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HomeMy WebLinkAboutEHPR-07-2016-24342 (2).TIF y ,;E Catawba .Couun,ty,�North Caro'l'ina Disbursement Toucher a kk ..,..- ,,:e2O a__, e v y, ..,t ed—, Vendor No. Date 08/09/16 Make Payment To: ��®NO Voucher No(s). Charles Wagner d� ,Z 2304 Snow Creek Rd NE U o� 4rr Hickory, NC 28601 4',S ATTACHMENT Prepared by Julia English Description Amount Refund fees. Repair permit not needed. 300.00 Sub-Total $ 300.00 Food Tax Sales Tax Total $ 300.00 a For Accounting if 4 �.�a s "ti /� �b�:' a�,. ' ���i � � .' �; - � �� � �s v Funtl icp 4411.1 r3 Object 4Pro�ect AmountK 4 se poiy: o,,,..,,� r .tia�a�e.a ..�,: ,....n, dm,,,. ,� x I�.t-.aw,., ...�.,u,��.z. <.<, .. ..,. e:«... .a, fie ,��a�.�<.., <<h; � . -.R� . � , a�� '.l ww�„ X110 �� 580200 ,��6630®0� � Total - The undersigned hereby certifies that the goods or services specified above have been received or performed. Payment has not been previously authorized and this expenditure is a proper charge to the appropriation indicated. The above charge is certified to you for payment. (SIGNATURE-APPROPRIATE OFFICIAL) CATA, Environmental Health - Division of Public Health COUNTY PO Box 389—100-A South West Blvd.-Newton, North Carolina 28658 (828)465-8270—Fax(828)465-8276 tsrth G ww.catawbacountync.gov/environmentalhealth/ AUTHORIZATION OF REFUND Date: 8/9/2016 Case #: EHPR-07-2016-24342 Applicant: Charles Wagner Refund Amount: 300.00 Refund Reason: Repair permit not needed. Was able to fix problem. Authorizing Signature: f/ f /A Received By Staff: % q hip c & ? ak1 Date: "Leading the Way to a Healthier Community" Act pTH;7.7:4,, d t • lei n p?,,v " yw iUF/111:17GCLL{il Prcverl.Prouwle.Protect: 1 CATAWBA COUNTY � 100A SOUTHWEST BLVD � NEWTON,NORTH CAROLINA 28658 RECEIPT PHONE: 828.465.8399 C.7 Tuesday,August 9, 2016 /842 san www.catawbacountync.gov PAYOR: WAGNER, CHARLES PAYMENTS TRANSACTION NUMBER: TRC-773464-09-08-2016 PAYMENT DATE : 08/09/2016 PAYMENT TYPE: DV INVOICE NUMBER FEE NAME FEE AMOUNT 07-16-330748 Authorization to Construct (Repair) ($300.00) Fee TOTAL PAYMENTS : ($300.00) EHPR-07-2016-24342 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 3310 43RD AVE PL NE, HICKORY NC 28601 Applicant CHARLES WAGNER, 2304 SNOW CREEK RD NE, HICKORY NC 28601-7407 H:8282565633 **NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 08/09/2016 11.22 Page 1 of 1 �13A O� THIS IS NOTA PERMIT Case # El- PR-07-2016-24342 CATAWBA COUNTY HEALTH DEPARTMENT 0 U PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES •rt /842 sM Environmental Health Plan Review - Septic Malfunction .a 3• o+ �o r� r AUTH_CONST- SEPTIC_MALFUNCTION 0 a� Applicant CHARLES WAGNER, 2304 SNOW CREEK RD NE, HICKORY NC 28601-7407 H:8282565633 HOME:8282565633 NAME TO APPEAR ON PERMIT CHARLES WAGNER SITE ADDRESS: 3310 43RD AVE PL NE, HICKORY NC 28601 PIN # 372408991713 NAME of SUBDIVISION: OLLIE WAGNER Lot# 6/A Section/Block PROPERTY SIZE: Square Feet 20,037.60 ,Acres .460 DIRECTIONS: from Sulpher Springs Rd, turn left on 43rd Av PI NE, last mobile home on left PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Community Well DESCRIBE WORK: sewage on 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: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF