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HomeMy WebLinkAboutCBPR-04-2016-23722.TIF / / � THIS IS NOT A PERMIT Case # CBPR-04-2016-23722 Q jj ' CATAWBA COUNTY HEALTH DEPARTMENT -�o .U \ d - PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES X - tir /842 ski Commercial .Commercial Building Plan Review - Building New • o + +o , ner MIL IMPROVEMENT- AUTH_CONST %MIER cl Owner RICHARD RIOS, 6533 BAKERS VIEW DR, VALE NC 28168 H:8289942795 C:8284550693 HOME:8289942795 NAME TO APPEAR ON PERMIT Richard Rios SITE ADDRESS: 4912 S NC 127 HWY, HICKORY NC 28602 PIN # 269910265270 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 80,150.40 Acres 1.84 DIRECTIONS: HWY 127 SM TURN LEFT ONTO WALNUT GROVE LN,TURN IMMEIDATELY LEFT INTO THE PARKING LOT PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 100 WATER SUPPLY: Public Water DESCRIBE WORK: **FOR SEPTIC APPROVAL ONLY AT THIS TIME ** 40X60 METAL BUILDING FOR STORAGE/OFFICE WITH 1/2 BATH (SINK AND TOILET ONLY) 1-2 employees, 100 GPD per MC Existing Business on property.000 GPD from EHPR-11-11-13222 jfhis will be separate structure w/separate system. 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? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: ** NO STRUCTURE SELECTED ** FACILITY TYPE: Business OTHER DESCRIPTION: DESCRIPTION OF Business 58x51, Bldg 21x17, Shed 12x20 EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 40X60 METAL BUILDING Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-chappllcation 05/11/2016 13:48 Page 1 of 4 • CATAWBA COUNTY Case# CBPR-04-2016-23722 j Public Health Department Subdivision 4 �` Environmental Health Division PIN# 269910265270 /g47. PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 NAME ON PERMIT: ( RICHARD RI05), 6533 BAKERS VIEW DR, VALE NC 28168 ( Richard Rios) Site Address: 4912 S NC 127 HWY, HICKORY NC 28602 Property Size: Square Feet 80,150.40 Acres 1.84 Directions: HWY 127 SM TURN LEFT ONTO WALNUT GROVE LN,TURN IMMEIDATELY LEFT INTO THE PARKING LOT 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 VAN!"M S 1"J�Gml '�(II 5 „lo f1;J! 'y 1 i;>l'�', .n, I II1P"l Pi'P'f' 4 ;llI' nn Il l iililR111 IFEENAME.� i G , ka RLW1 III I i�1'l� DATE ,il, �� 141FEEFAMOUNT !, �.- � �IWfl Authorization to Construct Fee (New/Expansion) 04/25/2016 $150.00 Fee Improvement Permit Fee 04/25/2016 $150.00 ��p'I�I��II) i ihribTAra tESII�f��Il�Clliel��U�ll1'" ���II[Ihlil�hhli Id 'I'�Il�llil i�. '1;1111lil�uin.o"$300 00. x. IINUiiil. t,.nln mii Uf¢rau'i;r a tt�I:dl t llI atulil!Itill[lltU.k�. P�llA4tW@ C �stgitl @tl�' .r'kiJIS� 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) E`I-chapplicati n 05/11/2016 13:48 Page 2 of4 gA THIS IS NOT A PERMIT Case # CBPR-04-2 0 1 6-23 722 savv CATAWBA COUNTY HEALTH DEPARTMENT 0 -- "o• 0 ` 1 oa �` PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES y: /842 SM Commercial Building Plan Review - Building New o • •• o dkLS IMPROVEMENT- AUTH_CONST a•• ~ VIOAO\IXDI V:CH Owner R ARD RIOS, 6533 BAKERS VIEW DR, VALE NC 28168 H:8289942795 C:8284550693 HOME:8289942795 NAME TO APPEAR ON PERMIT Richard Rios SITE ADDRESS: 4912 S NC 127 HWY, HICKORY NC 28602 PIN # 269910265270 NAME of SUBDIVISION: Lot N Section/Block PROPERTY SIZE: Square Feet 80,150.40 Acres 1.84 DIRECTIONS: HWY 127 SM TURN LEFT ONTO WALNUT GROVE LN, TURN IMMEIDATELY LEFT INTO THE PARKING LOT PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 100 WATER SUPPLY: Public Water DESCRIBE WORK: **FOR SEPTIC APPROVAL ONLY AT THIS TIME ** 40X60 METAL BUILDING FOR STORAGE/OFFICE WITH 1/2 BATH (SINK AND TOILET ONLY) 1-2 employees, 100 GPD per MC Existing Business on property. This will be separate w/separate system. 