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HomeMy WebLinkAboutEHPR-04-2016-23587 (2).TIF UTHIS IS NOT A PERMIT Case # EHPR-04-2016-23587 ci CATAWBA COUNTY HEALTH DEPARTMENT 0 :o h f I]PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES . 3w 842 :M Environmental Health Plan Review - OSWP .In •f U o. 1 IMPROVEMENT o ¢4`o • '• Owner HOLLY LYNNE HALFORD, 2705 N CENTER ST APT 32, HICKORY NC 28601 H:8285691836 C:8285!46746 HOME:8285691836 NAME TO APPEAR ON PERMIT Holly Lynne Halford SITE ADDRESS: 4205 WILSON RD, VALE NC 28168 PIN # 268704501375 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 557,132.40 Acres 12.79 DIRECTIONS: Hwy 10 west, Left onto Banoak Rd beside Banoak Elementary School, Travel about 1 mile, Left onto Wilson Rd, about .6 mile Right onto gravel driveway. Go to top of driveway, Go to the far Right at double silver gates. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: IP Only. Gate will need to be unlocked. Call to set up time to meet homeowner on property. Well is existing on the property. 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? No 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: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF Barn, Well house, Shed towards front of property EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 33x43 #OF NEW BEDROOMS:: 2 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: E9-ehappl l cation 04/072016 10:10 Page 1 or 5 r`° CATAWBACOUNTY Case EH PR-04-2016-23587 ,A' P Public Health Department Subdivision i r� P 4\ ' Y Environmental Health Division PIN# 268704501375 \ 42/ PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 NAME ON PERMIT: ( HOLLY LYNNE HALFORD), 2705 N CENTER ST APT 32, HICKORY NC 28601 ( Holly Lynne Halford) Site Address: 4205 WILSON RD, VALE NC 28168 Property Size: Square Feet 557,132 40 Acres 12.79 Directions: Hwy 10 west, Left onto Banoak Rd beside Banoak Elementary School, Travel about 1 mile, Left onto Wilson Rd, about .6 mile Right onto gravel driveway. Go to top of driveway, Go to the far Right at double silver gates. 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. Date: Signature of Applicant or Agent 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 (° tPI Rg rx.. P3 s ! s v °' : t s.. 5j .�i Fk[# g t, i k 'r: 1 FEENAME( i s rsEr, a S_ a DATE ' I' vFEE'AMOUNTE Improvement Permit Fee 04/06/2016 $150.00 ' l TOTAL FEES 5 r r kM 1 � �a $150 0 ' f v s t: � G r a ! 5 . 113.t147. v lffaMO....L .,,.r..17: d iiitiiiiF. ...'. ".iz li tila,iskev#.- ,.,, -_ 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-ehapplication 04/07/2016 10:10 Page 2 of 5 4 A �G THIS IS NOT A PERMIT Case # EHPR-04-2016-23587 i a CATAWBA COUNTY HEALTH DEPARTMENT 0' . �o. .f ierw ,t v ° w PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Ig 2 sM Environmental Health Plan Review - OSWP +o , r0 U. Or:/ • IMPROVEMENT oAV Applicant HOLLY LYNNE HALFORD, 2705 N CENTER ST APT 32, HICKORY NC 28601 H:8285691836 C:8285146746 HOME:8285691836 NAME TO APPEAR ON PERMIT SITE ADDRESS: 4205 WILSON RD, VALE NC 28168 PIN # 268704501375 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 557,132.40 Acres 12.79 DIRECTIONS: Hwy 10 west, Left onto Banoak Rd beside Banoak Elementary School, Travel about 1 mile, Left onto Wilson Rd, about .6 mile Right onto gravel driveway. Go to top of driveway, Go to the far Right at double silver gates. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: IP Only. Gate will need to be unlocked. Call to set up time to meet homeowner on property. Well is existing on the property. 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? No 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: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF Barn, Well house, Shed towards front of property EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 33x43 #OF NEW BEDROOMS:: 2 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: IN-ehapplicn[ion 04/06/2016 14:50 Page I of 5 CATAWBA COUNTY Case a EHPR-04-2016-23587 `z a. Public Health Department Subdivision � 1 IN# < ��y ,�; Environmental Health Division ' 268704501375 �w& PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 18.2 s, NAME ON PERMIT: Site Address: 4205 WILSON RD, VALE NC 28168 Property Size: Square Feet 557,132.40 Acres 12.79 Directions: Hwy 10 west, Left onto Banoak Rd beside Banoak Elementary School, Travel about 1 mile, Left onto Wilson Rd, about .6 mile Right onto gravel driveway. Go to top of driveway, Go to the far Right at double silver gates. 