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Home My WebLink AboutRBPR-08-2016-24485.TIF UoTHIS IS NOTA PERMIT Case # RBPR-08-2016-24485 CATAWBA COUNTY HEALTH DEPARTMENT a��yY,��.�• no• a f0 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES I � ' 1* 842 ra Residential Building Plan Review - Accessory Structure �o�e!a _ a R •-EXSSYSTEM c , Contractor SAME AS OWNER„ Owner GARY HEFNER, 2150 DERBY ST, HICKORY NC 28602 C:828-381-0815 NAME TO APPEAR ON PERMIT Gary Hefner SITE ADDRESS: 2150 DERBY ST, HICKORY NC 28602 PIN # 279115541720 NAME of SUBDIVISION: CLEARVIEW ACRES PL 14-28 Lot# 6 Section/13Iock G PROPERTY SIZE: Square Feet Acres 0.5 DIRECTIONS: 2150 Derby St/Hickory PRIMARY CONTACT: Owner • SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Community Well DESCRIBE WORK: Pvt Detached Metal Carort 24 x 36 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: ACCESSORY STRUCTURE FACILITY TYPE: Accessory Structure OTHER DESCRIPTION: DESCRIPTION OF single family dwelling EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 66 x 42 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 24 x 36 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 a labeling o}eII property lines and corners and making the site accessible so a comple . evaluation can be performed. Date: ✓/}/�i Signature of Applicant or Agent An Environmental Health Specialist will contact you withi work' g days of application date. . ______.---,If yo eed Further information or assistance please call 828-466-7291 % AREA2 .11 ...***i * *****************,**************************************************************** E9-ehapplication 08/10/2016 14:25 Pagel of 4 �JgA CATAWBA COUNTY Case# RBPR-08-2016-24485 !T r n Public Health Department Subdivision CLEARVIEW ACRES PL 14-28 � , "1 Environmental Health Division PIN# '' J' PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 279115541720 `g. :u NAME ON PERMIT: (GARY HEFNER), 2150 DERBY ST, HICKORY NC 28602 ( Gary Hefner) Site Address: 2150 DERBY ST, HICKORY NC 28602 Property Size: Square Feel Acres B'S Directions: 2150 Derby St/Hickory FEENAME DATE 'FEE AMOUNT Existing Tank Check Fee 08/10/2016 $80.00 TOTAL FEES $80.00 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 08/10/2016 14 25 Page 2 of 4 r Et n� THIS IS NOT A PERMIT couNn ---- 1 CATAWBA COUNTY HEALTH DEPARTMENT coin. nom � Application for Environmental Services Page 1 Improvement Permit Li Authorization to Construct❑ Septic Repair Septic Malfunction Septic Expansion n New Well Permit Replacement Well n Well Abandonment n Well Repair n Existing System Inspection (Pre-Approval Required) _ Application is for New Construction ❑ Existing Facility ❑ Property Address 02/57 j2F',r,�i cT-1 Subdivision �/r C,4 Mo (917;401) Lot# Acres n Section/Block/Phase—7 Driving Directions to Property /c/ �n N f jiti7% Y A �� Pr 1 i rtbie NAME TO APPEAR ON PERMIT? I , owner ❑ Applicant ❑ Contractor Applicant Contact Information NameExti,,,m,,r.,7Addres j� rrrd.� h. Phone Cell Phone AOC - Al--2 f Owner Contact Information Name Address Phone I Cell Phone Contractor Contact Information Name Address Phone I Cell Phone WHO WILL BE THE PRIMARY CONTACT? I Owner IT Applicant ❑ Contractor Description of Existing Structures on Site )`Ji,fir' # of Bedrooms *.r 3 Structure Dimensions #of Occupants Basement ❑'Yes n 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�Y o Does the site contain any jurisdictional wetlands? ayes K1-Ne; Does the site contain any existing wastewater systems? CO Is any wastewater going to be generated on the site other than domestic sewage? es 0-N6' Is the site subject to approval by any other public agency? Yes D Are there any easements or right of ways on this property? Describe Existing water supply in use n Individual Well R'fommunity Well ❑ Semi-Public Well n 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 0 Conventional 11 Innovative 0 Other ❑ Any CrAn nD �A THIS IS NOTA PERMIT itacoonzn CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type 'IP-Primary Residence n New�Residence n Addition to Residence # of New Bedrooms *t Project Description /// 4/ (C r in7 Structure Dimensions 0 if of Occupants Basement R-Yes ❑ No Basement Fixtures ® Yes No n Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes No Plumbing n Yes n No Describe Plumbing Needed n Multi-Family Residence#Units #Bedrooms per Unit*t Total#Bedrooms *t Structure Dimensions IP 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 i Other Facility Type Specify If Church# of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type I I Individual Well n Semi-Public Well n Community Well Abandonment Type Drilled n Bored ❑ Dug _ Unknown Well Repair Requested L 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. *My 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 Agent '� Date a/D/l Printed Name of Owner or Agent h �f // • • Catawba County, North Carolina This map product was prepared from the Catawba County,NC,Geospatial Information System. N Catawba County has made substantial of ons to ensure the accuracy of location and labeling information contained on this map.Catawba County promotes end recommends the independent venficauon oi:any data contained nn this map product by the user.The Caraty ofCmawba its employees,agents and personneldisclatm,and shall not M1e held liable foram'and all damages loss or liabthty whether direct,indirect or consequential which arises or may danse from this map product or the use thereof by any person or entity. Selected Parcel Number: 2791-15-54-1720 1 inch=60 feet Prepared for: B r \� 1 10 V 60 2940 / N 6'' 100 -' 4 00 CP 5 \--\\ 1S4 40 1 up cn 0862 �� \ \ 0 \ \\ \ 2525 60 'oo� �z sz 6� �S N.° 2778 \\_____i o �� 3 Q5533 s0 /6 6 161 g3 L `/172 � \) --- \ yrs 621\ G 2513 \ b �000 O oo p 3635 2 621\ o � � o� 1 � �\ 7 150 9 \, \ '\ 1gc8 9567\ } �s 1 14 "0 14 \ 00 3 o cs 2135 00oc0 1 i 0428\ \ 02122 8 i 13 \, -- �- \2456\ � % 'co, o 00 18 jo ^�� T11IS IS NOT LEGAL,DOCUMENT ......„-----\\_\ 'cm Tuu 1 ate Saved: 7/19/2 t 16 c41 1 'M CATAWBA COUNTY HEALTH DEPARTMENT 3375 (704) 468270 Lot Eval._Improve. Permit Repair Permit Cert. of Comp. Permit Oper. Permit_ Own U a 'IC • IJprece:J phone r2g4- 4411 ••re 8150' DcJLi S I- Lf-k 1 Subdivision • Section : ock Lot* Lot Siz _ Directions: 4th „• .. 4* a 6.i, S T a..l� ens," e-. t Facility: House X Mobile Home_ Business_ . Other: Zoning Approval yes/no ft Multi-family other . 100% Repair Area yes/no Bedrooms Seats Employees . GPD Flow Application Rate Hot Tub or Spa yes/no Special Fixtures . REPAIR NOTICE: REPAIRS MUST BE WITHIN Basement yes/no ' Basement Plumbing yes/no . 30 DAYS OR DAYS FROM DATE OF Water Supply: Private_ Public^ . PERMIT. Type of System: Trench Bed T Pump Pump/Panel_Panel_LPP_Other Tank Size: Septic Tank ^ate Pump Tank Nitrification Field: Total Square Feet 1 X(oQ Depth of Stone Ica ' I Bed Size la )t'(0 0 Trench Width Total Length of All Trenches Number of Trenches Individual Trench Length / / / / Feet on Center Maximum Trench Depth Distance of Nearest Well Lot Evaluation: Approved yes/no (Void After 24 months) Tope % Slope Sketch of lot Evaluation Site - System Design - Final Texture Structure /� /• --- .rusFM i til' Y Clay Men. P x d I ) I'NC L L.c Y Soil Wetness Soil Depth J :' Restric. Hoz. at _" ,- •--- -. . - _ ^ AIA Mt--)` MN 61 C. f-ij Available space yes/no f I Overall Class S PS U 1 Comments: �� Rt.pprra, I)rerts)A4Id Mr1-1 h 1e toe it " d I Loicl tudt lorA-b-el old r 1'. set ZfnrNica t • N •C \ **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN THROUGH THE ISSUANCE OF THIS PERMIT** Permit Date g t A (Improvement Permit vo after 60 months) Ov / /Age .77>/ ' ..e sanitariandeeah/£ 4,4 S S Installed B ./%Z,([j r , Date 7--9- / Sanitari /zo/94h aw,,i (Note a 49, ha'•es/information in red or by sketch on 'Slick) White-Office Blue-Bldg. Insp. Comp. .' Yellow-Owner/Agent Green-Bldg. Insp.I.P.