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HomeMy WebLinkAboutEHPR-06-2016-24173 (2).TIF �\;A Co THIS IS NOT A PERMIT Case # EHPR-06-20 1 6-24 1 73 CATAWBA COUNTY HEALTH DEPARTMENT 13 S:41 0 d err g ! PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES /841. SM Environmental Health Plan Review - Septic Malfunction : 1151 AUTH CONST - SEPTIC_MALFUNCTION Contractor LEATHERMAN SEPTIC TANK SVC INC (HARVEY LEATHERMAN), 8420 REEPSVILLE RD RD, LINCOLTON NC 28092 H:828244440913:7044622194 HOME:8282444409F:7044622636 Owner PAT DAVY, 5188 WRIGHT DR, HICKORY NC 28602 C:8283815926 NAME TO APPEAR ON PERMIT Pat Davy SITE ADDRESS: 5188 WRIGHT DR, HICKORY NC 28602 PIN # 279116843195 NAME of SUBDIVISION: WESTOVER WOODS Lot Ir' 3 Section/Block E PROPERTY SIZE: Square Feet 19,602.00 Acres 0.45 DIRECTIONS: 140 West to Hwy 321 South, Exit Hwy 127, Right onto Leslie Dr&go past BB&T bank, Left onot Wright Dr, 2nd house on the Right. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: Tank Only Replacement* Found hole in the lid at septic inspection for sale of home. 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: 61x55 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 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: 69-ehappliention 06/27/2016 10:05 Page 1 of 7 V,A • CATAWBA COUNTY Case 14 EHPR-06-20 1 6-24 1 73 ,SAC n-, Public Health Department Subdivision WESTOVER WOODS m,. —II Environmental Health Division r,�I 6i PO Box 389. 100-A Southwest Blvd Newton,NC 28658 PIN4 279116843195 4% u NAME ON PERMIT: Site Address: 5188 WRIGHT DR, HICKORY NC 28602 Property Size: Square Feet 19,602.00 Acres 0.45 Directions: 140 West to Hwy 321 South, Exit Hwy 127, Right onto Leslie Dr& go past BB&T bank, Left onot Wright Dr, 2nd house on the Right. 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: L- Z'7— 2-or 4- Signature of Applicant or Agent C'>---''—/ 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 '`l'FEENAME: ':'till '4 .,1,,,,.L.':,',',..41;. rr r �° 1 C ;i,111��1 .n jr: EI ll. rNTI,' Pall �..f...w. . ,t_.. _ DATE I.,r FEErA`MOUNT Authorization to Construct (Repair) Fee 06/27/2016 $150.00 !ihlir, 1, �:{1TOTAL FEES . 111 +6ti I'll 150 00 FEES ARE NON-REFUNDABLE ONCE A SITE V1SIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-ehapplicalinn 06/27/2016 09:38 Page 2 of 7 � \'r- , ' THIS IS NOT A PERMIT counr - CATAWBA COUNTY HEALTH DEPARTMENT .� Application for Environmental Services Page 1 � Improvement Permit❑ Authorization to Construct X Septic Repair❑ Septic Malfunction El Septic Expansion n New Well Permit❑ Replacement Well ❑ Well Abandonment ❑ Well Repair Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility Property Address S/519 Lu(ktc.4 6 ö R,of_ Subdivision 1-4-tc116,2y, Ai r Lot# Acres Section/Block/Phase Driving Directions to Property .L - -to .uES Y to .3 ■Zl i t s l to OA,ye 4-ACZA-- 341 i_/3 4 i( t Gam, t. Gv w:.1&t-i NAME TO APPEAR ON PERMIT? ki Owner LJ Applicant ❑ Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name (J D AvLj ItAddress cl c3 W kt ‘,LT Vcil i .. N C— Phone Cell Phone ag zg — 32 j -S 4z.b Contractor Contact Information Name la-11-0i en,,w s S(2:-/)6,- few,i( s.e4 „" ZNG Address 9yfzp iajrpsu,i16 iI OAb Phone L1 n.JGp f N 70,0 Cell Phone Q3?S — 3&1 — 5 9 Z WHO WILL BE THE PRIMARY CONTACT? 17-Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site # of Bedrooms *t 3 Structure Dimensions l lo00 ^ Yi #of Occupants Basement [/Yes E No Basement Fixtures C Yes 9 No (01 The Applicant shall notify the local health department upon submittal of this applicat,on 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 allo Does the site contain any jurisdictional wetlands? ® Yes F_No Does the site contain any existing wastewater systems? 