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Home My WebLink AboutEHPR-4-11-10318 (2).TIF �� C O� THIS IS NOT A PERMIT Case # EHPR-4-11-10318 � � - CATAWBA COUNTY HEALTH DEPARTMENT c� ,„''C Plan Review Application for Environmental Services 1842 sM Environmental Health Plan Review - Septic Malfunction SEPTIC MALFUNCTION NA T O APPEAR ON PERMIT JAMES B HOLLAND JR s�TE A��RESS: 2286 OLD CONOVER STARTOWN RD, Newton, NC Pin#: 373119525167 NAME of SUBDIVISION: Lot # 2 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 1.33 DIRECTIONS: RADIO STATION RD, RIGHT ON OLD CONOVER STARTOWN RD, ON RIGHT BEFORE GHOSTLY HOLLOW APPLICANT OWNER CONTRACTOR JAMES B HOLLAND JR JAMES B HOLLAND JR 2318 OLD CONOVER STARTOWN RD 2318 OLD CONOVER STARTOWN RD NEWTON NC 28658 NEWTON NC 28658 �J�� ... � � � ��: PRIMARY CONTACT: Owner APPLICATION FOR: Existing Structure DIM EXISTING STRUCTURE: 31 X 39 EXISTING FACILITY TYPE: House NUMBER OF EXISTING BEDROOMS: 2 SEWER TYPE: Septic Tank NUMBER OF EXISTING OCCUPANTS: 4 EXISTING WATER SUPPLY IN USE: Private Well CALCULATED DESIGN FLOW: Public water IS available for this property. PUBLIC WATER TYPE AVAILABLE: County/City/Township Water DESCRIBE WORK: SEPTIC MALFUNCTION DESCRIPTION OF PRIVATE HOME EXISTING STRUCTURES ON SITE (IF ANY) PROPOSED FUTURE ADDITIONS NONE OR IMPROVEMENTS: PROPERTY EASEMENTS: NONE PROPOSED CONSTRUCTION I understand that this is a formal application for a well permit, Improvement permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is transferable and may be eligible for a non-expiring date, but may be revoked if this information, site plans or intended use changes for the proposed facility. A Well Permit and Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable. Note: You must obtain 7oning Approval prior to locating a home or structure on this property. Any representation by you of house or structure location should conform to applicable setbacks. Date: /-� ��` �� Signature ofApplicant or Agent �G ��¢z�—dC An Environmental Health Specialist will contact you within 2 working days of application date. [f you need further information or assistance please call 828-466-7291 AREA2 ******************�:�************�****************�****************�****��*************�**�************�*�*******�***�* Minimum Setbacks Front: Side: Rear: Side St: Max Height: FEE NAME DATE AMOUNT BALANCE DUE Authorization to Construct (Repair) Fee 04/08/201 1 $300.00 $0.00 TOTAL FEES $300.00 $0.00 04/08/ I I 12:40 �aA CATAWBACOUNTY Case# EHPR-4-11-10318 y � G Public Health DeparUnent � � � Subdivision .-3 Environmental Health Division - I'lan Review � �`�' PO Qox 389, 100-A Southwest [31vd, Ne��ton, NC 28658 Lot# Z 1 8 2 s� PIN# 373119525167 ApplicantlOwner JAMES B HOLLAND JR, 2318 OLD CONOVER STARTOWN RD, NEWTON NC 28658 Site Address: 2286 OLD CONOVER STARTOWN RD, Newton, NC Property Size: SF 1.33 ACRES Directions: RADIO STATION RD, RIGHT ON OLD CONOVER S"I'ARTOWN RD, ON RIGHT BGFORE Gf-IOSTLY HOLLOW CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 04/08/ l 1 12:40 ,�� THIS IS NOT A PERMIT ; � CATAWBA COUNTY HEALTH DEPARTMENT � �g ; Application for Environmental Services Page 1 1 84 2 �M Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ E�eisting System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility ❑ Property Address �� c�� 0/� �ohOVLY �,]� O cj - Subdivision �� U � , � - oL ��,_� � Lot # � Acres , 3 3 Section/B1ocWPhase Driving Directions to Property � 1 ��. �u a NAME TO APPEAR ON PERMIT? 