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HomeMy WebLinkAboutEHPR-04-2016-23679 (2).TIF • THIS IS NOT A PERMIT Case # EHPR-04-2016-23679 fi �N R CATAWBA COUNTY HEALTH DEPARTMENT 0 r�o.} }0 C.i v�J ''� . ' i . ��cp1P,!' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1841, sm Environmental Health Plan Review - Septic Malfunction .134. en o :: AUTH CONST - SEPTIC_MALFUNCTION o Owner MURL RAY SMART JR., 4134 RIVER RD, HICKORY NC 28602 C:8282944865 NAME TO APPEAR ON PERMIT Murl Ray Smart Jr. SITE ADDRESS: 4134 RIVER RD, HICKORY NC 28602 PIN # 370008985098 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 480,466.80 Acres 11.03 - DIRECTIONS: Hwy 321 South to Exit 41 -River Road, Left at Exit Ramp, 1 1/4 mile to paved Dr on Left, House is not visible from River Rd. (mailbox w/#on it) PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Sewage is on the ground. 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, Pool, Shed EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: House 72x42, Pool 22x40, Shed 12x16 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION BASEMENT? Yes 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 identification and labeling of all property lines and corners and making the site accessible so th a complete,y$1to evalu tion can be performed. Date: if' / 9— /G' Signature of Applicant or Agent 772 c` �a dd-/ri d An Environmental Health Specialist will contact you within 5 working days of application c;te. If you need further information or assistance please call 828-466-7291 AREA2 I/O-ehapplication 04/19/2016 11:09 Pagc 1 of 8 Iv,A CATAAVBACOUNTY Casey EHPR-04-2016-23679 a.l � Public Health Department Subdivision ilY l Environmental Health Division PINk 370008985098 PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 1842 ,. NAME ON PERMIT: (MURL RAY SMART JR.), 4134 RIVER RD, HICKORY NC 28602 ( Murl Ray Smart Jr.) Site Address: 4134 RIVER RD, HICKORY NC 28602 Property Size: Square Feet 480,466.80 Acres 11.03 Directions: Hwy 321 South to Exit 41 -River Road, Left at Exit Ramp, 1 1/4 mile to paved Dr on Left, House is not visible from River Rd (mailbox w/#on it) 1 fl nl!n611i1�f<�'R: r II I tPil ?nr 4 i ri �' 1t'��4'.�-1p1 '8"t)7p)i�l �mll':r pr �n r.l^iilnlil LFEENAME� �Ill�����nl�,n bi '��r rg,,„'h1�,.1�f 1Il!?��I�IFItAL DATE„ ',t!rllifi�ir FFE AMOUNTI Authorization to Construct (Repair) Fee 04/19/2016 $300.00 I ,„aTO• .... ES� (r1l1f. �l�l(194�11�V!Ii�thvs iI tit iG(�(il hI(Ill�tl°i' 1Pdif..... .0 u1 ltI IP I'aGir i I I IP.UL. Iti17lIW114Wlar u.Jf�J IItillia lAilli IW!➢IIWCP,IW��A81l IILI111!liiIIIIlI116L—,t31iW71IIIL' IIIIIrUtJ,alffillaJr I1LllllliWiii(cl 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) 1;9-ehaplicatinn 04/19/2016 11.09 Page 2 of 8 CeTeWRe THIS IS NOT A PERMIT courTr - CATAWBA COUNTY HEALTH DEPARTMENT ,,c,„;;;;;;;;;--, Application for Environmental Services Page 1 Improvement Permit❑ Authorization to Construct Li Septic Repair ❑ Septic Malfunction Septic Expansion n New Well Permit Ti Replacement Well ❑ Well Abandonment❑ Well Repair El Existing System Inspection (Pre-Approval Required) ❑ : Application is for New Construction El Existing Facility i ' Property Address 1/'/ II /ei tie l., ROI) U Subdivision ya//c ko rz cj 4 C .1 dG v 2 Lot# Acres %Zi✓frf it I2 b, Section/Block/Phase Driving Directions to Property 3 a I S re l K Hi -- k lc Le -CT AT Feel ;ea n P — nil; M i& p- 1)/) ,'r o Dinve- CAI I-e-CT -- /-/o Lcrt -J401 visieLt /-Rot" ?/,-e2 RA, NAME TO APPEAR ON PERMIT? lOwner ❑ Applicant ❑ Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information k Name / ) u-2 L RA y inn A pc/ .C"2 Address yi.3 4 yeev5.' it- 20 /-Iic kb RI n/C 2feo1- Phone , 9 y y yc;5-J Cell Phone l,ey Contractor Contact Information Name License # Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? BE Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site - 1 • ea. '7 __ n' # of Bedrooms *j' S Structure Dimensions 27C1-1 # of Occupants , Basement —Yes El No Basement Fixtures El Yes y No sned vx ll -, ( / -cIo 1 7- 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. ❑}'es Cl3' o Yes f No Does the site contain any jurisdictional wetlands? Does the site contain any existing wastewater systems? El Yes v] No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes f�No Is the site subject to approval by any other public agency? ❑ Yes 111410 Are there any easements or right of ways on this property? Describe Existing water supply in use HrIndividual