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HomeMy WebLinkAboutRBPR-04-2016-23736.TIF s�Y'A THIS IS NOT A PERMIT Case # RBPR-04-2016-23736 i-T Mill � - CATAWBA COUNTY HEALTH DEPARTMENT O c '-` • =y O �''.'' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES .774111., r 1g42 SM Residential Building Plan Review - Building New ' 1: c r IMPROVEMENT - AUTH_CONST - NEW WELL } • o ''. Applicant JESSE MALLEAUX, 3351 2ND ST PL NW, HICKORY NC 28601 C:8284856101 OTHER:8284856123 Owner CLIFTON STILES, 1446 SWEETBRIAR LN, HICKORY NC 28602 C:828-312-7763 NAME TO APPEAR ON PERMIT Jesse Malleaux SITE ADDRESS: 1176 WISTERIA DR, HICKORY NC 28602 PIN # 269902691861 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet Acres 1424 DIRECTIONS: Hwy 127 in Mountain View, on to Huffman Farm Rd, turn right on Pittstown Rd, First right on to River Birch,turn 2nd Left on to Mulberry, first right onto Winding Oak Dr, first left onto Wisteria Dr. Gate at very end of cul-de-sac PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 720 WATER SUPPLY: Private Well DESCRIBE WORK: New single family dwelling, 60x40, 4 bedrooms, possible basement. **Would like septic to be sized for House and future 20x30 guest house with 1 bedroom, kitchen and 1 full bath. 480 gpd House + 240 gpd Guest House** 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: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 7 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 60x40 House 20x30 Guest House #OF NEW BEDROOMS:: 5 BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE. CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO E9-ehapplication 05/02/2016 09:18 Page 1 of 5 anA CATAWBA COUNTY Case# RBPR-04-2016-23736• ,C'tit L Public Health Department Subdivision < ail C4'�,c; Environmental Health Division PIN# 269902691861 °"4I° PO Box 389, 100-A Southwest Blvd,Newton. NC 28658 /8.2 sx NAME ON PERMIT: (JESSE MALLEAUX), 3351 2ND ST PL NW, HICKORY NC 28601 ( Jesse Malleaux) Site Address: 1176 WISTERIA DR, HICKORY NC 28602 Property Size: Square Feet Acres 14.24 Directions: Hwy 127 in Mountain View, on to Huffman Farm Rd, turn right on Pittstown Rd, First right on to River Birch, turn 2nd Left on to Mulberry, first right onto Winding Oak Dr, first left onto Wisteria Dr. Gate at very end of cul-de-sac 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 ............................................................................................................ rill ibiti. I 111 P! .� N ^ r_.r ' h�, llii.,.. ' ,T1171 iJFEENAME n ,, I :� DATE ' FEEAMOUNT Authorization to Construct Fee (New/Expansion) 04/26/2016 $500.00 Fee Improvement Permit Fee 04/26/2016 $150.00 Well Permit& Inspection Fee 04/26/2016 $300.00 iil4S �^HI' .11111 ii ' _ 111 iilll� i i y� V r: ' I F i�n.11aloti'lllF il, dTOTALFEES .,!b�o„,it! >. 1,,(n,i„.., VIifft.... :, ,I,to1111�`II{71 '$95000�.