mobile home EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 16 x 70 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: 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 II property lines and corners and making the site accessible so that a complete site evaluation can be performed. .7 Date: _ Signature of Applicant or Agent An Environmental Health Specialist will contact you within 5 working day of application dat If you need further information or assistance please call 828-466-7291 AREA2 L9-ehapphcation 07/21/2016 11:56 Page 1 of7 sN3 _. CATAWBA COUNTY Case# EHPR-07-2016-24342 `Q r 2 Public Health Department Subdivision OLLIE WAGNER . -t� �� Environmental Health Division PIN# 372408991713 PO Box 389. 100-A Southwest Blvd.Newton,NC 28658 /8,'1, tm NAME ON PERMIT: (CHARLES WAGNER), 2304 SNOW CREEK RD NE, HICKORY NC 28601-7407 ( CHARLES WAGNER) Site Address: 3310 43RD AVE PL NE, HICKORY NC 28601 Property Size: Square Feet 20,037.60 Acres .460 Directions: from Sulpher Springs Rd, turn left on 43rd Av PI NE, last mobile home on left -711""' Nelld iiP7t71 riNp � 7. •c �' +lithtlggirTlAiiA1 � rd; FEEAME0 •o,• rmfhitIlliaiillhlq,1 u tp_ATEN1FEEMOUNT - Authorization to Construct (Repair) Fee 07/21/2016 $300.00 ,II'i I;i 1, �, TOTALFEES t1q *It,I°41111'llfli IIIIIIIIIl jIl61t� iillill'! lliilll!iµ' s30000ll��f � ,ts I ilk. f b ix I{ Ir � t t1i Ili6t:�u . .41Hh4lhttit nt,hiu,trL :,t.uht! Iilia:1 . .'iilll@'' ;tart:I- ...%ild 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-chapel icatinn 07/21/2016 11:56 Page 2 of 7 CATAWBA THIS IS NOT A PERMIT coou�1vCATAWBA COUNTY HEALTH DEPARTMENT „e„,:ca,e Application for Environmental Services Page I 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) E Application is for New Construction ❑ Existing Facility ❑ Property Address 5 /4 i) .'( � }}1 Subdivision ��„C keen,t,• 4, e t' �'� /'z5 J Lot# Acres Section/Block/Phase Driving Directions to Property - .073/4 ch4-24. 3 O-,J �. 1'?r ',�� ,� &I/2/7", et k p cs� NAME TO APPEAR ON PERMIT? [a-Owner ❑ Applicant ❑ Contractor Applicant Contact Information Q Name �dE j * rJ1 / t+ C1! !9 1� . -The c� 1 Phone ss ��l a '��` '� 1 �I t Cell Phone Owner CodfaclInformdon� Name Address Phone Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site , aim hi--e- -y„tiQ 3_ #of Bedrooms *f Structure Dimensions /(p '1b # of Occupants g Basement ❑ Yes T/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 any question is "yes'', applicant must attach supporting documentation. ® Yes G3 No Does the site contain any jurisdictional wetlands? el}fYes ® No Does the site contain any existing wastewater systems? ID Yes Cd'N/o Is any wastewater going to be generated on the site other than domestic sewage? El Yes I 4N-o Is the site subject to approval by any other public agency? ® 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 ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes Fa/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 0 Alternative 0 Conventional ❑ Innovative 0 Other 0 Any CATAWBA THIS IS NOT A PERMIT • . COUNTY CATAWBA COUNTY HEALTH DEPARTMENT 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 ® No ❑ Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling Ti Yes in 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.) ❑ 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 Ti 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. lfstructure 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 evaluationat / can be performed. (1- ? Signature of Owner or Agent � -"Zi ,cw`2 w'i Yt.Jt Date Printed Name of Owner or Agent Catawba County Environmental Health i \--; iint\,. „). C, e (7:7 t: 4(c• # 120 es'? �. •18.53 • q� • C"--.. "Iu000... . 