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 accessibIR so that a complete site evalyation can be performed. Date: '41-6-I/p Signature of Applicant or Agent s,C6.1104, .Y/ M4 fir 4, An Environmental Health Specialist will contact you within 5 wOacingOdays of appl ation date. If you need further information or assistance please call 828-466-7291 AREA2 a,° ti u�" } i n �'I r e. ua } (1.1a�r� p x- rFl i '4l �3i v ii �;i 3 '' .. hk fe$a pDATF ft "y_'rFEEAMOUNT a Improvement Permit Fee 04/06/2016 $150.00 p6 s °hm" e } ;h Ott l�r4 .,..5''t 56,-6-041 - t� , TOTAL FEES ez ,{ ;,,sa;; 4n.:4° .4., .ws ...."24.,..itEi,.,eiiO4—. 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-ehappllcahon 04/06/2016 14:49 Page 2 of 5 CATAWBA THIS IS NOT A PERMIT yco� v� - CATAWBA COUNTY HEALTH DEPARTMENT „ ,„ Application for Environmental Services Page 1 Improvement Permit Authorization to Construct❑ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit fl Replacement Well ❑ Well Abandonment Well Repair ❑ Existing System Inspection (Pre-Approval Required) n Application is for \\New Construction Existing Facility ❑ Property Address /,905 L3 SLM P1 • Subdivision . Ala e-)It ' /6g Lot# Acres �,9, 7t Section/Block/Phase Driving Directions to Property Hv;dv IU)Iwi vjet �jGOO +o 1i3 OAK RdOM I-c?��, .s; 'e hvUitbik %• kl IeenleN-IIIK,� ",rinrr.I . T; vet I m,le-tn W;15th . or.i Le f Reel 6 0 frog Tom R 5k�1-c ttit IveI elk Ai u)A\I , O it Tr6 (d-�I1/e�ur�/ Ti;z).i Rt, A. ,/,k,e,,luen t, NAME TO APPEAR ON PERMIT? Vi Owner n Applicant n Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information r Name Hoy LJ/w e 1_1 449,(1, Address ( .`il0 j a , reaeg 61,4432 1-W4oR Xi( ZO i /,,,�y / Phone 53,:z?-51,9_ ( 3 p // Cell Phone f 8`-H-W /cf� Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? V Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site bKt4)41211 hGU5t15Ti7nrY�i'.cilyeA. # of Bedrooms *t Structure Dimensions # of Occupants Basement ❑ Yes n No Basement Fixtures _ Yes ❑ No —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 L'No Does the site contain any jurisdictional wetlands? ❑ Yes Ea'No Does the site contain any existing wastewater systems? ❑ Yes lr'No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes 12'No Is the site subject to approval by any other public agency? - Yes l Are there any easements or right of ways on this property? Describe 1 Existing water supply in use Z Individual Well ❑ Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes to 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) J ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other a Any cA rrA 7 BA THIS IS NOT A PERMIT COUNTYYt1V€V IJ CATAWBA COUNTY HEALTH DEPARTMENT �,,,;a< Application for Environmental Services Page 2 Proposed Facility Type �7 H Primary Residence (1 New Residence ❑ Addition to Residence # of New Bedrooms *1- Project Description Q \c Structure Dimensions 33 't z # of Occupants ,2 Basement _ Yes • No Basement Fixtures ❑ Yes ❑ No ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑ Yes H No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence# Units #Bedrooms per Unit*t Total #Bedrooms *j Structure Dimensions LJ Food Service Specify Type # Seats Floor Space -Entire Food Service Facility (Sq Ft) # Employees per Shift # of Shifts Dining Area(Sq. Ft.) H Business Specific Type of Business Retail Floor Space #of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Church# of Seats Kitchen n Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well H Semi-Public Well n Community Well Abandonment Type 7 Drilled n Bored ❑ Dug n Unknown Well Repair Requested n Yes H No Describe Calculated Design Flow, Commercial '' 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. t 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 depallment 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. Signature of Owner or Agent 4,2fr : pfvuZ (11? ;k Date 4/79-16 Printed Name of Owner or Agent g A an � A-d Catawba County Environmental Health 5 l6 s N. 66 o O 1 J 177 17 Ate ?12 in • cy . { � q 01 Parcel: 268704501375, 4205 WILSON RD VALE, 1in=80ft 28168 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 04/06/2016 Catawba County Environmental Health ///1). ,,Iir Nr .4. NO,•• 45 ill* t:' 05 en tt IL. X15 ''"` 3 i ♦.. X11_ass r, a . 