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Home My WebLink AboutEHPR-11-09-2536 (2).TIF THIS IS NOT A PERMIT Case # EHPR-11-09-2536 CATAWBA COUNTY HEALTH DEPARTMENT y V :,,0 C Plan Review Application for Environmental Services Ig~}2 SM Environmental Health Plan Review - OSWP APPLICANT OWNER CONTRACTOR GREGORY PADGETT KELLY WARD 1310 GRADY LN 1020 HORSE ROCK RD HICKORY NC 28602- HICKORY NC 28602 (828)294-0597 NAME TO APPEAR ON PERMIT GREGORY PADGETT Pin#: 278004937446 SITE ADDRESS: 1020 HORSE ROCK RD, Hickory, NC DIRECTIONS: I27S/ RT DWAYNE STARNES RD/ ENTER BAKER MTN ESTATES/ LEFT BAKER BARN RD/ HORSE ROCK RD/ HOUSE AT CORNER OF DWAYNE STARNES & HORSE ROCK RD NAME of SUBDIVISION: BAKER MOUNTAIN ESTATES Lot # 57 Section/Block/Phase PROPERTY SIZE: Square Feet Acres .92 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure Bedrooms 4 Basement: Yes Water Using Fixtures in Basement:Yes No. in Family Whirlpool Tub : Gal. Capacity: MULTIPLE FAMILY RESIDENCE: Units 1.00 Total Number of Bedrooms DAYCARE: Number of Children RESTAURANT: Seats Square Feet Dining Area Square Feet Foodstand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees Ist 2nd 3rd OTHER: (Specify) Do you aniticipate any additions to Facility? If so, describe: INGROUND POOL Has any grading, removal, or addition of soil been done to this property? If so, describe Are there easements/right-of-ways recorded on this property? NONE Type of Water Supply: Individual Well Community Well Municipal X Semi-Public 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 norrexpiring 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 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. / - Date: Z 60 Y Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 working days of application date. If you need further information or assistance please call 828-466-7291 AREA 2 (FOR OFFICE USE ONLY) Zoning Approval: Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front 30 FEE NAME PATE AMOUNT Side 10 Existing Tank Check Fee 11/05/2009 $80.00 Rear 10 TOTAL FEES S80.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 1 1 /05/09 10:52 t THIS IS NOT A PERMIT WLS # CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Expansion ❑ Existing Tank Check ~ New Well Permit E] Replacement Well ❑ Well Abandonment E] 1. Name to Appear on Permit G RQC~ PQ 0 Cy A-J 2. Permit Requested By ( C"A 942Y Business Phone Address 1310 GKac+ Lkc., u. IBC ~~S(rtJ:~ Home Phone 3. Property Owner ke- 0G,\pv, WCL\-J Business Phone Address Il~'aU 40r(se- Rdc.(c tZe" l }lt~lcc~t, , t~ C Home Phone 4. Name of Subdivision Qcd~ M ov\ N r E: S_J'akon Lot # G r7 Section/Block/Phase Property Address 10_,),U9,-- c Rd . H" c(c i ivy n _D'100 ~ Directions to Property: ~tvL~ lad =x~L,-th ~k.~' V1a V-;- i,-y' ►7wc.~~~ S loVt~:A-QD Tu n h Qs{ -1 t_,r RcA Ig, G K in 1 k~ . 5. Property Size: Square Feet Acres Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home Dimension of Structure - Bedrooms* *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 system size increase in the future. Basement: yes/no Water Using Fixtures in Basement: yes/no No. in Family Whirlpool Tub yes/no Gallon Capacity MULTIPLE FAMILY RESIDENCES: Units Total Number of Bedrooms DAY CARE: Number of Children RESTAURANT: Seats Square Feet Dining Area -Square Feet Food stand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees I st 2nd 3rd OTHER: (Specify) 7. Do you anticipate any additions to Facility? Yes / No If so, describe: 8. Has any grading, removal, or addition of soil been done to this property? Yes / No If so, describe: 9. Are there easements/right-of-ways recorded on this property? Yes / No 10. Is a public water supply available on or adjacent to the above property? Yes / No Check type that is available: [ ] Community well [ ] Semi-public well [ ] County/City/Township water line **If No, a Well Permit must be issued with the Septic Permit.** 11. Well Type Applying For: [ ] Individual well [ ] Community well [ ] Semi-Public well 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 valid for 5 years or may be non-expiring under certain specified conditions. Improvement Permits and Well Permits are transferable, but may be revoked if this information, site plans or intended use changes for the proposed facility. An 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 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. **IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE IS AN ADDITIONAL CHARGE.