTT HENDRICKSON,5824 REST I TOME RD,CLAREMONT NC 28610 C:6318307422 NAME TO APPEAR ON PERMIT Scott Hendrickson SITE ADDRESS: 5824 REST HOME RD,CLAREMONT NC 28610 PIN# 375504719421 NAME of SUBDIVISION: l.nt ii 2 Section/Block PROPERTY SIZE: Square Feet 32,234.40 Acres 0.74 DIRECTIONS: N NC 16 Hwy,right Shell Hollar Rd,left Rest Home Rd on right PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 600 WATER SUPPLY: Private Well DESCRIBE WORK: existing system inspection for metal building,well abandonment 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? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Accessory Structure OTHER DESCRIPTION: DESCRIPTION OF residence EXISTING STRUCTURES 0 DIM EXISTING STRUCTURE: 54 x 65 NUMBER OF EXISTING BEDROOMS: 5 #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 50 x 30 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: APPLICATION FOR WELL ABANDONMENT ABANDONMENT TYPE: Dug eha�plicauu 04/13/2023 16:27 Page 1 of7 $AI THIS IS NOTA PERMIT Case# EHPR-04-2023-44000 CATAWBA COUNTY HEAI;I'H DEPARTMENT `~ PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Ig 2 su Environmental Health Plan Review-OSWP EXS SYSTEM-ABANDONMENT Applicant SCOTT HENDRICKSON,5824 REST HOME RD,CLAREMONT NC 28610 C:6318307422 NAME TO APPEAR ON PERMIT Scott Hendrickson SITE ADDRESS: 5824 REST HOME RD,CLAREMONT NC 28610 PIN# 375504719421 NAME of SUBDIVISION: Lot it 2 Section/Block PROPERTY SIZE: Square Feet 32,234.40 Acres 0.74 DIRECTIONS: N NC 16 Hwy,right Shell Hollar Rd,left Rest Home Rd on right PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 600 WATER SUPPLY: Private Well DESCRIBE WORK: existing system inspection for metal building,well abandonment 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? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Accessory Structure OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: 5 #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 50 x 30 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: APPLICATION FOR WELL ABANDONMENT ABANDONMENT TYPE: Dug eliapplIcation 04/10/2023 13:36 Page 1 oF 7 „• CATAWBA COUNTY Case# EHPR-04-2023-44000 a» ,Z Public Health DepartmentE” 1 II( Subdivision ,s, Environmental Health Division PIN4 375504719421 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 NAME ON PERMIT: (SCOTT HENDRICKSON).5824 REST HOME RD,CLAREMONT NC 28610 ( Scott Hendrickson) Site Address: 5824 REST HOME RD.CLAREMONT NC 28610 Property Size: Square Feet 32,234.40 Acres 0.74 Directions: N NC 16 Hwy,right Shell Hollar Rd,left Rest Home Rd 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:9^ /,----.2 3 Signature of Applicant or Agen If you need further information or assistance please call 828-465-8270 AREA3 FEENAME• DATE FEE AMOUNT Well Abandonment Fee 04/10/2023 $100.00 Existing Tank Check Fee 04/10/2023 $80.00 TOTAL FEES S180.00 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) chapplication 04/10/2023 13:36 Page 2 of 7 catawba county public health Application for Environmental Health Services THIS IS NOT A PERMIT 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 -6e9,+ S!hid•y�' RP. C�4RC.�?©•�7 -"C• a, gel d Acres a 81fj Subdivisio ?'� Lot# Z Driving Directions to Property pi I (t6►,,t e i l a !� e t- .j e c I t t Rd 6'11 r•c k t Describe work 3p1~X 5"D f 7 As/2:73C4 5L.,a Applicant Name Applicant Address ✓ 5 'l I$3 y Ao, a 4 - RA GG }� eA,fo,..1,v e, o?go*J o Phone 63J- Sao_ >y� Email $ or)-w,y 9J3g a,,a/L Owner Name$�}'Tc'-+— Owner Address I Phone I I Email Contractor Name Contractor Address Phone Email Name to Appear on Permit? IgOwner El Applicant ❑Contractor Who will be the Primary Contact? (A Owner ❑Applicant ❑Contractor Proposed New Construction-Residential • ary Residence ❑ New Residence 0 Addition to Residence #of New Bedrooms*t #of Occupants Pro) t