11111.01:e16,. y 49 !. � 0 .41 V 4 ch r 22S i ",�a d F 71- .4111P 271) i (40 • ar I. i I ), I. (4, f ,tiL tik.. .41, * . 0 .9 ( it : 111P 7 . -1 s"Ill Parcel: 268704501375, 4205 WILSON RD VALE, 1in=200ft 28168 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 04/06/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 268704501375 Owner: HALFORD HOLLY L Parcel Address: 4205 WILSON RD Owner2: null City: VALE, 28168 Address: 2705 N CENTER ST APT 32 LRK(REID): 13731 Address2: null Deed Book/Page: 3179/0002 City: HICKORY Subdivision: State/Zip: NC 28601-1344 Lots/Block: / School Information: Last Sale: $40,000 on 2013-03-22 Plat Book/Page: School District: COUNTY Legal: RD 2043 WILSON RD Elementary School: BANOAK Middle School: JACOBS FORK Calculated Acreage: 12.790 Tax Map: 013 B 04015 High School: FRED T FOARD Township: BANDYS School Map State Road #: 2043 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: PROPST Zoningl: R-40 Building(s) Value: $500 Zoning2: Land Value: $55,400 Zoning3: Assessed Total Value: $55,900 Zoning Overlay: DWMH-O Year Built/Remodeled: null/null Small Area: PLATEAU Current Tax Bill Split Zoning Districts: null/null Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710268600J Building Details 2010 Census Block: 3019 WaterShed: null 2010 Census Tract: 011802 Voter Precinct: P2 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This maplreport 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. ©2016, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=268704501375&typ=P 4/6/2016 T J'1_ �t Case Y ,� CwT:av'OACOUrvTV �; . � 0 U'ELL-Ol-2015-057373 � �G Public Health Department T� ASP Subdivision r �3' ! NQ *,\\ Eiink.ol-w0-2o7 W6 yzos Wilson fzd, �(alc M0w .Well !Aus Le- cA leas: 1ooq• Crum Serk c s4c KS 1 5etiC ferlr Q(C'5 - Soft. -iron,, aretKs - 19 -P-,from Propef-41 \i hec - 9hockw(S - 1ncl,,df r) ropbctl Ytruauye5 it Keep well oa ok n`arA-o(- wr1s 4 05erTitl5 C/ . g r6 ken •�s• s ho• aory. - ` r.5' w;s V■h\$on v-a- I"do U, yam . CAT.AW BA COUNTY Case 4 WCOC-04-20t5-059346 t/ j Public Health Department Subdivision (� �,�) F:nvironmrnml Health Division PINY 268704501375 PO Box 389. 101)-A Southwest Blvd, Neuron. NC 28658 LOT# Name on Permit HOLLY HALFORD, 2705 N CENTER ST APT 32, HICKORY NC 28601 Site Address: 4205 WILSON RD, VALE NC 28168 0 a ' �.rtif 0 Property Size: Square Feet 557,132.40 Acres 12.79 3y z • Directions: HWY 103:URN ON BANOAK RI), APPROX 11/2 MI TURN FIT ON WILSON. TRAVEL ' "" .3. APPROX 1 MI ON RIGHT FIND 2 SILVER GAFFS -a ' { WELL CERTIFICATE OF COMPLETION WATER SUPPLY: Well Type: Individual Well WELL-01-2015-057373 INSPECTIONS INSPECTION# COMP DATE INSPECTION TYPE STATUS INSPECTOR EHINSP-293123 03/23/2015 EH Well Record Received Approved EH Admin EHINSP-289347 02/11/2015 Eli Well Head Approved Megen McBride EHINSP-288770 02/03/2015 EI-I GPS Data Collection Approved Megen McBride EIiINSP-288771 02/03/2015 EH Well Grouting Approved Megen McBride Ashley Moretz 01/30/2015 VVnl.1.DRILLLR DATE!DRILLED Well permits are valid for 5 years from the date of issuance and are subject to suspension and/or revocation from non-compliance with appropriate state and local rules and regulations, or if false information was given in order to obtain a permit. Wells shall be constructed in accordance with all state and local regulations and rules. The Well Completion Report must be submitted to the Health Department within 30 days upon completion of a well. Megen McBride 03/23/2015 ,AUTHORIZED STATP.AGP.N r APPROVAI.DAl I 04/10/2015 I1 :47 Page I of l c : Cp CATAWBA COUNTY �' C., I OOA SOUTHWEST BLVD RECEIPT Fill NEWTON, NORTH CAROLINA 28658 /U 1t.:P.. PHONE: 828.465.8399 �e��' `'C Wednesday, April 6, 2016 842 SM www.catawbacountync.gov PAYOR: Halford, Holly Lynne PAYMENTS TRANSACTION NUMBER: TRC-650719-06-04-2016 PAYMENT DATE : 04/06/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 04-16-326934 Improvement Permit Fee $150.00 TOTAL PAYMENTS : S150.00 EHPR-04-2016-23587 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 4205 WILSON RD. VALE NC 28168 Applicant HOLLY LYNNE HALFORD, 2705 N CENTER ST APT 32, HICKORY NC 28601 H:8285691836C:8285146746 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 04/06/2016 14:48 Page 1 of 1