� L'Wr.9h i ' i 'WIIW014a Iii,om'Loik I'• 41:11alllNlLlialliIW11illia 4; ialitII atli1. t iyhlpVCl�l�d 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-ehapplicatinn 05/02/2016 09:18 Page 2 of'5 -4-1V'A il �G THIS IS NOT A PERMIT Case # RBPR-04-2016-23736 .7 11 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES '�� r t. /842 SM Residential Building Plan Review - Building New • 12 •CI o h • IMPROVEMENT - AUTH CONST- NEW WELL •0 So; Applicant JESSE MALLEAUX, 3351 2ND ST PL NW, HICKORY NC 28601 C:828485610 I OTHER:8284856123 Owner CLIFTON STILES, 1446 SWEETBRIAR LN, HICKORY NC 28602 C:828-312-7763 NAME TO APPEAR ON PERMIT Jesse Maileaux SITE ADDRESS: 1176 WISTERIA DR HICKORY NC 28602 PIN # 269902691861 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet Acres 1424 DIRECTIONS: Hwy 127 in Mountain View, on to Huffman Farm Rd, turn right on Pittstown Rd, First right on to River Birch, turn 2nd Left on to Mulberry, first right onto Winding Oak Dr, first left onto Wisteria Dr. Gate at very end of cul-de-sac PRIMARY CONTACT: Applicant SEWER TYPE: Public Sewer GALLONS PER DAY: 720 WATER SUPPLY: Private Well DESCRIBE WORK: New single family dwelling, 60x40, 4 bedrooms, possible basement. **Would like septic to be sized for House and future 20x30 guest house with 1 bedroom, kitchen and 1 full bath. 480 gpd House + 240 gpd Guest House" 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: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 7 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 60x40 House 20x30 Guest House #OF NEW BEDROOMS:: 5 • BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well - REPLACE WELL?: NO • E9-ehapplication 04/26/2016 13:28 Page 1 of5 t/tw CATAWBA COUNTY Case# RBPR-04-2016-23736 fj®�'i Public Health Department Subdivision . - _ 1, ' < R Environmental Health Division PIN# 269902691861 .. PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 J .2 s. NAME ON PERMIT: (JESSE MALLEAUX), 3351 2ND ST PL NW, HICKORY NC 28601 ( Jesse Malleaux) Site Address: 1176 WISTERIA DR, HICKORY NC 28602 Property Size: Square Feet Acres 14.24 Directions: Hwy 127 in Mountain View, on to Huffman Farm Rd, turn right on Pittstown Rd, First right on to River Birch,turn 2nd Left on to Mulberry, first right onto Winding Oak Dr, first left onto Wisteria Dr. Gate at very end of cul-de-sac 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 send labeling of all property lines and corners and making the site a essi so that o�yI to site evaluation can be performed. Date: Fh✓17,tA1P//,(z Signature of Applicant or Agent /�//�rlllt,,lhay An Environmental Health Specialist will contact you within 5 wor g days of application date. If you need further information or assistance please call 828-466-7291 AREA2 FEENAME' ,' .` DATE. FEE AMOUNT ' Authorization to Construct Fee (New/Expansion) 04/26/2016 $500.00 Fee Improvement Permit Fee 04/26/2016 $150.00 Well Permit & Inspection Fee 04/26/2016 $300.00 ;? 'TOTAL FEES .,;, . ' $950.00 ' i.. 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 - 04/26/2016 13:28 Page 2 of 5 CATAAAAA\VBA THIS IS NOT A PERMIT count` k CATAWBA COUNTY HEALTH DEPARTMENT ,,,„ � Application for Environmental Services Page I Improvement Permit% Authorization to Construct RZ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit LPJ Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction V Existing Facility ❑/! Property Address Ipt,�/�W"'f�"S4�Iev1& Subdivision mark Cu" 41itt ei t NC 244062 Lot# Acres /4t ar/Le. 11-f-� Section/BlocWPhase Driving Directions to Property ut/yl,, aast 1 Io7� /N /t'ala. t., VtAa n-'v ret/Lfri Pd �c It?ALS impn.) /Ltcr innto rffs-1 In `I?c4 . Tafu At 4Zvsf rn9lx Iwh.Ath Malt CiWTI- 444t124/cm oZn4 f -I# Oirh MttlSuvy I &Si rt9� evct Wtndw Daft c r, —Rvct Iek- 4 NAME TO APPEAR ON PERMIT? RI Owner ❑ Applicant ❑ Contractor 014D WiST211 tw Applicant Contact Information pay�� Q ' Name Address Phone Cell Phone Owner Contact Information Name eJ1SSc F 1L[4a4/a t.. I/iA,G i4K Address 33 1 2.,,d ✓✓5hczfi watt_ /'1W 1 {-ft deny / /SIC Z�6 01 Phone cloSSe_ CfaP fl -- q{ 6(0) - Cclf Phone 44elj�� ca(-sgy�,��,�4o3 Contractor Contact Information J Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? 