Description Structu imensions,also specify dimensions of decks&porches (Choose On ❑Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes 0 No Retaining Wal ' 0 Yes 0 No A ssory Dwelling #of New Bedrooms*t #of Occupants Structure Dimensions (Choos One) ❑Basement 0 Crawl Space 0 Slab If Basement.Will There Be Water Using Fixtures In Basement 0 Yes ❑ No Retaining 11>2' ❑ Yes 0 No Accessory Structure(s)Describe / ' 7 ,9 ,, J >i.,i 6 Structure(s)Dimensions st, < 30 tr- Plumbing 'Yes tif No Describe Plumbing Needed (Choose One) ❑Basement El Crawl Space 2f Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes ❑ No Retaining Wall>2' 0 Yes tgk No lti-Family Residence #of Apartments #Bedrooms per Apartment*t Total#Bedrooms in Structure*t ft of Occupants Struc a Dimensions (Choose e) ❑Basement El Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes ❑ No Retaining Wa >2' ❑ Yes 0 No Well Construction/Abandonment/Repair Proposed Well Type 0 Individual Well ❑ Semi-Public Well ❑Community Well Abandonment Type 0 Drilled ❑ Bored f t Dug 0 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 a Existing Structures on Site Describe 5 u rt in 'l rt '( ilmsK Cet raix / I'14 Structure Dimensions 5't L' S #of Bedrooms * S #of Occupants a Basement ❑ Yes NT No Basement Plumbing El Yes ❑ No 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 El 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 El 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. �❑ es tii,No Does the site contain any jurisdictional wetlands? N Yes "'No Does the site contain any existing wastewater systems? ❑Yes )$'No Is any wastewater going to be generated on the site other than domestic sewage? @4 Yes 0 No Is the site subject to approval by any other public agency? ❑Yes 0 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 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,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. Signature of Owner or Legal Agent Date pC 3 Printed Name of Owner or Legal Agent SccrT W, f fF v 'Q S 04' • _. .. .0 vu -rM •• JL.JV L2 S $1 °43'17" W 39.69' • 57,311 ker,, -Owe fro , • (F) Noii - -- -- 45 RAIT SAND CLgY ROAD 5' S 86.27'45`E 279,21' (Tota U J� F 264.21' 'a i i. 0 a0 Z Well •I \c) 1 L4 47' �IdVe 111 0 2 Sty J N o w Block q a W �, .5 Story Bldg R! a p . a o Fr & Brk M < f Dwelling - Y O � 3 r 47 Fr. v • fU �►- _ FBI-d k �D N O Well n g �: (u IIA 1 t p I m ,,t1Q C'? a lir N co i'i' r �eA,0'' a ) (; Z M .: \ a�a O o 1 - ' ,` ,Pye Overhel power•L; li iy/05' C PP.CP NIP 8 _ 5132 — - ^ ne. s ` ` _ T"—~- N 5°445 +W �6,32 {rota() I ` EIP \ • • 111i\2) I • ' Lot 1 i SMITH, JAMES A. ...: \ 1 Deed Book/Page: 3491/1134 Made • 1171 Lot 3 •ly indicated ROCKL I/E , Deed Boo{ Is of Practices 40 0 40 80 120 . ■ ■ ■ ■ S L-2829 GRAPHIC SCALE - FEET • Catawba County Environmental Health 1 a, N N O (180) •5846 b--5144 188.28 .0. (260) in U IL:VI CV t� �'i •5828 .58 4 3 r '� N 0 cn • (24S)0 Ni. r (132) i c.; •5820 r) 0 HONEYCUTT RD (230) 1 (425) Parcel: 375504719421, 5824 REST HOME RD 1 in=60ft CLAREMONT, 28610 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 04/10/2023 4/10/23, 1:24 PM. Parcel Report Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 375504719421 Owner: ROCKETTE ALICE K Parcel Address: 5824 REST HOME RD Owner2: City: CLAREMONT, 28610 Address: PO BOX 105 LRK(REID): 44572 Address2: Deed Book/Page: 3137/0146 City: GRANITE FALLS Subdivision: State/Zip: NC 28630-0105 Lots/Block: 2/ School Information: Last Valid Sale: School District: COUNTY Plat Book/Page: 23/218 Elementary School: OXFORD Legal: LOT 2 PL 23-218 Calculated Acreage: .740 Middle School: RIVER BEND Tax Map: 1000 00006E High School: BUNKER HILL Township: CLINES School Map State Road #: 1702 TaxNalue Information: Tax Rates Zoning Information: City Tax District:All in County Zoning District: COUNTY County Fire District: OXFORD Zoningl: R-40 Building(s) Value: $298,700 Zoning2: Land Value: $12,100 Zoning3: Assessed Total Value: $310,800 Zoning Overlay: DWMH-O,WP-O Year Built/Remodeled: 1916/1968 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 #: 3710375500J If available, Building Permits for this parcel. Septic links 2010 Census Block: 1017 are not permits. 