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? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: ** NO STRUCTURE SELECTED ** FACILITY TYPE: Business OTHER DESCRIPTION: DESCRIPTION OF Business 58x51, Bldg 21x17, Shed 12x20 EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: U OF OCCUPANTS: PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 40X60 METAL BUILDING Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-ehappl icati o n 04/25/2016 14:45 Page 1 of 4 aaA • CATAWBACOUNTY Case# CBPR-04-20 1 6-2 3 722 L lia L Public Health Department Subdivision Y� L'nvironmcntal Health Division PINd 269910265270 N S PO Box 389, 100-A Southwest Blvd,Newton, NC 28658 taA2 ru NAME ON PERMIT: ( RICHARD RIOS), 6533 BAKERS VIEW DR, VALE NC 28168 ( Richard Rios) Site Address: 4912 S NC 127 HWY, HICKORY NC 28602 Property Size: Square Feet 80,150.40 Acres 1.84 Directions: HWY 127 SM TURN LEFT ONTO WALNUT GROVE LN, TURN IMMEIDATELY LEFT INTO THE PARKING LOT 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 FP “,„,r r I1" °I1 1 I IIu 11'4!1 Tt77' I]r ii r to I T�a EENME�,fW, ,, , 11 .1 1E,11 w. DATEDETAMOUN Authorization to Construct Fee (New/Expansion) 04/25/2016 $150.00 Fee Improvement Permit Fee 04/25/2016 $150.00 1��••' MJ ��1�11� _� TOTA`L�:FEES :114I,Ifigl 1'hill lliiiih' `11111111, ��IH��ISS66 BBII['iri• - Nr IA II,1 1r. • ,—IA,LIi ullj LdH ,It •.b elitikiIIuai.I&Jillli tlr. UPI llikkir ilfiliLlu 'IIV9111111 Ulaita 4lIttli& 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-ehappl icat ion 04/25/2016 14:45 Page 2 of 4 A THIS IS NOT A PERMIT Case # CBPR-04-2016-23722 d y CATAWBA COUNTY HEALTH DEPARTMENT E � •T o CI% � , � ?D' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES_ �+� \8 2 M Commercial Building Plan Review - Building New •o • o d . .o ' IMPROVEMENT - AUTH_CONST .&L,'', -. ti Owner RICHARD RIOS, 6533 BAKERS VIEW DR, VALE NC 28168 H:8289942795 C:8284550693 HOME:8289942795 NAME TO APPEAR ON PERMIT Richard Rios SITE ADDRESS: 4912 S NC 127 HWY, HICKORY NC 28602 PIN # 269910265270 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 80,150.40 Acres 1.84 DIRECTIONS: HWY 127 SM TURN LEFT ONTO WALNUT GROVE LN, TURN IMMEIDATELY LEFT INTO THE PARKING LOT PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 100 WATER SUPPLY: Public Water DESCRIBE WORK: **FOR SEPTIC APPROVAL ONLY AT THIS TIME ** 40X60 METAL BUILDING FOR OFFICE WITH 1/2 BATH (SINK AND TOILET ONLY) AND FOR STORAGE. 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: ** NO STRUCTURE SELECTED ** FACILITY TYPE: Business OTHER DESCRIPTION: DESCRIPTION OF SHED EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 40X60 METAL BUILDING 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 la ling of all property lines and corners and making the site accessi so that....a com5te site evaluation can be performed. L Date: i'L� Ali SigrtatureofApplicantorAgent 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-ehapplication 04/25/2016 13 42 Page 1 of4 s gA • CATAWBA COUNTY Case# CBPR-04-2 0 1 6-23 722 V ti Public Health Department Subdivision d, , , Environmental Health Division PIN# 269910265270 s PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 /8 w NAME ON PERMIT: (RICHARD RIOS), 6533 BAKERS VIEW DR, VALE NC 28168 ( Richard Rios) Site Address: 4912 S NC 127 HWY, HICKORY NC 28602 Property Size: Square Feet 80,150.40 Acres 1.84 Directions: HWY 127 SM TURN LEFT ONTO WALNUT GROVE LN, TURN IMMEIDATELY LEFT INTO THE PARKING LOT `FEENAME DATE FEE AMOUNT Authorization to Construct Fee (New/Expansion) 04/25/2016 $150.00 Fee Improvement Permit Fee 04/25/2016 5150.00 -,TOTAL FEES' ;i $300,00 f 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 04/25/2016 13:42 Page 2 of 4 rrAwB© THIS IS NOT A PERMIT COUNTY ,,.