12/0wner ❑ Applicant ❑ Contractor Description of Existing Structures on Site /1 #of Bedrooms *t Structure Dimensions #of Occupants Basement ❑ Yes ❑ No Basement Fixtures Q 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 ally question is'yes". applicant must attach supporting documentation. ® Yes Pt 'No Does the site contain any jurisdictional wetlands? ® Yes WINO Does the site contain any existing wastewater systems? ❑Yes D'I10 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? e neat en adjdiA.�Pe" 'Yes 'No Are there any easements or right of ways on this property? Describe t1 ae!'=�"-d"O'—"^ Existing water supply in use I I Individual Well ❑ Community Well I I Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** VYes n No (C17" ina0 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 X Any CATAWBA THIS IS NOT A PERMIT a COUNTY CATAWBA COUNTY HEALTH DEPARTMENT N' ,,��e�� Application for Environmental Services Page 2 Pr posed Facility Type rfir Primary Residence n New Residence ❑ Addition to Residence #of New Bedrooms *'j ill Project Description Alek} Cato- eehirW 6f222 d if Dimensions , 4,0g x iti3A- #of Occupants t" H�fcttt°o Basement IM/Yes ❑ /No Basemeni Fixtures . Yes ® No F—mil-Stvu -�F.(1 twit 7' 'Accessory Structure(s) Describe .Os�stb&. •t Lam,- „. I. -_ yt .ec •1 . aid i� pfi�hho # of New Bedrooms *t if applicab e 5-SenrfirmStructureDimensions Pac3UZf tzedaprhose. #of Occupants not, Accessory Dwelling g'Yes ❑ No 4 Mita, Qecegs fy Plumbing R/Yes ❑ No Describe Plumbing Needed Aza casoi . [. I dt.ue't,3 ❑ 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 ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled n Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ 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. ''i 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. Signature of Owner or Agent ����r kt-��i��LLDate o? M) Printed Name of Owner or Agent 114,rtaM Al/n a.N.tIiJ/ Catawba County, North Carolina . • This map product was prepared from the Catawba County,NC,Geospatial Information System. Ni Catawba County has made substantial efforts to ensure the accuracy of location and labeling information !. A contained on�his map.-Catawba County promotesand•recommends ihe-Independent-verification-ofam data contained on this map 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 product or the use thereof by any person or entity. Selected Parcel Number: 2699-02-69-1861 • 1 inch =200 feet Prepared for: • cc WJtt03 ili T'''•84 CO A t a w 1 0372 3209 _ a e _ s°°).-----J.:27 36 fgbilii , l (n \eJ- '�YV,.�Iut,rJi �71 L--\ \ \ /1f1E'\ SA) 1� ^ k Ji tl irr i re �d V "126' I 4.5\c,,, ,Hy. J 14.24A t✓fy' 1861 l_;' 5��\ -, V \!):\ R-11 • 287.49 2.5(j`�_ `7,, • LW D>8.99 2.98A000 N--, \ k/ — 26,p f 9.78 587 . 266 Ai'' 9699... ( ml 2Q0009'84 • -.e-.-• c• � 311I I U J ,-9 98 00 •6� > �. 00 • 636 • I 1 2 '300 .