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HomeMy WebLinkAboutEHPR-03-2016-23338.TIF s-C A THIS IS NOT A PERMIT Case # EHPR-03-2016-23338 G ~ 7s1Ye' CATAWBA COUNTY HEALTH DEPARTMENT 0 ';'� 10 . o �� "�' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES � � F 1842 sM Environmental Health Plan Review - Septic Malfunction . 0 r v a.; • •: AUTH_CONST- SEPTIC_MALFUNCTION '�` s es4. }4 0 Contractor COOL PARK PUMPING, INC (KELLY ISENHOUR), 1535 VICTORIAN HILLS CIR, CONOVER NC B:8282562926 C:8282171596F:828-256-2926 SAME AS PHONE ISENHOUR4 @EMBARQMAIL.Ct Owner ERIC WHITE, 3121 44TH AVE DR NE, HICKORY NC 28601 OTHER:828-256-8137 NAME TO APPEAR ON PERMIT ERIC WHITE SITE ADDRESS: 3203 SULPHUR SPRINGS RD NE, HICKORY NC 28601 PIN # 372416934269 NAME of SUBDIVISION: BRADIE WHITE AND OTHERS Lot# 5 Section/Block PROPERTY SIZE: Square Feet 17,424.00 Acres 0.4 DIRECTIONS: Springs Rd to Sulpher Springs Rd, House is on the Left PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: Septic is failing. 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 House & Out building EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: House 31x52, Out Bldg 12x28 NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: Improvement Permits issued as a result of this information are valid for 5 years or may be non-expiring under certain specified conditions.An Authorization to Construct issued by this department is valid for(5)five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. 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 identifica'on and labeling of all property lines and corners and making the site acceslible so that a complete site,evaluation can be performed. Dater it Signature of Applicant or Agent fL.:9L LQel/yt. kljr2j J An Environmental Health Specialist will contact you within 5 working days of application date. If you need further information or assistance please call 828-466-7291 AREA2 E9-ebapplication 03/07/2016 13:37 Page 1 of7 $ CATAWBA COUNTY Case# EHPR-03-2016-23338 ..T � Public Health D ,.. ® -t.; Department Subdivision BRADIE WHITE AND OTHERS d °9-0` ;, Environmental Health Division PIN# 372416934269 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 .18 :11 NAME ON PERMIT: ( ERIC WHITE), 3121 44TH AVE DR NE, HICKORY NC 28601 ( ERIC WHITE) Site Address: 3203 SULPHUR SPRINGS RD NE, HICKORY NC 28601 Property Size: Square Feet 17,424.00 Acres 0.4 Directions: Springs Rd to Sulpher Springs Rd, House is on the Left r t E:;P i ` -�eu " im' s r it gI�M ' I �r7- gv 14FEENAME. ,�j ,r r hti M , r ; iea eakDATEC1faFEE AMOUNT: Authorization to Construct(Repair) Fee 03/07/2016 $300.00 j t R 1iTOTALJFEES4 ° :?* 37r 111.' s Ig # i A 'k $300 00 4 flit 9-�i'i�4 f O H., e°,'X E al "4 tlf id RR' n4i ch,� ( Of ,.__. � F.,o4 �rw. ,a-�muv�s, s,��„�t s. r, .TrS_ 4,i.35.�1,...._.m ___d .a:��.3.t5 x ,r,�.ff� 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) E9-chapplIcation 03/07/2016 13:37 Page 2 of 7 CAy THIS IS NOT A PERMIT ten tin z CATAWBA COUNTY HEALTH DEPARTMENT „ a Application for Environmental Services Page 1 r Improvement Permit ❑ Authorization to Construct❑ Septic RepairT Septic Malfunction Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ 2 Application is for New Construction ❑ Existing Facility Property Address 3�D 3 3/4 ho r 5p S ell WR Subdivision C • - • Lot# Acres Section/Block/Phase Driving Directions to Property k5J9ri 5 M-/ 'p 5 1/417 r S2 / -. 6j/- 1// c�- tin S (117 /(° J NAME TO APPEAR ON PERMIT? 14 Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name E/i( hi/e Address 3/j 41w l' G Dr MC /f-%Gkory Phone • Cell Phone Contractor Contact Information Name Ae it y Z:s enhaur 6-.34) . /JEnre Pzoyihy Zn/G Address /53S Vide)r'i t7 /1,7/5 L+i-G/P ( mover Phone ga3 a s (0 29;2.