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HomeMy WebLinkAboutEHPR-03-2016-23396.TIF sl$A �G THIS IS NOT A PERMIT Case # EHPR-03-2016-23396 CATAWBA COUNTY HEALTH DEPARTMENT ti 0 ''"* PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES idp • a • •1842 SM Environmental Health Plan Review - Septic Malfunction 30 o II 44 e . # AUTH_CONST- SEPTIC MALFUNCTION o r ; o El � �r Owner BLAKE HUFFMAN, 1692 ADAM ST, CONOVERNC 28613 1-1:8282569138 C:8283203818 HOME:8282569138 NAME TO APPEAR ON PERMIT Blake Huffman SITE ADDRESS: 331 21ST ST SE, HICKORY NC 28602 PIN # 371212872292 NAME of SUBDIVISION: Lot# 2 Section/Block PROPERTY SIZE: Square Feet 16,552.80 Acres 0.38 DIRECTIONS: McDonald Parkway toward Tate Blvd, Sweetwater Rd (21st St SE), Last house on Right PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: Sewage is on the 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: House OTHER DESCRIPTION: DESCRIPTION OF House, Bldg EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: House 38x36, Bldg 12x12 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 4 PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? No 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 l am solely responsible for the proper identificat$n and labeling of all property lines and corners and making the site acces able so that,a,,`�mplete site evaluation can be performed. Date: 0- 15—�(,o Signature of Applicant or Agent [th Y'An Environmental Health Specialist will contact you within 5 working d 's of application date. If you need further information or assistance please call 828-466-7291 AREA2 E9-ehapplication 03/15/2016 14:34 Page 1 of 7 a$• CATAWBA COUNTY Case# EHPR-03-2016-23396 51I^. i•f L Public Health Department Subdivision ! 1;7, Environmental Health Division PIN# 371212872292 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 18. M„ NAME ON PERMIT: ( BLAKE HUFFMAN), 1692 ADAM ST, CONOVER NC 28613 ( Blake Huffman) Site Address: 331 2I ST ST SE, HICKORY NC 28602 Property Size: Square Feet 16,552.80 Acres 0.38 Directions: McDonald Parkway toward Tate Blvd, Sweetwater Rd (21st St SE), Last house on Right ; :r .. 9)G .3 r 9 3a d„ •'`r1'"3 .F 42,11919191107Z--v lu.,lv'.yva '"4 ax.'..1r1 a,T` FEENAMFt,; 4,a,a , - 3°�a . NAME S.t�!DATF, aitW FEE-AMOUNT Authorization to Construct(Repair) Fee 03/15/2016 $300.00 s sS TOTAL FEE . a ra��a, L - �a #l 4 -$ts ,�,� �t�r1'i . t-$o- `3i' `7.a.. a a �� ka ` aU9 00 : y ritbkr ,-aI:I:Iaau' A'M1 <t.l...E..`c U_d r*01MiiMard ' 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-ehappllcation 03/15/2016 14:34 Page 2 of 7 CATAWBA THIS IS NOT A PERMIT COUNTY v � �,., CATAWBA COUNTY HEALTH DEPARTMENT • '� ,. „ ,, : :::' Application for Environmental Services Page 1 Improvement Permit❑ Authorization to Construct n Septic Repair ❑ Septic Malfunction Septic Expansion n New Well Permit n Replacement Well n Well Abandonment ❑ Well Repair n Existing System Inspection (Pre-Approval Required) n Application is for New Construction n Existing Facility F' Property Address / 07/ o��. Se. Subdivision /it' J NC, Z84,0/ Lot# Acres Section/Block/Phase Driving Directions o Property 11 _.I .e ,�i �_0 _ it — . A i % -e,c> -wit s wi 4 NAME TO APPEAR ON PERMIT? Owner n Applicant n Contractor Applicant Contact Information Name IL/pL. �J �o y� Address //9, QdaK k �� C �ZG?J!/✓ 4c Phone 3Q J 9.7;9 Cell Phone 892g4526 8 g Owner Contact Information ' . Name >F3Cd e, W. ..)yvgMC,, Address ��9,/ �(,!!.11,01u GS`• (6702/4-) - Mil Phone vs) 46- 9me) Cell Phone Contractor Contact Information Name License# Address Phone ��/ Cell Phone WHO WILL BE THE PRIMARY CONTACT? n Owner Yi1 Applicant n Contractor Description of Existing Structures on Site r ( ,Blep 3 # of Bedrooms *j' 3 Structure Dimensions jiX J # of Occupants 31 ,.---- Basement ❑ Yes cx No Basement Fixtures n Yes p 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 0 No Does the site contain any jurisdictional wetlands? 