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Home My WebLink AboutEHPR-10-2023-45661.TIF A� THIS IS NOTA PERMIT Case# EHPR-10-2023-45661 CATAWBA COUNTY HEALTH DEPARTMENT C•) PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES \84 s. Environmental Health Plan Review-Septic Malfunction P AUTH CONST- REPAIR a o 1.)3 3 Plitt() Owner DALE STINCIC,3787 MILL RUN,TERRELL NC 28682 C:3306979199 DSTINCIC@CHARTER.NET NAME TO APPEAR ON PERMIT Dale Stincic SITE ADDRESS: 3787 MILL RUN,TERRELL NC 28682 PIN# 461712758206 NAME of SUBDIVISION: RIVERWOOD PL 16-257 Lot# 15 Section/Block PROPERTY SIZE: Square Feet 30,056.40 Acres 0.69 DIRECTIONS: NC 150,right onto Kiser Island Rd,left onto Riverwood Rd,left onto Mill Run,property on the left PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PE; r_Y: 360 WATER SUPPLY: Community Well ESCRIBE WORK: 0/23/23 REVISED TO SEPTIC REPAIR. MOVE EXISTING DRAINFIELD. PREVIOUS DESCRIPTION:Tank only.Cracked tank. 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 EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 54x108 NUMBER OF EXISTING BEDROOMS: 3 #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: e6.pplicau,n 10/23/2023 08:41 Page 1 of 3 • CATAWBA COUNTY Case#i EHPR-10-2023-45661 /r ..iii ,y, Public Health Department Subdivision RIVERWOOD PL 16-257 d lil -• '-3 Environmental Health Division PIN/e 461712758206 PO Box 389,100-A Southwest Blvd,Newton,NC 28658 S. NAME ON PERMIT: (DALE STINCIC),3787 MILL RUN,TERRELL NC 28682 (Dale Stincic) Site Address: 3787 MILL RUN,TERRELL NC 28682 Property Size: Square Feet 30,056.40 Acres 0.69 Directions: NC 150,right onto Kiser Island Rd,left onto Riverwood Rd,left onto Mill Run,property on the 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 AREAS FEENAME DATE FEE AMOUNT Authorization to Construct(Repair) Fee 10/04/2023 $150.00 Authorization to Construct(Repair) Fee 10/23/2023 S150.00 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) chapplication 10/23/2023 08:41 Page 2 of 3 DocuSign Envelope ID: D13FF302-4312-45E6-A74F-4BC0C599D9CC DocuSign Envelope ID:2600C734.1D37-4320-B741-02903D23CCBB �■ catawba county public health Application for Environmental Health Services THIS IS NOT A PERMIT Application is for: ❑New Construction lig Fadsting Facility ❑Improvement Permit uthorization to Construct [New Septic epttc Repair/Malfunction ijaptic Relocation ❑Septic Expansion ❑Existing System Inspection or Reconnection ❑New Well ❑Replacement Well ❑Well Abandonment ❑Well Repair Property Address 31 i� µ I 1 LAD j-('(01 MC— Acres ubdivision ;d Lot# Driving Directions to Property X, L r n- ran (t+l Q_un PrO c^ _ Describe work }�-11a elZ C f x.c e.[� —1-txr\1L i.".1- --1 S [1.2.U) C r C.1 1 e j ri Applicant Name rjj1` l s-k c,C Applicant Address 3-1 Phone 33r 109 -9)4q Email)54;n C l-kr, 4- Owner Name 5 Ve. Owner Address Phone Email Contractor Name Lop i},.)a-i .( iucrn-F- Contractor Address �.i Phone aco--31g-gyp) Email Name to Appear on Permit? [Owner [Applicant 0 Contractor Who will be the Primary Contact? ElOwner 5rApplicant 0 Contractor Proposed New Construction-Residential Primary Residence 0 New Residence ❑ Addition to Residence #of New Bedrooms*t #of Occupants 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 Basement 0 Yes ❑ No Retaining Wall>2' ❑ Yes 0 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 0 Yes ❑ No Retaining Wall>2' ❑ Yes ❑ No Accessory Structure(%)Describe Structure(s)Dimensions Plumbing ❑Yes 0 No Describe Plumbing Needed (Choose One) ❑Basement ❑Crawl Space 0 Slab if Basement,Will There Be Water Using Fixtures In Basement 0 Yes ❑ No Retaining Wail>2' ❑ Yes ❑ No Multi-Family Residence #of Apartments #Bedrooms per Aparttnent't Total#Bedrooms in Structure*t #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 0 Individual Well 0 Semi-Public Well ❑Community Well Abandonment Type 0 Drilled 0 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?0 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 DocuSign Envelope ID: D13=F302-4312-45E6-A74F-4BC00599D9CC DocuSign Envelope ID:2600C734-1D37-4320-8741-02903D23CCBB nnsrmg arructares on site Describe Structure Dimensions #of Bedrooms ,3 #of Occupants a Basement ❑Yes P1:lo Basement Plumbing ❑Yes ❑ No Existing Water Supply 0 Individual Well ❑Shared Well—Number of Connections ra/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 0 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 Iocal health department upon submittal of this application if any of the following apply to the property in question. If a answer to any question is"yes",applicant must attach supporting documentation. ❑ es Q No Does the site contain any jurisdictional wetlands? D'Yes 0 • Does the site contain any existing wastewater systems? ❑Yes V • 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? ❑Yes t! 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 prefeicuce) ❑Accepted 0 Alternative ❑Conventional 0 Innovative ❑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 pteveut the need ibr septic system expansion in Me future. t If structure is plumbed but has no bedrooms,calculated design flow will be determined by Eli Staff. **If No,a well permit must be issued with the Authorization to Construct. RETRIP TO T1lE PRQPERTY AND/OR SYSTEM REDESIGN WILL INCUR AN ADDITIONAL CHARGE(SEE FEE SCJJJiDULE) 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 connect. 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 n Vf the owner. Signature of Owner or Legal Agent '/k, Stil&LAG Date 10/20/2023 "WirsthARIRADe Printed Name of Owner or Legal Agent ra I e_ n C I ,1 $A • CATAWBA COUNTY �' "�" 100A SOUTHWEST BLVD �I ■ : V NEWTON,NORTH CAROLINA 28658 RECEIPT ` 7 PHONE:828.465.8399 \� 0 Monday,October 23,2023 I8 42 5M www.catawbacountync.gov PAYOR: Stincic,Dale PAYMENTS TRANSACTION NUMBER: TRC-76072040-23-10-2023 PAYMENT DATE: 10/23/2023 PAYMENT TYPE: Credit Card 312244978 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 10-23-429531 110-580200-663000 Authorization to Construct(Repair) $150.00 Fee TOTAL PAYMENTS: $150.00 EHPR-1 0-2023-45661 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 3787 MILL RUN,TERRELL NC 28682 Owner DALE STINCIC,3787 MILL RUN,TERRELL NC 28682 C:3306979199 DSTINCIC@CHARTER.NET **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 10/23/2023 08:41 Page I of 1