Well El Community Well ❑ Semi-Public Well ❑ 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) / ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other '(Any CATAWBA, THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT „o„,, ;b„r,a Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence New Residence n Addition to Residence #of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes n No n Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling n Yes n No Plumbing ❑ Yes ❑ No Describe Plumbing Needed [ 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.) n 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 n No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type n Individual Well 7 Semi-Public Well n Community Well Abandonment Type Drilled n Bored n Dug n Unknown Well Repair Requested n Yes ❑ 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. 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 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. �� / 6;- k.Signature of Owner or Agent / ( ea” /n/7/712 o-di ti- Date i 7 /�i Printed Name of Owner or Agent m6_R. L PC P,I , Ea7 sifz- Catawba County Environmental Health --"-----_________ ^--� 955 `�'"'— -----950---Th ---------7 945 / 1940 \Q 915 75, 5 970 J • • 905 N.4 ,.. 909. 895 • 77.18 • 9O\ 94S• 979 � ' g `1,C.a 9.2S , 935 ------------ Parcel: 370008985098, 4134 RIVER RD 1in=80ft HICKORY, 28602 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 04/19/2016 Catawba County Environmental Health N 1 pp,. Hi. __ .i., ._ , :.,• .220.69 /1: 7-- 117 11 4 _ S 6e --- n ? p al ,' — --- 1995 r--i ' , ./4.1/ / 4iire,... .,11111101111111.' Met) „ '., . air Ii 990 �. 161 .• ._.._. _.. .. 945�1 935 920 9 .91111‘ .I Sit%'irt,. "11 . 9p'S. It `--N. t 83)% 441)) . - ... -.ININ714s0 -. 4It • Artill' iligek ‘1?Solsrillir . 111111111114•0•111 ..........H \ \ . Parcel: 370008985098, 4134 RIVER RD 1 in=150ft HICKORY, 28602 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 04/19/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 370008985098 Owner: SMART MURL RAY JR Parcel Address: 4134 RIVER RD Owner2: null City: HICKORY, 28602 Address: PO BOX 3855 LRK(REID): 47927 Address2: null Deed Book/Page: 1686/0063 City: HICKORY Subdivision: null State/Zip: NC 28603-3855 Lots/Block: null/ null School Information: Last Sale: School District: COUNTY Plat Book/Page: Elementary School: BLACKBURN Legal: 4134 RIVER RD Middle School: JACOBS FORK Calculated Acreage: 11.030 High School: FRED T FOARD Tax Map: 131H 02015C School Map Township: HICKORY State Road #: 1144 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: MOUNTAIN VIEW Zoningl: R-20 Building(s) Value: $130,400 Zoning2: null Land Value: $62,700 Zoning3: null Assessed Total Value: $193,100 Zoning Overlay: ED-O Year Built/Remodeled: 1977/null Small Area: MOUNTAIN VIEW 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 #: null Building Details 2010 Census Block: 2003 WaterShed: null 2010 Census Tract: 011102 Voter Precinct: P23 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 alt 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. gitner 0Q6COAS fi'lc)ble hxYlo cp-) s 0140IN YDOCIQ\MA2 (NYE, hvi • CLurier jN1o,n 1 e_ \t,6 rolled http://gis.catawbacountync.gov/nomap/parcel_report.php?key=370008985098&typ=P 4/19/2016 r - v ~ C ^I i d Lu w 0 o Z * 91 \ , M cz e M j . z 11 La Io Z ^ U w EL r Q vi v) ..\1 1 W l .. X a U j Q ` ,La O z u- 8, Z s _ Q 1 , 1 ht * o I N I 1 it 1 Z re °a)) I i i (0 = ILI (17 i r\ I ) a z z s O u.i o j I'l EL � A I w Q ` ' `'1 Q d i T Z 0 v n f , J 1_ a) } •et U t, I w • 4 ,m 7`- Z E —i N 0 Q z z rf Q ES . Fes `" 0 2 1 >_ d v w lsi cps O O Z 8 0 d m w d • V0 z j c2 w Q 1 a o Q co 0_ w O ( Z m < - w d Z p W W fY u2 0 > D CY w Q! F- f— - cai 0 Z oC Q o O O Q N „ 4 7 ea Q °" N a 0 U m z Z 0 on Z 3 = U o s 2 - Q O D J v) BA CATAWBA COUNTY Et la I OOA SOUTHWEST BLVD ru NEWTON, NORTH CAROLINA 28658 RECEIPT aa��pl e�P PHONE: 828.465.8399 U i>1A vdw, 'C Tuesday, April 19, 2016 1842 sm www.catawbacountync.gov PAYOR: Smart Jr., Murl Ray PAYMENTS TRANSACTION NUMBER: TRC-658012-19-04-2016 PAYMENT DATE : 04/19/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 04-16-327363 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-04-2016-23679 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 4134 RIVER RD, HICKORY NC 28602 Owner MURL RAY SMART JR., 4134 RIVER RD, HICKORY NC 28602 C:8282944865 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 04/19/2016 11:09 Page 1 of 1