� 2`9 •,9 y •21.31A 100i • 7195 00 99837 • 3 0 59.04 ,7 0 0 m 9 v 3 ri 6011 7, 0'03 118.00 //i/ m ° pC) � p �sy M 2S rig 0 THIS IS NOT A LEGAL DOCUMENT F`P"a'LA$aver: 1/. t c'yl Time: 12:32.•' • Catawba County Environmental Health r i LJ "V--- � r 0 t7 rn N. I 44 '-.4„.11°711"4:e" : 4-, • \ 9.75 tr J ' t� Wig' • .. -------- illii.si Parcel: 269902691861 , 1176 WISTERIA DR Pill-e. N SeP 1in=150ft HICKORY, 28602 5BR169' q;o9Id ' Oohed�1., oAd ��I I -060 p1O This map/report product was prepared from the Catawba County,NC Geospatial Information Se i es. 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 04/26/2016 Parcel Report Page I of I • Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel 111 269902691861 Owner: STILES CLIFTON DANIEL Parcel Address: 1176 WISTERIA DR Owner2: STILES DENISE WILSON City: HICKORY, 28602 Address: 1446 SWEETBRIAR LN LRK(REID): 606356 Address2: null Deed Book/Page: 2889/1149 City: HICKORY Subdivision: null State/Zip: NC 28602-8968 Lots/Block: null/ null Last Sale: $120,000 on 2008-01-29 School Information: School District: COUNTY Plat Book/Page: Legal: null Elementary School: MOUNTAIN VIEW Middle School: JACOBS FORK Calculated Acreage: 14.240 Tax Map: null High School: FRED T FOARD Township: HICKORY School Map State Road #: null TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: MOUNTAIN VIEW Zoningl: R-40 Building(s) Value: $0 Zoning2: null Land Value: $95,300 Zoning3: null Assessed Total Value: $95,300 Zoning Overlay: WP-O Year Built/Remodeled: null/null Small Area: MOUNTAIN VIEW Current Tax Bill Split Zoning Districts: null/null Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: null Building Permits for this parcel. Firm Panel #: null Building Details 2010 Census Block: 2014 WaterShed: WS-III Protected Area 2010 Census Tract: 011801 Voter Precinct: P24 Agricultural District: Proximity 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. ©2016, Catawba County Government, North Carolina. AM rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=269902691861&typ=P 4/26/2016 ;� CATAWBA COUNTY Case WLS2008-00055 /°' �'-N. N.trlic�Fkalth Department r' 4 Envio omen a7Health Division Subdivision RONALD W. HELPER(HUNT V-)\ .-7/ PO Box 389,100-A Southwe9 Blvd Newton,NC 28658 Sect/BUPh/Lot# \,,u� (828)465-8270 FAX(828)465-8276 TDD(828)465-8200 PIN# 911279018503131-1 Applicant/Owner CLIFTON STILES Site Address: 1176 WISTESIA DR HICKORY NC D°S-led Se/ Property Size: SF 14.493 ACRES r Directions: 127S/LF HUFFMAN FARM RD/RT PITTSTOWN RD/RT RIVER BIRCH LN/RT MULBERRY LN/RT WINDING OAK DR/LF WISTERIA DR/GO TO END OF ROAD 'q`1 Improvement Permit (, Permit Valid For: Five years Ve"No Expiration ~ O Facility(Residential): House / House X Mobile Home Multi-Family Bedrooms_ 4 New? ✓ Addition? Projected Daily Flow L(s,p g.p.d Water Supply Private Well? Public? ✓ Semi-Public? Basement: Y Basement Plumbing: Y HotTub/Spa: N Special Fixtures(explain): .� Proposed Wastewater System: a-55. Rt-dv c l- j' Type: —/fit I_ Proposed Repair: 9,3 of o a v s.}",. Permit Conditions: 4—A,1 I I_F..�r.s—p�y_S_}s�^,—n.-,.-�-{6�_m.1. f_o' P:..�•. <- ..y_c_r_r-,<—/- ° �' Fri,.., yy r,,, . 1 j t —v -'.ti Pr;. t<.1 / rl hid.t La-.kd-.)-..-„_ ' L_ L i.� ,t 1-lr) ,4 }C QS LnW S r. ,nom'-1 �A t.+- a.,r� Sa$ e r .e--.1, ar..