130' . N ,6, .. • 69 X22' a. k !dIiBIlflliNl 1ilNlilllit . '\IIIIIII4111111111%ll..0°llr' -a ail. . 111140r . 1v� (337) A. \ . .••••" • Parcel: 372408991713, 3310 43RD AVE PL NE 1 in=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 07/21/2016 Parcel Report Page 1 of 1 • Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 372408991713 Owner: WAGNER CHARLES JUNIOR Parcel Address: 3310 43RD AVE PL NE Owner2: WAGNER ALLIE 0 City: HICKORY, 28601 Address: 2304 SNOW CREEK RD NE LRK(REID): 36989 Address2: null Deed Book/Page: 1381/0018 City: HICKORY Subdivision: OLLIE WAGNER State/Zip: NC 28601-7407 Lots/Block: 6-N null School Information: Last Sale: Plat Book/Page: 20/57 School District: COUNTY Legal: LOT 6-A 6A PL36-6 & PL 20-57 PL 20-57 Elementary School: SNOW CREEK Middle School: ARNDT Calculated Acreage: .460 Tax Map: 0700 00018M High School: ST STEPHENS Township: CLINES School Map State Road #: null Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: ST STEPHENS Zoningl: R-20 Building(s) Value: $0 Zoning2: null Land Value: $10,700 Zoning3: null Assessed Total Value: $10,700 Zoning Overlay: null Year Built/Remodeled: null/null Small Area: ST STEPHENS/OXFORD 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 #: 3710372400J Building Details 2010 Census Block: 1030 WaterShed: null 2010 Census Tract: 010301 Voter Precinct: P29 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=372408991713&typ=P 7/21/2016 { CATAWBA COUNTY HEALTH DEPARTMENT NEWTON, NORTH CAROLINA COMPLETION PERMIT FOR SEPTIC TANKS PERMIT N° 00637 (.rte �,,(eA �"' DATE : 6//075 OWNER P,�,49iLP12. Gr - ADDRESS BUILDING CONTRACTOR SUBDIVISION c 47ct-c (jt.H LOCATION 1144/1 ,941n4,4j, + 4.1;',,--�jrn-in d-f/ nree, Q y LOT # LOT SIZE 0 BLOCK OR SECTION C .1- HOUSE ( ) MOBILE HOME (/ BUSINESS ( ) OTHER ( ) FHA-VA LOAN ( ) SEPTIC TANK: (SIZE /(yll-D GALS) WATER SUPPLY : NO. BEDROOMS NO FIXTURES INDIVIDUAL PUBLIC GARBAGE DISPOS L UNIT:YES (�( NO ( ) IF WELL, TYPE : BORED DRILLED DUG AUTO WASHING MACHINE : YES ( NO ( ) DISTANCE FROM SEPTIC TANK OR NEAREST NITRIFICATION FIELD: rf74) SQ .FT . POLLUTION : FT. 1) NUMBER OF LINES 3 SEPTIC TANK INSTALLED BY: 2) LENGTH AND WIDTH OF LIMES ��te44 reeMi Yr2 ti' \3 t 3 ( )&6/ ) PERMIT FEE a) BED SYSTEM ( ) CERTIFICATE OF CO LETION : b) TRENCH SYSTEM ( � �t- ,.ete"/1/,/ 3) DEPTH OF STONE IN ANES 1.1/ _ REMARKS : ADEQUATE FALL (GRADE) ON: 1) BUILDING (HOUSE) SEWER LINE : YES (1) NO ( ) 2) NITRIFICATION LINES : DATE INSTALLED: YES ( �) NO ( ) `` SEPTIC TANK LAYOUT IJ x a m W H 0 '' a (M J/C klEALTILDEPARIMENI_COP_Y CATAWBA COUNTY HEALTH DEPARTMENT i G��7 IMPROVEMENT PERMIT FOR SEPTIC TANKS �/ Permit No. 6:448 NAYX OF OWNER ���l U) a efri, DATE 2/'9 3J(X ADDRESS OF OWNER �j PHONE 'IAME OF CONTRACTOR ADDRESS . �Qo� nr fe Vv ,C...4-.4.0-6 ,41/440 &,AZA iUBDIVISION Lir[J9 p.. . L/Jil'.