0 Yes 0 No Is any wastewater going to be generated on the site other than domestic sewage? CI Yes 0 No Is the site subject to approval by any other public agency? 0 Yes 0LNo Are there any easements or right of ways on this property? Describe Existing water supply in use (J Individual Well n Community Well Semi-Public Well [Z 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) U ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other )(Any CAT/V.\ isi T13IS IS NOT A PERMIT � CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type n Primary Residence E New Residence C Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement Yes I I No Basement Fixtures rc.i Yes DI No in Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions #of Occupants _ Accessory Dwelling ❑ Yes ❑ No Plumbing Yes ❑ No Describe Plumbing Needed I 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.) In Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts in Other Facility Type Specify If Church# of Seats Kitchen ❑ Yes n No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well In Semi-Public Well n Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug n 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. 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. Signature of Owner or Age 71. Date Z-Z7- ih Printed Name of Owner or Agent Yfr U b A' 1 Catawba County Environmental Health• ivvo%-e----- \ 13 / .. . 900 109 `y 1 0. / 1 20 YES 1 I : 10.60 O(� /(1`�S 1010 � ti aJo . 'O N 10 A\ \\\k sto CSil 05 R1 ;4 Q ss . a$ \ 10000 1f s dk:S' 'K 10000 ,/, S \\pe, \ 0 s' Cli Y� S'%1G�'C 00 $� �/ 101 NI3 c, 3 •63 4( ! Parcel: 2791 1 68431 95, 5188 WRIGHT DR 1in=50ft 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 06/27/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 279116843195 Owner: DAVY PAT G Parcel Address: 5188 WRIGHT DR Owner2: DAVY MARSHA A City: HICKORY, 28602 Address: 5188 WRIGHT DR LRK(REID): 62648 Address2: null Deed Book/Page: 2726/0627 City: HICKORY Subdivision: WESTOVER WOODS State/Zip: NC 28602-8296 Lots/Block: 3/ E Last Sale: $147,500 on 2006-02-01 School Information: Plat Book/Page: 17/226 School District: COUNTY Legal: LOT 3 3E PL 17-226 WESTOVER WDS Elementary School: MOUNTAIN VIEW PL 17-226 Middle School: JACOBS FORK High School: FRED T FOARD Calculated Acreage: .450 Tax Map: 201H 02003 School Map Township: HICKORY State Road #: 2577 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: HICKORY County Fire District: MOUNTAIN VIEW Zoningl: R-1 Building(s) Value: $141,200 Zoning2: Land Value: $21,200 Zoning3: Assessed Total Value: 0 Zoning Overlay: Year Built/Remodele : 1984/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 #: 3710279100J Building Details 2010 Census Block: 2028 WaterShed: null 2010 Census Tract: 011101 Voter Precinct: P24 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 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. . t 190* Olithdli http://gis.catawbacountync.gov/nomap/parcelreport.php?key=279 1 1 6843 19 &typ=P 6/27/2016 friA CATAWBA COUNTY ��� 100A SOUTHWEST BLVD NE NEWTON, NORTH CAROLINA 28658 RECEIPT � 0 4 , PHONE: 828.465.8399 U vll'�� vd�gy Monday, June 27, 2016 ry. is4Z sn+ www.catawbacountync.gov PAYOR: Davy, Pat PAYMENTS TRANSACTION NUMBER: TRC-706434-27-06-2016 PAYMENT DATE : 06/27/2016 PAYMENT TYPE: Check 2186 INVOICE NUMBER FEE NAME FEE AMOUNT 06-16-329850 Authorization to Construct (Repair) $150.00 Fee TOTAL PAYMENTS : S150.00 EHPR-06-2016-24173 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 5188 WRIGHT DR, HICKORY NC 28602 Applicant PAT DAVY, 5188 WRIGHT DR, HICKORY NC 28602 C:8283815926 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Contractor LEATHERMAN SEPTIC TANK SVC INC, 8420 REEPSVILLE RD RD, LINCOLTON NC 28092 H:82824444098:7044622194F:7044622636 receipt 06/27/2016 09:37 Page I of I