✓L or P;i) •Sir S‘islc /rcocrn I � . Owner or Legal Representative Sig atur9i ' _ _ _ - Date: I-�- 'U Authorized State Agent: a Date: I. !Z.S�d g The issuance of this permit by the Hea epartment does not guarantee the issuance of other permits. It is the responsibility of the applicant/property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are met. This Improvement Permit is subject to revocation if the site plan,plat or the intended use changes,or if site conditions are altered. The Improvement Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina 'Laws and Rules for Sewage Treatment and Disposal Systems' (15A NCAC 18A.1900). Neither Catawba County nor the Environmental Health Specialist warrant that the septic tank system will continue to function satisfactorily for any given period of time. Authorization to Construct Wastewater System (Required for Building Permit) ` See site plan and additional attachments( ). Proposed Wastewater System: Type Wastewater Flow g.p.d New Repair Expansion : Soil LTAR g.p.d./ft2 Type of Facility: • Basement: Y Basement Plumbing: Y HotTub/Spa N Special Fixtures(explain): Wastewater System Requirements Tank Size: Septic Tank _gal Pump Tank gal Grease Trap gal Drainfield: Total Area: -sq ft Total Length: ft Maximum Trench Depth in Trench Wdth ft Minimum Soil Cover in Minimum Trench Sepe ration ft Distribution: Distribution Box Serial Distribution Pressure Manifold LPP Other Additional Specifications: Authorized State Agent: Date: Permit Expiration Date- /have read and accept the specifications and all conditions of this permit as indicated Owner or Legal Representative Signature: Date: Form B r:T,demcrklFormsl/W I SAvame ,mow ,C A TAW BA COUN'T'Y %;�'-t- Public'Health Department Case 4 W LS200S-00055 • ' \� Subdivision 1.A\An .) En8irontnent:d Health Division RONALD W. HELPER (HUNT: / PO Box 389. I90-.A Southwest Blvd,Newton.NC 28658 Sect/BL/Ph/Lot ti ■ i� (828)465-8270 FAX(828)465-8276 TOO(823)465-8200 PIN# 9/12790/850313M Applicant/Owner CLIFTON STILES Site Address: 1176 WISTESIA DR HICKORY NC Property Si SF 14A ACRES Directions: 127S/LF HUFFMAN FARM RD/ RT PITTSTOWN RD/ RT RIVER BIRCH LN/ RT MULBERRY LN/ RT WINDING OAK DR/LF WISTERIA DR/GO TO END OF ROAD Q H \s cl ® Improvement Permit 0 Authorization To Constru tC 0 Well Permit hJ 14 SITE PLAN 3 PP / ,\ 5 yffc.r� I1+.cy L.C. \'=vifi.2) +-a 4„9✓e_i's f,>q L ' c M \I'P Y c' I„nd,n5 0,a)H• cl,_c....c, o } i ° l r y, Ac� 1nlfc . /h.a r2.ita,nl ia. fir).+, °,.._ j e. t4 L'In O + ja',J Prze i-.4c. DF 4o ODerld . -o o, 1,11 JP j ' l n -4- L” to •--J 61 , / c.«t k c <.\ N > 43Q11,4�2 l } Y 'y 0 i 'eel 0 Scale System components represent approximate contours only. The contracto • ust flag the system prior to beginning the installation to ensure that proper grade is maintained. Do not install system u tier wet conditions. This permit is subject of revocation if the site plan or site conditions are altered. IS ---y1 02310 Au I ized State Agent Date Form C cvldann,A m,aVtVuuon.,n, DEPARTMENT OF ENVIRONMENT AND NATURAL.RESOURCES Sheet of DIVISION OF ENVIRONMENTAL HEALTH PROPERTY ID q: ON-SITE WASTEWATER SECTION COUNTY: SOIL/SITE EVALUATION lAi L S Zoo - 60°55 CI c.i- for ON-SITE WASTEWATER SYSTEM OWNER: S�: �`S APPLICATIONDATE ADDRESS: DATE EVALUATED: PROPOSED FACILITY: 'tI 4C. U- - PROPOSED DESIGN FLOW(.1949): PROPERTY SIZE: (4.tt 9 