�i&j LOT NO. 6 74 SECTION OR BLOCK _ .0T SIZE Vel , VA LOAN Septic- Tank Contractor must follow all !OUSE ( ) MOBILE HOME F(1%' BUSINESS ( ) OTHER ( ) Detai .f this permit (layout) IO. BEDROOMS ( ) NO. FIXTURES ( ) SEPTIC TANK LAYOUT ;ARBAGE DISPOSAL UNIT: YES ( ) NO ( ) 'LUMBING UNDER BASEMENT FLOOR: YES ( ) NO ( ) IIZE OF TANK 1600 LIQUID GALLONS NITRIFICATION FIELD: Y 1. Number of lines .3 IPP 2. Length and width of lines: a. Bed Systemft. b. Trench system ;'j C3 ' 110) ft. 3. Total Depth of stone 4 'y o inches ;FLOODWATER INTERCEPTOR DRAIN: [ (IF REQUIRED) �// _ TATER SUPPLY: PRIVATE Q( ) PUBLIC ( ) IWNER NOTIFIED TO CHECK ONING: YES ( NO ( ) 7(J/A9 IWNER AGREES WITH LAYOUT: YES (II) NO ) 'WNER AGREES WITH SPECIAL INSTRU IONS: YES ( ) NO ( ) '• OR CONTRACTOR SIGO RE A �// -' E MIT FEE $ JteiA / I ERMIT VOID AFTER 3 MONTHS FINAL APPROVAL OF THIS SEPTIC TANS SYSTEM BY M'ROVEMENT PERMIT ISSUED BY THE HEALTH DEPARTMENT SHALL INDICATE THAT THE ANITARIAN ,if�_ ,...t0,44/ SYSTEM HAS BEEN CONSTRUCTED ACCORDING TO THE STANDARDS SET FORTH IN THE CATA W BA COUNTY SEWAGE DISPOSAL REGULATIONS, BUT IN NO WAY HEALTH DEPT. COPY SHALL BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION VATISFACTORILY FOR ANY GIyEt4 OIL CLASSIFICATION: SUITABLE ( ) PROVISIONALLY SUITABLE ) UNSUITABLE ( ) ITE FACTORS: . SLOPE (%) S - PS - U 7. SOIL PERMEABILITY S - PS - U . SOIL TEXTURE (12-48 IN.) S - PS - U UNDER 60 MIN. - OVER 60 MIN. SANDY, LOAMY, CLAYEY 8. OTHER S - PS - U . SOIL STRUCTURE (12-48 IN.) S - PS - U (SPECIFY) . SOIL DEPTH (IN.) - S - PS - U 9. SOIL SERIES: . RESTRICTIVE HORIZONS (IN.) S - PS - U A. CECIL ( ) B. HIWASSEE ( ) (IMPERVIOUS STRATA, ROCK) C. MADISON ( ) D. APPLING ( ) . SOIL DRAINAGE - GROUNDWATER S - PS - U E. PACOLET ( ) F. FLOOD PLAIN ( ) (EXTERNAL - INTERNAL) G. 2-1 CLAY SOIL H. OTHER-SPECIFY CATA,WBA COUNTY r RihlieHealth Depaiiment • Case# WLS2006-01848 i .i r Subdivision t '• Environmental Health Division Subdivision OLLIE WAGNER � :W PO Bus 339. 100-A Southwest Blvd.Newton.NC 28658 Sect/BUM/Lot it 6-A (828)465-8270 FAX(828)465-3276 TDD(328)465-8200 PIN# 372408991713 Applicant/Owner: CHARLES WAGNER �J\ Site Address: 3310 43RD AV PL NE HICKORY NC Property Size: SF 0.46 ACRES Directions: FROM SULPHUR SPRINGS RD/TURN ON 43RDAVE PL NE/ LAST MOBILE HOME ON LFT Catawba Coun Health De•artmes_e. a-ionPermit (it 4v ( r C7 6f • System Code SIT System Type: 5/ Description: 1 X 0 Un( 4"Pg Types V and VI systems expire in 5 years. (In accordance with Table Va) Owner must contact health department 6 months prior to exiration for permit renewal. PERMIT CONDITIONS: 1. Performance: System shall perform in accordance with Rule.1961. II. Monitoring: As required by Rule. 1961. III. Maintenance: As required by Rule. 1961. Other: Subsurface system operator required? Yes No 11,/- If 1/If yes, see attached sheet for additional operation conditions, maintenance and reporting. IV. Operation: This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and All conditions of the Improvement Permit and Construction Authorization. (l'ht. *tit, 12 _�y a 6 System Installer Installation Date t onzed b a Agent Date of Operation Permit Issurance Form F P-\Tidemcr Fnnnr\ilt}y'cue.rui ,.