- Date G S z Signature of Owner or Agent sAl-' z CATAWBA COUNTY NC'- Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 2780-04-93-7446 Name: WARD KELLY RHONEY Name2: Address: 1020 HORSE ROCK RD Address2: City: HICKORY State: NC Zip: 28602-8963 Account: 153551 Calc Acreage: 0.92 Tax Map: LRK: 602527 Deed Book: 2542 Deed Page: 0531 Subdivision Name: BAKER MOUNTAIN ESTATES Subdivision Block: Lots: 57 Plat Book: 43 Plat Page: 196 Building Number: 1020 Street Name: HORSE ROCK RD Site Zip: 28602 Township: HICKORY Fire Code: MOUNTAIN VIEW City Code: COUNTY State Road: Total Bldgs Value: $411,200 Land Value: $38,300 Total Value: $449,500 Year Built: 2000 Year Remodeled: Last Sale Date: 1/31/2002 Last Sale Amount: $430,000 Neighborhood: 79 Watershed: WS-III Protected Area Watershed Split: NO Voter Precinct: P24 E911 District: COUNTY Zoning: R-40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: WP-O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: MOUNTAIN VIEW Middle School: JACOBS FORK High School: FRED T FOARD School Split: NO P&Z Case Number: Census Tract 2010: 011801 Census Block 2010: 1005 Small Area Plan: MOUNTAIN VIEW Agricultural District: Printed: Thursday, November 05, 2009 10:21 AM Catawba County, North Carolina This map product was prepareciftom the Catawba Countil, NC, Geographic Information Si'Stem. Caiawba COUnty has made substantial efforts to ensure the accurac ' y OfIOCC76017 coid labeling information contained on this map. Catawba Countypromoies and recommends the independent verification of any data contained on this map product ky the user. 77ie County of Catawba, its einplo ' vees, agents and personnel disclaim, and shall not be held liablefor on~v and all damages, loss or liabilit)" Whether direct, indirect ,consequential which arises or maY oriseftoin this mop product or the use thereof by any person . Selected Parcel Number: :0-04-93-7446 1 inch 61 feet Prepared for: +4 0 r~ %Wj ~Ot p ~o -,7 CM Ono o II J~A irk, l +jh t r', `OJ \ \ e jfJ1 J oo . X0)0 Lit A'r =y,~ I~~! y ty r % ~~n"'"" ~'''{,•„'r"- `"tea r ~ ~ R fr x November 2009 10:22 AM 1 777, CATAW l►A COUNTY HEALTH DEPARTMENT N _ 7 4 5 A Telephone- (828) 465-827 DD• (828) 46t$ 05 Imp Prmt. , to Co R: t Ptah. Opr Prmt. Sys Type Well Prmt. Well Rpr Pit. _ Owner/Agent t Phone . 1 Address 06" hkv, Subdivision Akhl _ SectionlBlock[Pbase LOt.# - Lot Size. Directions t L ` ~ -c 1, - I"- lbaf-clr% Aft, Facility House obile Home Bu: ness Multi-fancily Other- Tax Map or Pin Number !.q74 Other Zoning Approval # -ZOO to Z / _ # Bedrooms # Seats # Employees Application Rate a - C GPD Flow LIAO. Hot Tub or Spa y al Fixtures Basement yc no 100% Repair Area yes/no Basement Plumbing _ o Water Supply Private Well Public Semi-Public {~######~Y ~Ki~#$######## Yt###1i##t#W#K~k~►'R='#$i:####~K######,t#g####Y,~#:f#yl#*F~Y$###~ki•#8#* ###!,#,k###~F###F~S#.#~#~#~Q~+F#~i~#7~-+f-*~#-#-R##a7###### Type of System. Trench Bed 'tmp Pump Panel Panel LPP~ ~ er_ _ '7o IczC (I Septic Tank Size D Pump Tank S- ;eat--- Nitrification Field. Total Square Felt3 ~ Depth of Stone Bed Size Trench Width_ Total Len th of All Trenches s7 Number of Trenches i Trench LengthSU /SC?i~~/SG /SO /_S';►_ FeSe n Center Maximum Trench Depth (,8 t Distance of Nearest Well ~A *DO NOT INSTALL SEPTIC 1«7EN WE"'# *WELL RECORD REQUIRED AT COMPYIO.N•" ###:k#####t########.i#########i.######,k#X11###################k#############*########*###############3#Y########i###+K+F+####}#### Topo 9% Slope ~ f a Tex_ure ' - ,L- Structure Clay Min. - ' Soil Wetness ` YRt Soil Depth" j Restric Hoz at i2 Available space e o Overall Cotanl> pts t 1,t,1 i .U' 4t INV~ Filter Required ( br', VE Riser required when S{1Wt tank is more than 6 inches deep. 5 d **NO GUARANTEE OR WARRANTY IS I -4PLIED OR" GN N AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** *Improvement Permit has no expiration d;:-:e and is transferable, but may be revoked if site plans or intended use changes for the proposed facility An Authorization to Construct is -alid for (5) five years from date issued and is not transferable. Well. Permit valid for 5 years provided site conditions do not change. « :11 location, installation, and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. The siting of the well by the Health Depart :pent staff is to provide protection from known possible sources of contamination. No volume of water is guaranteed at any site by the Hea :h Department. Permit Date -2 ' UZ3 _ EHS Owner/A °nt Septic Tank Ins d y Date t7 EHS _ Well Installed By Well Grout Approval Date Well Hea Approval Date ate Sample Collected Date of Results Results EHS White - Office Blue - Building Inspection O 2ration Permit Yellow - Owner/Agent Green - Building Inspection Authorization to Construct A C~ CATAWBA COUNTY, NC I00-A South West Blvd PLAN INVOICE Q+ F-] Newton, NC 28658- (828)465-8399 Thursday, November 5, 2009 1► 184 2 sM wwwxatawbacountync.gov Plan Case: EHPR-11-09-2536 Invoice Number: I NV-1 1-09-257028 Environmental Health Plan Review Invoice Date: 11/05/2009 Fee Name Fee Amount Existing Tank Check Fee Fixed $80.00 Total Fees Due: $80.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 11/05/2009 Credit Card -1 $80.00 $0.00 Total Paid: $80.00 Total Due: $0.00 plan mnic~',Sd Idc-J4 IS,IXhdvSa',,1'rrt 11/05/2009 10:51