0 Owner ❑ Applicant ❑ Contractor O Applicant Contact Information U Name �' � �, W Address �� _ - � , m � � Phone a � _ � � _ � 3 � Cell Phone � Owner Contact Information � Name Z Address � Phone Cell Phone � Contractor Contact Information W Name � Address � = Phone Cell Phone � Z WHO WILL BE THE PRIMARY CONTACT? 0'Owner ❑ Applicant ❑ Contractor Description of E�sting Structures on Site � Q # of Bedrooms *�' � Structure Dimensions 3/ — 3`� # of Occupants I Basement ❑ Yes [�—Ido Basement Fixtures ❑ Yes [�'No � Planned Future Additions or Improvements (Building Permit NOT requested at this time) OC Describe /�(� � Proposed Future Structure Dimensions # of Bedrooms *�' if applicable ? Are there easements or right-of-ways recorded on this property ❑ Yes � No Describe Is a public water supply available on or adjacent to the above properiy ** Yes ❑ No Check type available ❑ Community Well ❑ Semi-Public Well County/City/Township Water Line Existing water supply in use � dividual Well ❑ Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line ❑ I WOULD LIKE TO SCHEDULE A COMBINED FLAGGING AND SOIL EVALUATION (SEE COMBINED EVALUATION P R O CEDUES) �a� G THIS IS NOT A PERMIT � - � CATAWBA COUNTY HEALTH DEPARTMENT � � �` Application for Environmental Services ` ,page ,2 rg 2 ,� Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *�' Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes ❑ No ❑ Accessory Structure(s) Describe # of New Bedrooms *�' if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence # Units #Bedrooms per Unit* j' Total # Bedrooms *�' Structure Dimensions ❑ Food Service Specify Type # Seats Floor Space -Entire Food Service Facility (Sq Ft) # Employees per Shift # of Shifts Dining Area (Sq. Ft.) ❑ Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Church # of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy Application for 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 Calculated Design Flow, Commercial �' Additional information may be required to determine design flow from certain facilities. This vatue will be determined during consultation with on- site staff. *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 house plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system size increase in the future. j If structure is plumbed but no bedrooms, calculated design flow is required. ** If No, a well permit must be issued with the Authorization to Construct. Note: You must obtain Zoning approval prior to locating a home or structure on this property. Any representation by you of house or structure location should conform to applicable setbacks. 0 CHANGE WORK ORDER REQUIItING REDESIGN AND/OR RETRIP WILL INCURE AN � ADDITIONAL CHARGE (SEE FEE SCHEDULE) a I understand that this is a formal application for Environmental Services and authorize Catawba County Environmental � Health employees to go on this property for evaluation purposes. I certify the above information to be correct and understand � that an Improvement Permit issued as a result of this information is valid for 5 years or may be non-expiring under certain U specified conditions. Improvement Permits and Well Permits are transferrable, but may be revoked if this information, site W plans or intended use changes for the proposed facility. An Authorization to Construct issued by this department is valid for m (5) five years from the date issued and i not transferable � �/ = Signature of Owner or