--;;;--7-..•:‹ CAT:1WBA COUNTY ; /_':; `:.7, Public Health department Case# WLS2006-01848 I: .,,,(1,,' :,F.nviromnental Health Division Subdivision OLLI WAGNER ' ':'1i+Wt/ PO Box 389,100-A Southwest Blvd,Newton,NC 28658 Sect/BL/Ph/Lot# 6-A \moi- ,' r878 465-8270 FAX(828)465-8276 TDD(828;465-8200 �,,.,� _ ) PIN# 372408991713 Applicant/Owner CHARLES WAGNER Poc4k'CI Se-- Site Address: 3310 43RD AV PL NE HICKORY NC Property Size: SF 0.46 ACRES Directions: FROM SULPHUR SPRINGS RD/TURN ON 43RDAVE PL NE/ LAST MOBILE HOME ON LFT Improvement Permit Permit Valid For: Five years No Expiration Facility(Residential): Mobile Home House Mobile Home X Multi-Family Bedrooms 3 New? _ Addition? Projected Daily Flow g.p.d Water Supply Private Well? Public? Semi-Public? Basement: N Basement Plumbing: N HotTub/Spa: N Special Fixtures (explain): Proposed Wastewater System: Type: Proposed Repair: Permit Conditions: Owner or Legal Representative Signature: Date: Authorized State Agent: Date: The issuance of this permit by the Health Department 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 13uildin 2 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 Sewer Treatment and Disposal Systems' (ISA NCAC ISA .1900). Neither Catawba County nor the Environmental Health Specialist warrants 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) x See site plan and additional attachments In ) //II Proposed Wastewater System: +}, Type: lilt Wastewater Flow 3 b 0 g.p.d New Repair 17 Expansion Soil LTAR: g.p.d./ft2 Type of Facility: 1 f51' Ao1'. /{""- Basement: N Basement Plumbing: N HotTub/Spa: N Special Fixtures (explain): Wastewater System Requirements Tank Size: Septic Tank l gal Pump Tank gal Grease Trap gal Drainfield: Total Area: goo sq ft Total Length: ft Maximum Trench Depth IC in , Trench Width ft Minimum Soil Cover /2" Minimum Trench Seperation s ft Distribution: Distribution Box Serif lDisiribution ive— Pressure Manifold LPP Other Additional Specifications: Authorized State Agent: (2)-$ /94/ Date: /L-N -0 L Permit Expiration Date: «" N ( I have read and accept the specifications and all conditions of this permit as indicated. Owner or Legal Representative Signature: See OI,....( eci Date: rr Form B a At 12 AT id nnarkV5,n,sV-iLtavv.rm V V 12.-L DEC-15-2006 15:21 , CATAWBA COUNTY GOUT 1 828 465 8276 P.01 �v a., t }vb1 c kteal h Depa um�t Case# WLS2006.01848 - Eovuomnrntal Healta Division Subdivision OLLIE WAGNER / P7 Box 389.I00•A Southwest Blvd,Newton,NC 18655 Sec:Mr/Ph/Lot# 6-A \amu / (825)6658270 FAX(828)4654276 TDD(828)465.8200 PIN# 372408991713 ApplicantOwnerCHARLES WAGNER AOSl„C1 Sc Site Address; 3310 43RD AV PL NE HICKORY NC r Y` Property Size: SF 0.46 ACRES Directions: FROM SULPHUR SPRINGS RD/TURN ON 43RDAVE PL NEI LAST MOBILE HOME ON LFT Improvement Permit Permit Valid For: Five years No Expiration Facility(Residential): Mobile Home House Mobile Home X Multi-Family Bedrooms 3 New? — Addition? — Projected Daily Flow g.p.d Water SupplyPrivate Well? Public? Semi-Public? Basement! N Basement Plumbing: N HutTub/Spa: N — Special Fixtures(explain): Proposed Wastewater System: fie: Proposed Repair: Permit Conditions: Owner or Legal Representative Signature: Date: Authorized State