& Cell Phone ??f 2/ 7/.j 96 WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant ,'Contractor Description of Existing Structures on Site R7?za, NL Mt/hil/Viie #of Bedrooms *j 2.. Structure Dimensions: /X52 J / X a2('#of Occupants 7, Basement ❑ Yes No Basement Fixtures Q Yes n o The Applicant shall notify the local health depai tment 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 No Does the site contain any jurisdictional wetlands? Eyes No Does the site contain any existing wastewater systems? n Yes No Is any wastewater going to be generated on the site other than domestic sewage? ® Yes No Is the site subject to approval by any other public agency? in Yes No Are there any easements or right of ways on this property? Describe Existing water supply in use Individual Well ❑ Community Well ❑ Semi-Public Well I/County/City/Township Water Line Is a public water supply available? ** ❑ Yes ❑ No 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) l Accepted ❑Alternative ❑ Conventional ❑ Innovative ❑ Other ❑ Any ( ` 0 'Jzwt,1C 0 CAT]L �( [�j 7 THIS IS NOT A PERMIT 4`_eautirY Y- CATAWBA COUNTY HEALTH DEPARTMENT hil, ,oha; Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence #of New Bedrooms *j' Project Description Structure Dimensions #of Occupants Basement ❑ Yes ❑ No Basement Fixtures n Yes a No [ Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling n Yes ❑ No Plumbing ❑ Yes No Describe Plumbing Needed —I Multi-Family Residence#Units #Bedrooms per Unit*t Total#Bedrooms *t 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 7 Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored n Dug ❑ Unknown Well Repair Requested ❑ Yes E No Describe Calculated Design Flow, Commercial t Additional information may be required to determine design flow from certain facilities. This value 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. SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) Improvement Permits issued as a result of this information are valid for 5 years or may be non-expiring under certain specified conditions.An Authorization to Construct issued by this department is valid for(5)five years from the date issued and is not transferable;Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. 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. .. n Signature of Owner or Agent ,\__, 4 r t. to,/s /J, j Date 3 -/& Printed Name of Owner or Agent .� ,n(S Jic Q`�hal r Catawba County Environmental Health • NE to 4 Co- iv ... (172) cu ir 2 a° 1m H ii: N [Ci-13 8- a to m Cr N 40 0 2 a 4 (f 75) / mi ' in-L7 (152 10576 32ND AV'NE ate; sr frkv, 0200 . Parcel: 372416934269, 3203 SULPHUR 1in=50ft SPRINGS RD NE HICKORY, 28601 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 2014 Catawba County NC 03/07/2016 Parcel Report Page 1 of 1 • Parcel Report - Catawba County NC • Parcel Information: Owner Information: Parcel ID: 372416934269 Owner: MSWEW LLC Parcel Address: 3203 SULPHUR SPRINGS RD Owner2: NE Address: 3203 SULPHUR SPRINGS RD NE City: HICKORY, 28601 Address2: LRK(REID): 50443 City: HICKORY Deed Book/Page: 2995/0029 State/Zip: NC 28601-7708 Subdivision: BRADIE WHITE AND OTHERS Lots/Block: 5/ School Information: Last Sale: $70,000 on 2009-07-07 School District: COUNTY Plat Book/Page: 12/68 Elementary School: SNOW CREEK Middle School: ARNDT Legal: LOT 5 PL 12-68 High School: ST STEPHENS Calculated Acreage: .400 Tax Map: 1416 01007 School Map Township: CLINES State Road #: 1529 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: ST STEPHENS Zoningl: R-20 Building(s) Value: $49,000 Zoning2: Land Value: $11,900 Zoning3: Assessed Total Value: $60,900 Zoning Overlay: Year Built/Remodeled: 1947/ Small Area: ST STEPHENS/OXFORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710372400J Building Details 2010 Census Block: 2018 WaterShed: 2010 Census Tract: 010301 Voter Precinct: P29 Agricultural District: 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. ©2015, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=372416934269&typ=P 3/7/2016 /y'A CATAWBA COUNTY 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 INVOICE/RECEIPT I ,� PHONE: 828.465.8399 ���.��{ Monday, March 7, 2016 /8 42 sM www.catawbacountync.gov Invoice Number: 03-16-325903 Invoice Date: 03/07/2016 EHPR-03-2016-23338 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 3203 SULPHUR SPRINGS RD NE, HICKORY NC 28601 Owner ERIC WHITE, 3121 44TH AVE DR NE, HICKORY NC 28601 Contractor COOL PARK PUMPING, INC, 1535 VICTORIAN HILLS CIR, CONOVER NC 28613 B:8282562926C:8282 I 71596F:828-256-2926 SAME AS PHONE ISENHOUR4 @EMBARQMAIL.COM ACCOUNT: 50126 PAYOR: COOL PARK PUMPING, INC FEES EHPR-03-2016-23338 FEE AMT DUE AMT Authorization to Construct(Repair) Fee 03/07/2016 $300.00 $300.00 FEES: $300.00 $300.00 TOTAL FEES: $300.00 $300.00 invoicereceipl 03/07/2016 13:37 Page 1 of I