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HomeMy WebLinkAboutEHPR-06-2016-24136 (2).TIF �qA G THIS IS NOT A PERMIT Case # EHPR-06-2016-24136 d H CATAWBA COUNTY HEALTH DEPARTMENT 0 F' 0 j PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES' /842 sM Environmental Health Plan Review - Septic Malfunction ;• o - ti AUTH CONST- SEPTIC_MALFUNCTION O+moo : w - Owner CHAD HEATHERLY, 1928 33RD ST NE, HICKORY NC 28601 C:8285141114 NAME TO APPEAR ON PERMIT Chad Heatherly SITE ADDRESS: 1928 33RD ST NE, HICKORY NC 28601 PIN # 372311662516 NAME of SUBDIVISION: Lot 6 6 Section/Block 0 PROPERTY SIZE: Square Feet 16,117.20 Acres 0.37 DIRECTIONS: From Springs Rd, Food Lion will be on the Right onto 25th Ave NE, Left onto 33rd St NE, Go past the trailer park&the S curve. After the curve it is the 3rd house on the Left. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: Septic Inspection said there was a lot of black sludge in the drain field & tree roots have grown through the 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? 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 EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 55x50 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION 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: 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 identificatio nd beling of all . roperty lines and corners and making the site acces • leo that. ete site evaluation can be performed. Date: (r � 7CJ Signature of Applicant or Agent b r' 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-ehappli cation 06/21/2016 15:17 Page 1 of 7 hv,A * CATAWBA COUNTY Case#< EHPR-06-2016-24136 ,C' ' G Public Health Department Subdivision Q G Environmental Health Division ®` .S P1N# 372311662516 /842 sm°°°tl° PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 NAME ON PERMIT: (CHAD HEATHERLY), 1928 33RD ST NE, HICKORY NC 28601 ( Chad Heatherly) Site Address: 1928 33RD ST NE, HICKORY NC 28601 Property Size: Square Feet 16,117.20 Acres 0.37 Directions: From Springs Rd, Food Lion will be on the Right onto 25th Ave NE, Left onto 33rd St NE, Go past the trailer park &the S curve.After the E m uftrve it is the 3rd house on the Left. � I EEN "M 1lf :1 1{i 7Il .'Onto oqi j' b D 1 � OU Authorization to Construct (Repair) Fee 06/21/2016 $300.00 1 EE E "llllldlua�ll a nall'19 u ��ua ' 'k�;' tI� 1� s ' i 'rl 111 � iii:" ...“ • ". u I fl r w q 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) P9-ehapplicaton 06/21/2016 15:17 Page 2 of 7 CATAWBA THIS IS NOT A PERMIT cot,'nrrL lv v ,Tzt 1 CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permit❑ Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility ❑ Property Address'1928 33RD ST NE Subdivision HICKORY NC 28601 Lot# Acres '34 Section/Block/Phase Driving Directions to Property From springs rd it Food Lion is on your right turn on the road immediately after it then turn right again at the next road, follow that road past the trailer park and through the s curve.After the curve it's the third house on the left. • NAME TO APPEAR ON PERMIT? 0 Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name CHAD HEATHERLY Address 1928 33RD ST NE HICKORY, NC 28601 Phone 828-514-1114 Cell Phone 828-514-1114 Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ] Applicant ❑ Contractor Description of Existing Structures on Site # of Bedrooms *t 3 Structure Dimensions #of Occupants 3 Basement S Yes ❑ 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. O Yes 0 No Does the site contain any jurisdictional wetlands? 0 Yes 0 No Does the site contain any existing wastewater systems? C] Yes 0 No Is any wastewater going to be generated on the site other than domestic sewage? ® Yes 0 No Is the site subject to approval by any other public agency? O Yes No Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well ❑ Community Well ❑ Semi-Public Well II 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 XAny CATA`j ]BA THIS IS NOT A PERMIT couv7A, VV 1J CATAWBA COUNTY HEALTH DEPARTMENT u:naai „„„, '�" Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence #of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ® Yes 0 No ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence# Units //Bedrooms per Unit 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 ❑ 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. j' If structure is plumbed but no bedrooms,calculated design flow is required. ** If No, a well permit must be issued with the Authorization to Construct. SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) Improvement Permits issued as a result of this information are valid for 5 years or may be non-expiring under certain specified conditions. An Authorization to Construct issued by this department is valid for(5) five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. I have read this application and certify that the information provided herein is true,complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. // Signature of Owner or Age (J Date L /—! Printed Name of Owner or Agent C' .02/1 t 7/ea f 10--j Catawba County Environmental Health ye r /77- . i' 1•\1/2\ ) n. • tr: 165 o J 11'1 iA' i till ' 165 125 • w i a i t El ..i 1 p t 165 3:::j b 100 8 b 165 dr cl Parcel: 372311662516, 1928 33RD ST NE 1in=50ft HICKORY, 28601 This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim, and shall not be held liable for any and all damages,loss or liability,whether direct, indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 06/21/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 372311662516 Owner: HEATHERLY CHAD EDWARD Parcel Address: 1928 33RD ST NE Owner2: null City: HICKORY, 28601 Address: 1928 33RD ST NE LRK(REID): 54441 Address2: null Deed Book/Page: 3014/0241 City: HICKORY Subdivision: null State/Zip: NC 28601-3238 Lots/Block: 6/0 School Information: Last Sale: $112,500 on 2010-02-19 School District: COUNTY Plat Book/Page: Legal: LOT 6 CRESTLUND SUBD BLOCK 0 Elementary School: WEBB A MURRAY Middle School: ARNDT Calculated Acreage: .370 Tax Map: 159H 15003 High School: ST STEPHENS Township: HICKORY School Map State Road #: 1494 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: HICKORY County Fire District: ST STEPHENS Zoningl: R-1 Building(s) Value: $135,500 Zoning2: null Land Value: $11,400 Zoning3: null Assessed Total Value: $146,900 Zoning Overlay: null Year Built/Remodeled: 1963/1971 Small Area: null 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 #: 3710372300J Building Details 2010 Census Block: 2042 WaterShed: null 2010 Census Tract: 010303 Voter Precinct: P28 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. All rights reserved. • UbC ' , r h flo Citif\D http://gis.catawbacountync.gov/nomap/parcelreport.php?key3723 1 1 6625 16&typ=P 6/21/2016 BA CATAWBA COUNTY A 0� 100A SOUTHWEST BLVD r NEWTON, NORTH CAROLINA 28658 RECEIPT C) rye, °vw), ''G' PHONE: 828.465.8399 a► Tuesday, June 21, 2016 /842 5M www.catawbacountync.gov PAYOR: Heatherly, Chad PAYMENTS TRANSACTION NUMBER: TRC-698203-21-06-2016 PAYMENT DATE : 06/21/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 06-16-329691 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : 5300.00 EHPR-06-2016-24136 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 1928 33RD ST NE, HICKORY NC 28601 Owner CHAD HEATHERLY, 1928 33RD ST NE, HICKORY NC 28601 C:8285141114 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 06/21/2016 15:17 Page 1 of 1