Agent: - Cate: The issuance of this permit by the Health Department 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 Sewge Treatment and Disposal Systems' (ISA NCAC 18A.1900). Neither Catawba County nor the Environmental Health Specialist warrants 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) t See site plan and additional attachments I j Proposed Wastewater System: (la,a,U( _Type: t Wastewater Flow 3 6 0 g.p.d New Repair it Expansion Sell LTAR: g.p.d/ft2 Type of Facility: 1 II5 TtAt of 4, /low Basement: N Basement Plumbing: N HotTub/Spa: N Special Fixtures (explain): Wastewater System Requirements Tank Size: Septic Tank gal Pump Tank _ gal Grease Trap gal Dralnflaid: Total Area: $00 sq ft Total Length: ft Maximum Trench Depth 30 in Trench Width ft Minimum Soil Cover 1211 Minimum Trench Separation s ft Distribution: Distribution Box i aeri7PDistribution is Pressure Manifold_ LPP„ Other_ Additional Specifications: (1 X V rray) f� . Authorized State Agent: 1 "'t'/� /24 f f • Date: /L-N-0‘ Permit Expiration Date: 12-11-1 (1 1 have read and accept the specifications and all conditions of this permit as indicated. • Owner or Legal Representative Signature: j /'�' -t ` ' i�6rrc�/7/Date- / c/t .4 As potI c I p k'e1 I p 5 Forma R TI6nmr 1 N PormwLicoo.rvi o rL--'- ------IN CATA}VITA COUNTY tc. Case# WLS2006-01848%dn ..:t Public Health Department-.i.Environmental HealthSubdivision Division OLLIE WAGNER C 7 , ! PO Box 389,100-A Southwest Bhd,Newton,NC 28658 SectBJJP1/Lot# 6-A �,•,: • (528)465-8270 FAX(828)465-8276 TDD(828)465-8200 PIN# 372408991713 Applicant/Owner CHARLES WAGNER Site Address: 3310 43RD AV PL NE HICKORY NC Property S, SF 0.46 ACRES Directions: FROM SULPHUR SPRINGS RD/TURN ON 43RDAVE PL NE!LAST MOBILE HOME ON LFT ® Improvement Permit 0 Authorization To Construct 0 Well Permit SITE PLAN 94-Jill `c .th;.,,, i O a ' I' — 1 b ft on Greta i I ih}/ } 1 rr �.4f a� es. _ of I S t'f to 0 I iI l / C Y'- –'4 I — Srt-tZ'n., Ali LIIO:^/ 1,7 (ram 'fro ��D Any L3, (I \''' \ X 18t 4-I 4 ea) * 30 -iranoti 411 t Iz ( vvsr v` g J'tarj ri- nCh— Jm lX; *17/ 9-n,e w d✓u��z;'.ci.1 ( 6Ocf Scale System components represent approximate contours only. The contractor must flag the system prior to beginning the installation to ensure that proper grade is maintained. Do not install system under wet conditions. This permit is subject of revocation if the site plan or site conditions are altered. 14 /444 - /4 u 6 Authorized State Agent Date Form C R:\Tidemmn/'ormSVttLSaaa.rpt . -r--S , CATAWBA COUNTY 100A SOUTHWEST BLVD ., - a NEWTON,NORTH CAROLINA 28658 RECEIPT v►.1�1 PHONE: 828.465.8399 V\ ,, / Thursday, July 21, 2016 1842 861 WWW.catawbacountync.gov PAYOR: WAGNER, CHARLES PAYMENTS TRANSACTION NUMBER: TRC-744068-21-07-2016 PAYMENT DATE : 07/21/2016 PAYMENT TYPE: Check 1873 NCDL 1301214 exp 6/8/2020 dob 6/8/27 INVOICE NUMBER FEE NAME FEE AMOUNT 07-16-330748 Authorization to Construct (Repair) S300.00 Fee TOTAL PAYMENTS : S300.00 EHPR-07-2016-24342 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 3310 43RD AVE PL NE, HICKORY NC 28601 Applicant CHARLES WAGNER, 2304 SNOW CREEK RD NE, HICKORY NC 28601-7407 H:8282565633 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 07/21/2016 11:55 Page I of 1