�' �"�''�l„e .1 CATAWBA COUNTY HEALTH DEPARTMENT ,gym' Nm,b . Application for Environmental Services Page 1 ImprovementPcrmitt Authorization to Construct Septic Repair n Septic Malfunction n Septic Expansion n New Well Permit n Replacement Well i i Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) n Application is for New Construction X Existing Facility n AL Property t1912 S . NC. 4" ),--7 Subdivision 14 t t-tin , Nic Rite 0 Lot# Acres II Section/Block/Phase cpDriving Directions to Property l7Wy 1021 §vtcth turn !eI 1 04 I'D Wei no- el voile L,1 ttvn lmmttAtettly I,tit in±o -tic p&rkin5 luit NAME TO APPEAR ON PERMIT? 40 Owner ❑ Applicant n Contractor Applicant Contact Information Name Address Phone Cell Phone 8Owner Contact Information , Name Pf tow-el (-- 1 DS Address U33 '&z.Ct',✓_< vta0 by N/0.re rI .pSiG n' Phone $ag-0,00. .02-1q Cell Phone gag-455- 01.g3 Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? 1 Owner _ Applicant ❑ Contractor Description of Existing Structures on Site # of Bedrooms *t Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures Yes ❑ No i-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 No Does the site contain any jurisdictional wetlands? ❑ Yes 1 .No Does the site contain any existing wastewater systems? ❑ Yes lt.I No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes PtNo Is the site subject to approval by any other public agency? ❑ Yes M No Are there any easements or right of ways on this property? Describe_ Existing water supply in use n Individual Well n Community Well n Semi-Public Well County/City/Township Water Line Is a public water supply available? ** It 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 COUNTY CATAWBA._�� ,,,, CATAWBA COUNTY HEALTH DEPARTMENT „„„-;;;;;;,-a--, Application for Environmental Services Page 2 Proposed Facility Type n Primary Residence n New Residence n Addition to Residence #of New Bedrooms *f _ Project Description Structure Dimensions # of Occupants Basement C Yes n No Basement Fixtures ❑ Yes n No ❑ Accessory Structure(s) Describe # of New Bedrooms ft if applicable Structure Dimensions # of Occupants Accessory Dwelling Yes n No Plumbing n Yes n No Describe Plumbing Needed n Multi-Family Residence#Units #Bedrooms per Unit*j' Total#Bedrooms *t Structure Dimensions n Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) , #Employees per Shift # of Shifts Dining Area(Sq. Ft.) ,v\ ""�p� Business Specific Type of Business l.,un Cp (fit pear Retail Floor Space a4UQ P' s7" # of Employees per Shift � P� # of Shifts ( I(7) (z 2 - me ( `'. ❑ Other Facility Type Specify w ° p If Church# of Seats Kitchen n Yes ❑ No If Daycare Specify Occupancy v Application for Well Construction/Abandonment/Repair Proposed Well Type Individual Well El Semi-Public Well n Community Well Abandonment Type n Drilled n Bored n Dug n Unknown Well Repair Requested n Yes n 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 department is valid for(5)five years from the date issued and is not transferable; Improvement Permits and Well Pennits 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 Date 14-1 a 5// t/ Printed Name of Owner or Agenti C{ik-Yel It 05 Parcel Report i':i Pace 1 0. 