'KYes *No Does the site contain any existing wastewater systems? ❑ Yes XNo 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? ❑ Yes 410 Are there any easements or right of ways on this property? Describe Existing water supply in use n Individual Well Li Community Well ❑ Semi-Public Well 53:1 County/City/Township Water Line Is a public water supply available? ** Yes E] 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) '0 Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other XAny CATAWBA THIS IS NOT A PERMIT counrY CATAWBA COUNTY HEALTH DEPARTMENT No Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence Ti New Residence n Addition to Residence # of New Bedrooms *f Project Description Structure Dimensions # of Occupants Basement ❑ Yes L. No Basement Fixtures ❑ Yes L No n Accessory Structure(s) Describe # of New Bedrooms *f if applicable Structure Dimensions # of Occupants Accessory Dwelling Ti Yes n No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence# Units #Bedrooms per Unit*j' Total # Bedrooms *f Structure Dimensions ❑ Food Service Specify Type # Seats Floor Space -Entire Food Service Facility (Sq Ft) #Employees per Shift #of Shifts Dining Area(Sq. Ft.) Ti Business Specific Type of Business Retail Floor Space #of Employees per Shift #of Shifts ❑ Other Facility Type Specify If Church# of Seats Kitchen 7 Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well n Semi-Public Well n Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug Ti 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. 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 Agent e ctht. Date 5 -fir /4 Printed Name of Owner or Agent n44 Catawba County Environmental Health \ \ l \ (352) \ 0311 \ N } ti� (220) -- a -- V.. 4 \ \ (202) j 4, F- �� 0321 �c J <0),0331 v > � s 12031 %), cS0 (78) 4/ r J tilliii '� 0341 �s (201) ...)0 (79) IS. .338 C4" t 0351 Y a+-^. Parcel: 371212872292, 331 21ST ST SE 1 in=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 03/15/2016 Parcel Report Page 1 of 1 • Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 371212872292 Owner: HUFFMAN BLAKE DANIEL SR Parcel Address: 331 21ST ST SE Owner2: HUFFMAN EDNA G City: HICKORY, 28602 Address: 1692 ADAM ST LRK(REID): 91139 Address2: Deed Book/Page: 1775/0055 City: CONOVER Subdivision: State/Zip: NC 28613-8604 Lots/Block: 2/ Last Sale: School Information: School District: COUNTY Rat Book/Page: 30/218 Legal: LOT 2 2 PL 30-218 21ST ST PL 30-218 Elementary School: ST STEPHENS Calculated Acreage: .380 Middle School: ARNDT Tax Map: 123H 02047A High School: ST STEPHENS Township: HICKORY School Map State Road #: 1468 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: HICKORY County Fire District: HICKORY RURAL Zoningl: R-4 Building(s) Value: $30,100 Zoning2: Land Value: $7,700 Zoning3: Assessed Total Value: $37,800 Zoning Overlay: Year Built/Remodeled: 1930/ Small Area: Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers - Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel, Firm Panel #: 3710371200J Building Details 2010 Census Block: 3012 WaterShed: 2010 Census Tract: 011000 Voter Precinct: P35 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. ©2015, Catawba County Government, North Carolina. All rights reserved. CA04\C) tieC� -1 ',(1/ IC rie(triS ejafr bCCti ` `f 4fLQ . o °C- -C9C/1fYtt\- http://gis.catawbacountync.gov nomap/parcel_report.php?key°371212872292&typ=P 3/15/2016 c y'A \ CATAWBA COUNTY �Q ]OOASOUTHWESTBLVD H NEWTON,NORTH CAROLINA 28658 RECEIPT U PHONE: 828.465.8399 Tuesday, March 15, 2016 I g 41:79,1 www.catawbacountync.gov PAYOR: Huffman, Blake PAYMENTS TRANSACTION NUMBER: TRC-638044-15-03-2016 PAYMENT DATE: 03/15/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-326160 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-03-2016-23396 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 331 21ST ST SE, HICKORY NC 28602 Owner BLAKE HUFFMAN, 1692 ADAM ST,CONOVERNC 28613 H:8282569138C:8283203818 **NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 03/15/2016 14:34 Page 1 of 1