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HomeMy WebLinkAboutEHPR-05-2023-44314.tif /�'A �\. THIS IS NOT A PERMIT Case# Iii IPR-05-2023-44314 CATAWBA COUNTY I lEAL1'II DEPARTMENT �U\ PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 84' m Environmental Health Plan Review-Septic Malfunction AUTH CONST- SEPTIC MALFUNCTION Applicant *FOOTHILLS SEPTIC&GRADING LLC (BRANDON JANYSSEK),2819 SIGMON DAIRY RD, NEWTON NC 28658 C:8283085994 FOOTIIILISSEPTICGRADING@@GMAIL.COM Owner ALEX ROPER,, C:8283841399 NAME TO APPEAR ON PERMIT Alex Roper SITE ADDRESS: 1355 FIELDCREST DR,HICKORY NC 28602 PIN # 279010467734 NAME of SUBDIVISION: MEADOWBROOK VILLAGE PL 14-82 1 of to 4 Section/Block PROPERTY SIZE: Square Feet 14,810.40 Acres 0.34 DIRECTIONS: S NC 127 Hwy right Valley Field Rd,right Fieldcrest Dr,2nd on left PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: failing drainfield replace tank as well 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 EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 40 x 36 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 6 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: YES Other described: 05/10/2023 09:34 Page I of 6 CATAWBA COUNTY Case# fif 1PR-OS-2023-44314 Public Health Department Subdivision MEADOWBROOK VILLAGE PL 1 4 I Environmental Health Division PIN# 279010467734 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 g 2 ]M NAME ON PERMIT: (ALEX ROPER),, (Alex Roper) Site Address: 1355 FIELDCREST DR,HICKORY NC 28602 Property Size: Square Feet 14,810.40 Acres 0.34 Directions: S NC 127 Hwy right Valley Field Rd,right Fieldcrest Dr,2nd 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 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 05/10/2023 $300.00 TOTAL FEES S300.00 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) d ppli.:,u,.n 05/10/2023 09:34 Page 2 of6 catawba county public health Application for Environmental Health Services THIS IS NOT A PERMIT 9t/31 y eli) Application is for: New Construction ❑Existing Facility ❑Improvement Permit ❑Authorization to Construct ❑New Septic ['Sptic Repair/Malfunction ❑Septic Relocation ❑Septic Expansion ❑ Existing System Inspection or Reconnection L❑New Well ❑ Replacement Well _ ❑Well Abandonment ❑Well Repair Property Address 135T ;e_LAC D r- NC- Acres ( .3 Subdivision Lot# Driving Directions to Property Describe work �rC1;� �;n.Q r~.e_q; I7ArNL l , - , Applicant Name Applicant Address Phone Email Owner Name d Qn1Tr Owner Address `—`"� Phone 6.12.�, �pq ' 1,i9 I Email Contractor Name ro 11 f Sp k.cc_ , .- LLC Contractor Address aicla _ Phone t ,3g11 519/ Email - :Iirfeprh`J 'J et;Name to Appear on Permit? [Ira-Wrier ElApplicant 0 Contractor Who will be the Primary Contact? ❑Owner ❑Applicant j i-t ontractor Proposed New Construction-Residential Primary Residence ❑ New Residence ❑ Addition to Residence #of New Bedrooms*-l• #of Occup.nts Project Description Structure Dimensions,also specify dimensions of decks&porches (Choose One) ❑Basement 0 Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Baseme t ❑Yes ❑ No Retaining Wall>2' 0 Yes 0 No Accessory Dwelling #of New Bedrooms*t #of Occupants Structure Dimensions (Choose One) 0 Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Baseme t ❑Ycs 0 No Retaining Wall>2' ❑ Yes 0 No Accessory Structure(s)Describe Structure(s)Dimensiuns Plumbing ❑Yes ❑No Describe Plumbing Needed (Choose One) ❑Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Baseme t 0 Yes ❑ No Retaining Wall>2' ❑ Yes ❑ No Multi-Family Residence #of Apartments #Bcdrooms per Apartment*t Total#Bedrooms in Structure*f #of Occupants Structure Dimensions (Choose One) 0 Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Baseme ❑Yes ❑ No Retaining Wall>2' 0 Yes ❑ No Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well 0 Semi-Public Well ❑Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑Yes 0 No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank?❑Yes 0 No Environmental Health Catawba County Government Center, 25 Government Drive I PO. Box 389, Newton, NC .8658 Phone: (828)465-8270 I Fax: (828)465-8276 I EHAdmin@CatawbaCountyNC.gov RYA .. 1 E tx sthng Structures on Site Describe Structure Dimensions #of Bedrooms* 3 #of Occupants Basement Rl'es 0 No Basement Plumbing Et-Yes El No Existing Water Supply ❑Individual Well ❑Shared Well—Number of Connections El Community Well [}County/City/Township Water Line Is a public water supply available?** ❑ Yes ❑No Commercial ❑ Proposed New Construction ❑Existing/Change of Use El 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 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 iQ1Io Does the site contain any jurisdictional wetlands? 21-es ❑No Does the site contain any existing wastewater systems? ❑Yes 91`Io Is any wastewater going to be generated on the site other than domestic sewage? ❑Yes Is the site subject to approval by any other public agency? O Yes 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(sj: (systems can be ranked in order of your preference) ❑ Accepted ❑Alternative ❑ Conventional ❑Innovative 0 Other y *Any room that will be intended for sleeping at the time of construction or for future consideration should be noted a a bedroom and counted on all applications.The number of bedrooms will be confirmed by rooms identified on floor plans as a bedroom at th*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 arc 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. Authcrized county and state officials arc 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. 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CAFAWBA COUNTY E7, 100A SOUTI IWEST BLVD NEWTON,NORT I I CAROLINA 28658 RECEIPT V7 � P I IONE:828.465.8399 %,►► Wednesday,May 10,2023 18 4 2 sM www.catawbacountync.gov PAYOR: *Foothills Septic&Grading LLC *Foothills Septic&Grading LLC(Janyssek,Brandon) PAYMENTS TRANSACTION NUMBER: TRC-63726730-10-05-2023 PAYMENT DATE: 05/10/2023 PAYMENT TYPE: Credit Card 305050616 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 05-23-422400 110-580200-663000 Authorization to Construct(Repair) $300.00 Fee TOTAL PAYMENTS: $300.00 E I-I P R-0 5-2 023-44314 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 1355 FIELDCREST DR,I IICKORY NC 28602 Applicant *FOOTHILLS SEPTIC&GRADING LLC,2819 SIGMON DAIRY RD,NEWTON NC 28658 C:8283085994 FOOTHILLSSEPTICGRADINGaGMAIL.COM **NO PEOPLESOFT ACCOUNT ASSIGNED** Owner ALEX ROPER,, C:8283841399 receipt 05/10/2023 09:33 Page 1 of 1