1• i • Parcel Report - Catawba County NC . Parcel,Information: • . . Owner Information: • i . Parcel ID: 269910265270 • . ••Owner: RIGS RICHARD A . Parcel Address: 4912 S NC 127 HWY. r Owner2: RIOS DEANNA L City: HICKORY, 28607.. • Address: 6533 BAKERS VIEW DR LRK(REID): 183 ••:'Address2: null - Deed Bock/Page: 3098/1893 '' City: VALE Subdivision: null •:State/Zip: NC 28168-7522 Lots/Block: null/null School Information: • Last Sale: $155,000 on 2011-11-01 • Plat Book/Page: School District: COUNTY Legal null Elementary School:BANOAK Calculated Acreage,: 1.:8G0 ';Middle School:JACOBS FORK Tax Map: 001 J 010010 =High School: FRED T FOARD• Township: JACOBS FORK School Map State Road i#: 127 TaxNalue Information: Tax Rates(pdf) Zoning Information: • • City Tax District: All in;County Zoning District:COUNTY, ' County Fire District:;PROPST •• 'Zoningl: RC Building(s) Value: $80,000 ' Zoning2: R-20 Land Value: $40,100 • • • 'Zoning3: null . I . Assessed Total Value: $120,100 . Zoning Overlay: WP-O • Year Built/Remodeled: 1981/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 #: 3710269900J • Building Details 2010 Census Block: 3000 • • WaterShed: WS-III Protected Area 2010 Census Tract: 011802 • . • Voter.Precinct P3 . Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report F i This map/report pmd..ct was prepared Irma He Catawba Courtly,NC Sayan:vial Information Ser,r,ces.Catawba County has mace substantial courts to ensure_ . 1- the a Bracy of ink:aliun am:labeling brim contained on this mat-or Bata en this:boor.Catawba County promotes cod recommends the independent': itnnisat on cf any dal:,con contained on this map.report product by tho Ls',.MC County of Catawba,its employees agent t . ha pemonn_I disclaim.m,and shot!not be hold liable for any and all damages loss or b:lily,whether direct indirect or conseeirentail abaci arises or may arise lion,tills!tee/report p- c n or the use thereof by any oe:son or aridly. 82016, Catawba County Government, North Carolina.All rights reserved. ..730 • lCD �( r• • http://gis.catav hacouiitync.gov/nomap/parcel_report.php''key=2 699 1 0265 2 7 0&tvr P 4/25/2016 • • : Catawba County Environmental Health • • 8 .\1/4\\\t); . , ,: 6 N y b (328) • \N n • X . . .. ; .. ' • S H I I J f ir ....,. • \\ 7 : 0, 0. . • • .. • • . 3*. U) 0 8.1. . ;:; • • WALNUT GROVE LN a5 275. 9745 / r • Parcel: 269910265270;4912 S NC 127 HWY tin=60ft . HICKORY, 28602 • This map/reporl product was oreoared from the Catawba County,NC Geeepatial Information Services.Catawba County has made substantial efforts 'e ensure the accuracy of location and labeling intonation'contained on this map or data on this report.Catawba County promotes and recommends the independent venheation of any data contained on this map/report product by the user.The County at Catawba,as employees,agents;and. I personnel,disclaim,and shell not be held liable for any and at damages,loss'or iiabitity.whether,direct,incited or consequential which arises or may arise from this map/repod product or,the use thereof by any person or entity.•::' ' . t ;•Copyright 2014 Catawba County NC ' 64!25/2016 . gA �_� CATAWBA COUNTY U anew C P 0 Box 389 -Newton, North Carolina 28658 - (828) 465-8270 - Fax (828) 465-8276 - TDD (828) 465-8200 1842 sM Public Health—Environmental Health Division www.catawbacoun tw,c. ov/phealth/ehmain.asp December 9, 2011 Ms. Deanna Rios 6533 Bakers View Dr. Vale,NC 28168 Reference: Notice of Site Limitations and Future Septic System Function Issues Relative to Proposed Business Occupancy at 4912 S NC 127 Hwy, Hickory, NC; Catawba County Application Plan Case EHPR-11-11-13222 Dear Ms. Rios; On November 