2010 Census Tract: 010101 Septic Final Permit OP-05-2019-116050 for this parcel. Agricultural District: Building Details WaterShed: WS-IV Protected Area Voter Precinct: P27/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. ©2023,Catawba County Government,North Carolina.All rights reserved. gis.catawbacountync.gov/nomap/parcel_report_php?key=375504719421&type=u 1/1 • ilia• CATA\VBA NY Case# OP-05-2019-116050 Ptil j Public HealthCOU Department T Subdivision • Environmental Health Division PIN# 375504719421 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 2 w Site Address: 5826 REST HOME RD, CLAREMONT NC 28610 Name cm Permit: ALICE ROCKETTE Property Size: Acres 0.74 Directions: Hwy 16 N,right Shell Hollar,left Rest Home Rd,home on right Operation Permit Permit Category: Repairs Wastewater Flow: 240 g.p.d. Type of Facility: Primary Residence- Basement? No Basement Plumbing? No Bedrooms: 2 Water Supply: Private Well Maximum Occupants: 4 System Type: IIIG-OTHER NON-CONY TRENCH SYSTEMS Description: 25%REDUCTION System Code: BIOA36 System Code Description: BioDiffuser ARC 36 Types V and VI systems expire In 5 years. Owner must contact Environmental Health 8 months prior to expiration for permit renewal. System Installation Comments: PERMIT CONDITIONS: 1.All maintenance, monitoring, &performance requirements shall be in accordance with 15A NCAC 18.1900, Rule.1961 2.Operation&Maintenance Specifics: Subsurface system operator required? Yes No_X_ This system has been installed in compliance with applicable NC General Statutes,Rules for Sewage Treatment and Disposal. KELLY ISENHOUR 1099 05/02/2019 System Installer Installation Date A* -4-,-- /— /See----- 05/14/2019 Authorized State Agent Permit Issuance Date • Fonn F iltpwttit 05/15/2019 14:12 Catawba County Environmental Health kb7R- - PI, 5 ,88.E 0P05 aat11 4)(ea5al � tI A \-1..._____F-------- - i il .1:, rs (245) I (132) I Parcel: 375504719421, 5824 REST HOME RD lin=40ft CLAREMONT, 28610 This map/report product was prepared from the Catawba County,NC Geospatial information Services. Catawba Cpunty has made substantial efforts to ensure the accuracy of location and labeling information contained on thus map or data on this report Catawba County promotes and recommends the Independent verification of any data contained on this mapheport product by the user.The County of Catawba,I employees,agents,and personnel,disclaim, and shall not be held!table for any and all damages,loss or liability,whether direct,Indirect or consequential which arises or may arise from this mapheport product or the use thereof by any person or ortthy. Copyright 2014 Catawba County NC 05114/2019 - CATAWBA COUNTY O� I00A SOUTHWEST BLVD `f ;?� NEWTON,NORTH CAROLINA 28658 RECEIPT PHONE:828.465.8399 v Monday,April 10, 2023 18 4 2 sM www.catawbacountync.gov PAYOR: Hendrickson,Scott PAYMENTS TRANSACTION NUMBER: TRC-61 571 170-10-04-2023 PAYMENT DATE: 04/10/2023 PAYMENT TYPE: Check 121 NY 655304845 dob 8/13/58 exp 8/13/2028 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 04-23-421019 110-580200-663000 Existing Tank Check Fee $80.00 04-23-421019 I O-580200.663000 Well Abandonment Fee $100.00 TOTAL PAYMENTS: $180.00 EHPR-04-2023-44000 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 5824 REST HOME RD,CLAREMONT NC 28610 Applicant SCOTT HENDRICKSON,5824 REST HOME RD,CLAREMONT NC 28610 C:63I8307422 **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 04/10/2023 13:35 Page I of I