LOCATION OF SITE: l 1 7 6 1,,/.;S t c-•;- Ln PROPERTY RECORDED: WATER SUPPLY: 0 Private VPublic 0 Well 0 Spring a Other • EVALUATION METHOD: U,,A�ygerBoring 0/Pit a Cut TYPE OF WASTEWATER: IF-Sewage o Industrial Process o taxed ............... .... ..... :.::.._:: :::::::::::::::::::::•:::::::::::::€::::::ii°::::i!:'iii;iii€:':'€€ i?iiiSiii i:`€isi_:::::::::::::::::::::::::::;:::: :::::ii::::i¢iiiii : :i:::::i :::::si :€ :Lick::..i. ::::::::::':::'::::'::':: ii _.. :S. ........................................................... :: :::::::::::::::::::::viii: �::::................:: ... SOIL 1 T0AY 'oLO : _::::_::::::: ::::::::::: : : ,........ ..::::: .zi::: i:i::::::i :i:: : : ::::::::::::::::::::::-.............................. ::::::: :: . :: . . ..: . . . ..... .1941 ::;::::::::::::=:::::::::::::::::::::::::::::::::::::::::.:::: ::.........._:::::::::::: fiirmi <' : . i€!.. ....... ..... _ :i-:::: i : i.::i s=.::.:: � 45 ::[ ::::: :::::: .. . . .. ....... .... 1 .... . ......... . SCA�)f =p . .SAN.:[s: : :::_:::::::::.19dt. .... ...:.....:......''''''29Ai SOIL F3.::: :::: :Y45 6 i .:1944 �bpi£:::::::: ::kDSITiD1V(i`: iDEPTI - STRUOTC1Rrf..° : ::`�NSISTLaCr YETNESSI.. . 'S4T ... ..SAPRO::: i RES7 .PASlS ! ':':: sTa'- :(NJii ...::: TEN7JRE:.::::..::::.:..:.:MINE ' Y:::::: :::::COLOR[ta [�DEPT$i:::[CLASS 'i aHDAf�i'.::-[C&LTA:Rii: 24" 3:CLI G, • 1 L `/ L4-t(Y` S e_ Isbk s SP1SLKP1ti Le, , 3S 10 + PS • • . 1 2 . • 3 I 1 4 \l/ s -��-� S 31—k . C. 41 y r DESCRIPTION ATIIAL SYSTEM R R FPA SYSTEM OTHER FACTORS(.1946): Available Space(.1945) 4 S SITE CLASSIrTCATION(.1948): PS Tri- TEE System Typc(s) Site LIAR EVALUATED BY: g Y OTHER(S)PRESENT: , 3 3 - . 3 S COMMENTS: LEGEND use the-jollowin a standard abbreviations I • SOIL .CONVENTIONAL LPP MINERALOGY/ LANDSCAPEPOSTDON CROUP TEXTURE .1955 LTAR* .1957 LTAR* CONSISTENCE STRUCTURE ' CC(Concave Slope) I S(Sand) 1.2-0.5 0.6-0.4 NEXP(Non-a¢rensive) G(Single Gat) CV(Convex Slope) LS(Loamy Sand) SE)G(Slightly Expansive) M(Massive) D(Dainago Way) EXP(Expansive) CR(Crumb) DS(Debris Slump) II SL(Sandy Loam) - 0S-0.6 OA-03 DR(Granular) FP((flood og FS(Foot Plain) I.(Loam) _ (Subtol&Blocky) °pe �K(Angular Blocky) H(Head Slope) III , SCL(Sandy Clay Loam) 0.6-03 03-0.15 PL(Platy) L(Lia®r Slope) SiL(Silt Loam) PR(Prinnatic) N(Nose Slope) CL(Clay Loam) R(Ridge) SiCL(Silty Clay Loam) MOIST S(Shoulder Slope) Si(Slit) T Cremate) VFR(Very Friable): N5(N®.m&y) IV SC(Sandy Clay) 0.4.0.1 01-0.05 FR(Pliable) SS(Slightly Surly) SiC(Silty Clay) PI(Firm) S(Sticgq, C(Clay) VF7(Ven,Film c Vey Sticky) VS Nay Sticky) 0(Organic) Nmo FFI(Ememely Fuel NP(Nonplmtie) 5P(SIlgely Puns) .*Adjust LTAR due to depth,consistence,structure,soil wetness,landscape,position,wastewater flow and quality. P(Plastic) NOTES - ' VP(Very Nast) . HORIZONDEPTH. In inch=belownanaal soil surface DEPTH OF FILL In inches from land surfs= ItfSTRICI7PEHOZ2OH Thickness and depth from land surface SeLPRO117E - S(mitable)or U(unsuitable) SOIL RTINTSS Inches from land surface to free water or inches flute land surface to soil colon with chmma2 or less-record Mmmil color dip designation CLICcIF1Cd7701 S(Suitable),PS(Provisionally Suitable),orU(Unsuitable) Ewluaticm of saprelite shall be by pie Long-tom Acceptors Rate(LTAR):gal/day/e . 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