Agent �_/`�" � Printed Name of Owner or Agent Date � � �— �� // Catawba County, North Carolina N This map product was prepnr�ed fi�om the Catnwba Connry, NC, Geog�•aphic lnformatron Svstem. Catawbn Coimry has made substantral efforts to ens:a�e the accr+racy of location and labeling rnformation contarned on this map. Catativba Cotmry promo�es and recommends the independent veriftcation of any data contnined on �his map prodtict by Ihe r�ser. The Coin�ty of Calawba, its em�loyees, agenls nnd personnel disclaiin, nnd shall no[ be held liable jor any nnd al1 dainages, loss or lia6iliN, whether drrect, indirect or conseqirential whrch arrses or �ncry arise fi�om this mup prod:�cr or 1he r�se rhereo by a�ry person or entiry. Leg211d Selected Parcel Number: 3731-19-52-S167 1 inch = 60 feet Prepared for: �� ; � � - 4� / e� ^ % , ,'' � \:� / / �' ,' ; ; ; ,; �I� ; �, `� ., % C �'� ' `� �``�.,,� � / `� ,..�.. ,�, Q �--_�' �.� ,, . � � � �,, ,, ��...,_..,. �•c, ry -� �._._, �, �_... �.�a ` 29 � ��_ �� `--- �"; � 3 �S' ��``�,. ,,. , � , ',,`�.,, a �---J • � -, `'�-,....,�`'". � � � �� , . � , , . k t ,.,� ..,,, . � �4 .. , • - ,.:� � '.. ' ....... `,. rv.,i, � -�'� �. - 107. � PLAT 47-4 � . �. .� , �. s � .. .., � � ., . .. . . , • . . . , . .�_ . -----.�_ . . 2 � __ .. � - {,, .... t �, .. � 5167 .. .. �o� 3 ry . �,, 04 � co .� � ,,,� � ; � -...,. � ��'� 1.24A � � , �� , �' �� 5027 `�; �' � ~ 1 �`� ,� -�.v � �; /� � THIS IS NOT A LEGAL DOCUMENT Friday, April 08, 2011 12:20 PM .00A / i �' 1 CATAWBA COUNTY NC - Parcel Report Information Regardinq Selected Parcel(s) Parcel ID: . � 3731-19-52-5167 Name: HOLLAND JAMES B JR Name2: HOLLAND BARBARA Y Address: 2318 OLD CONOVER STARTOWN RD Address2: City: NEWTON State: NC Zip: 28658-8503 Account: 31173000 Calc Acreage: 1.33 Tax Map: 050N 03014 LRK: 31571 Deed Book: 1355 Deed Page: 0289 Subdivision Name: Subdivision Bfock: Lots: 2 Plat Book: 47 Plat Page: 4 Building Number: 2286 Street Name: OLD CONOVER STARTOWN RD Site Zip: 28658 Township: NEWTON Fire Code: City Code: NEWTON State Road: 1149 Total Bldgs Value: $38,100 Land Value: $17,900 Total Value: $56,000 Year Built: 1930 Year Remodeled: Last Sale Date: 4/1/1984 Last Sale Amount: $36,500 Neighborhood: 108 Watershed: Watershed Split: Voter Precinct: P25 E911 District: NEWTON Zoning: R-20A Zoning2: Zoning3: Zoning Split: N Zoning Overlay: Zoning District: NEWTON Split Zoning Dist: N SplitZoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: STARTOWN Middle School: MAIDEN High School: MAIDEN School Split: NO P&Z Case Number: Census Tract 2010: 011200 Census Block 2010: 1026 Small Area Plan: Agricultural District: Printed: Friday, April 08, 2011 12:20 PM �� Cp� . CATAWBA COUNTY, NC �,� ,� 100-A South West Blvd PLAN RECEIPT � r� Newton, NC 28658- U ,� ��Q �' (828)465-8399 Frida A ril8 2011 �► Y� p � j84'L SM www.catawbacountync.gov P�an �ase: EHPR-4-11-10318 �nvoice Number: INV-4-11-273951 Environmentai Health Plan Review Invoice Date: 04/08/2011 Site Address: 22g6 OLD CONOVER STARTOWN RD, Newton, NC APPLICANT OWNER CONTRACTOR JAMES B HOLLAND JR JAMES B HOLLAND JR 2318 OLD CONOVER STARTOWN RD 2318 OLD CONOVER STARTOWN RD NEWTON NC 28658 NEWTON NC 28658 Fee Name Fee Amount Authorization to Construct (Repair) Fee Adjustable $300.00 Total Fees Due: $300.00 PAYMENTS PAYER: BARBARA HOLLAND Date Pay Type Check Number Amount Paid ChangE 04/08/2011 Check 1125 $300.00 $0.00 Total Paid: $300.00 Total Due: $0.00 plun rc�:cipl 04l08l2Q1 l 12:39