3, 2011, you submitted an Application for Environmental Services for a change of business use on your property at the location referenced above. The application was necessary as part of the building services requirement for Environmental Health approval prior to a required safety inspection and occupancy certification for a commercial building. After two site investigations we were unable to locate the existing septic system on this property and have asked for your assistance to locate the system, which you have declined to do; therefore we are unable to issue the petmit/approval for which you have applied. However, since the proposed intended use of the property does not intensify the use of the wastewater system, we have determined through discussion with building services officials that further investigation may not be necessary for your proposed business occupancy. Please be advised that, as per our conversation on December 6, 2011, that since the wastewater system on your property has not been properly evaluated, Catawba County Environmental Health makes no representation as to the continued functioning or future ability to repair the system for the proposed building use. Please contact me if you should have any questions or concerns regarding this notice. Since �i/�- G���I'T� Michael E. Cash, R.E.H.S. Environmental Health Supervisor Catawba County Public Health File redl¢tl s 1wexoiz GREATER cxe g "Keeping the Spirit Alive Since 18421" HICKORY gA THIS IS NOT A PERMIT Case # EHPR-I I-I I-13222 a CATAWBA COUNTY HEALTH DEPARTMENT w\" :p ^C Plan Review Application for Environmental Services \\\J84Z s� J_ Environmental Health Plan Review - OSWP '7JII �lASid IMPROVEMENT data eitti/ NAME TO APPEAR ON PERMIT f RICHARD'S APPLIANCE liEPATRT SITE ADDRESS: 4912 S NC 127 HWY, Hickory, NC Pin#: 269910265270 NAME of SUBDIVISION: Lot# Section/Block/Phase PROPERTY SIZE: Square Feet Acres 1.84 DIRECTIONS: HWY 127 S/THE OLD JACOB'S FORK ART GALLERY BUILDING APPLICANT OWNER CONTRACTOR RICHARD'S APPLIANCE REPAIR LESLIE BRINKLEY • 4912 S NC 127 HWY 6I 1 5TH AV NE HICKORY NC 28602- HICKORY NC 28601 (828)323-7545 PRIMARY CONTACT: ..liar APPLICATION FOR: Existing Structure DIM EXISTING STRUCTURE: 37 X 58 EXISTING FACILITY TYPE: Business NUMBER OF EXISTING BEDROOMS: 0 SEWER TYPE: Septic Tank NUMBER OF EXISTING OCCUPANTS: EXISTING WATER SUPPLY IN USE: Public Water CALCULATED DESIGN FLOW: 100 Public wa vailable for this property. PUBLIC WATER TYPE AVAILABL : County/City/Township Water DESCRIBE WORK: NO WORK BEING DONE/SAFETY INSPECTION/CHANGE IN USE/NO SEPTIC RECORD ON FILE DESCRIPTION OF BUILDING TO BE USED AS APPLIANCE REPAIR/RETAIL AND OFFICE/STORAGE EXISTING STRUCTURES ON SITE(IF ANY) PROPERTY EASEMENTS: NO _ �.---------__ CPROPOSED CONSTRUCTION j COMMERCIAL BUSINESS TYPE: APPLIANCE PARTS BUSINESS FLI ESTAB TYPE: SEATING CAPACITY: TOTAL FLOOR SPACE(SQ FT): 2,146 EMPLOYEES PER SHIFT: I NUMBER OF SHIFTS: 1 TOTAL EMPLOYEES: RETAIL FLOOR SPACE(SQ FT): 500 DINING AREA FLOOR SPACE (SQ FT): DAYCARE OCCUPANCY: KITCHEN: 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 cedify 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 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: 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 AREA2 *****************s*******************************r*********************************************sass******************* 1 1/07/11 08:50 CATAWBA COUNTY Case# EHPR-11-11-13222 Public Health Department b't Subdivision 2 I- Environmental Health Division-Plan Review 'TRW PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 Lot# PIN# 269910265270 Applicant/Owner RICHARD'S APPLIANCE REPAIR,4912 S NC 127 HWY, HICKORY NC 28602- Site Address: 4912 S NC 127 HWY,Hickory,NC Property Size: SF 1L4 ACRES Directions: HWY 127 S/THE OLD JACOB'S FORK ART GALLERY BUILDING Minimum Setbacks: Front: Side: Rear: Side St: • Max Height: FEE NAME DATE AMOUNT BALANCE DUE, Improvement Permit Fee 11/03/2011 $150.00 $0.00 TOTAL FEES $150.00 $0.00 CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) • 11/07/11 08:50 CATAWBA COUNTY._MEALTH DEPARTMENT NEWTON , NORTH CAROLINA COMPLETION PERMIT FOR SEPTIC TANKS PERMIT C — 3424 DATE : S/.. me„, IL /f ! OWNER :_ , ( ADDRESS a R i Sr –O , /-R,2 , C. BUILDING CONTRACTOR SUBDIVISION "4 LOCATION 4455 e zcsceJ A y _ LOT # LOT SIZE dd BLOCK OR SECTION HOUSE ( ) MOBILE HOME ( ) BUSINESS (L)�0`I•HER ( ) FHA-VA LOAN ( ) SEPTIC TANK: (SIZE Deb GALS) WATER SUPPLY : NO . BEDROOMS — NO FIXTURES I INDIVIDUAL ✓PUBLIC GARBAGE DISPOSAL UNIT :YES ()NO (L)- IF WELL, TYPE : BORED ✓DRILLED DUG AUTO WASHING MACHINE : YES ( )-NO ( ) DISTANCE FROM SEPTIC TANK OR NEAREST NITRIFICATION FIELD: %o b SQ. FT. POLLUTION: /et it- FT. 1) NUMBER OF LINES 3 SEPTIC TANK INSTALLED BY: 2) LENGTH AND WIDTH OF LINES , O /�( /,S ' PERMIT FEE a) BED SYSTEM (c)./ CERTIFICATE OF COMPLETION BY : b) TRENCH SYSTEM ( ) S r 3) DEPTH OF STONE IN LINES /a REMARKS : ADEQUATE FALL (GRADE) ON: 1) BUILDING (HOUSE) SEWER LINE : YES ( 0/NO ( ) 2) NITRIFICATION-L,INES — - - - - DATE-INS-TALrLEDJO r�4 It ` g3! YES ( e4.-""-NO ( ) ma /4.. SEPT C LANK LAYOUT /aeh 1 j a as O O J HEALTH DEPARTMENT COPY /a7-S h _ ai,& I yI :3m , 7t ''t._ __ Q - L)1 II CATAWBA COUNTY .'-IEALTH DEPARTMENT q9 pp� IMPROVEMENT PERMIT FOR SEPTIC TANKS 11041://mtit No. 1243-g• NAME OF OWNER ?sLP Ik- 1.4 l_ , , t t/ /.DATE ?,.Q'�`/j a)J f 9 S'/ ADDRESS OF OWNER v 8 / Sp'9 _A H/C y ../ , Q-.. v LONE a fe - b a Q A NAME OF CONTRACTOR / ADDRESS LOCATION par-, !a,'j 5 &.c., LO_ ) 9✓Z.,w,r-wJ c ant . S 3 J SUBDIVISION LOT NO. SECTION OR BLOCK 1 LOT SIZE 14j FHA, VA LOAN HOUSE ( ) MOBILE HOME ( ) BUSINESS ( I-OTHER ( ) 1 F SEPTIC TANK LAYOUT , ,� NO. BEDROOMS ( NO. FIXTURES (7) /N GARBAGE DISP OSAL UNIT: YES ( ) NO (�.----- ) PLUMBING UNDER BASEMENT FLOOR: YES ( ) NO V SIZE OF TANK /OD ) LIQUID GALLONS 34,-e NITRIFICATION FIELD: 1. Number of lines 3 1 /5 2. Length and width of lines: 1 a. Bed System Jn� S/(60 ')(1. . b. Trench system B ft. ) 3. Total Depth of stone 17) inches GROUNDWATER INTERCEPTOR DRAIN: (IF REQUIRED) 1 /DO A WATER SUPPLY: PRIVATE (PUBLIC ( ) 1 ✓ .�p��xnn,�/ OWNER NOTIFIED TO CHECK ZONING: YES (4-NO ( ) .,....c{' V OWNER AGREES WITH LAYOUT: YES (U— NO ( ) I ® V OWNER AGREES WITH SPECIAL INSTRUCTIONS: YES ( 0 ( ) 1 V ' OWNER OR CONTRACTOR SIGNATURE/ / � �"�^� PERMIT FEE $ 3'8,,0 PERMIT VOID AFTER 36 MONTHS IMPROVEMENT PERMIT ISSUED BY SEPTIC TANK CONTRACT R MUST FOLLO . ] ETAILS OF E -PETTE1 LAYOUT) SANITARIAN ,Qf 5`,„ „_ti, HEALTH DEPARTMENT COPY SOIL CLASSIFICATION: SUITABLE ( ) PROVISIONALLY SUITABLE ( 1.)--U(SUITABLE ( ) SITE FACTORS: 1. SLOPE (%) 4 P - U 7. SOIL PERMEABILITY S - 4131 U 2. SOIL TEXTURE (12-48 IN.) S - PS U UNDER 60 MIN. - OVER 60 MIN. SANDY, LOAMY, CLAYEY U (SPECIFY)` 8. OTHER S - PS - U 13. SOIL STRUCTURE (12-48 IN.) S -C7-5-72,_� 4. SOIL DEPTH (IN.) S '?-V'S 41 U 9. SOIL SERIES: / 15. RESTRICTIVE HORIZONS (IN.) PS - U A. CECIL d,�—B—IIIWASSEE ( ) I (IMPERVIOUS STRATA, ROCK) C. MADISON ( ) D. APPLING ( ) 6. SOIL DRAINAGE - GROUNDWATER S JPS - U E. PACOLET ( ) F. FLOOD PLAIN ( ) (EXTERNAL - INTERNAL) G. 2-1 CLAY SOIL H. OTHER-SPECIFY