Loading...
HomeMy WebLinkAboutEHPR-06-2016-24160.TIF %SI,A THIS IS NOT A PERMIT Case # EHPR-06-2016-24160 CATAWBA COUNTY HEALTH DEPARTMENT D`� J'"i 0 • � V PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES • 1842 sw Environmental Health Plan Review - Septic Malfunction , x.404 •"r AUTH_CONST- SEPTIC_MALFUNCTION ` ; `' f: Applicant DENNIS CALDWELL,2019 STARTOWN RD, HICKORY NC 28602 H:8283456580 C:8283082758 HOME:8283456580 Owner PATSY SMITH -CALDWELL,2019 STARTOWN RD, HICKORY NC 28602-8308 H:8283456580 HOME:8283456580 NAME TO APPEAR ON PERMIT PATSY SMITH-CALDWELL SITE ADDRESS: 2019 STARTOWN RD, HICKORY NC 28602 PIN # 372109053559 NAME of SUBDIVISION: Lot# A Section/Block B PROPERTY SIZE: Square Feet 27,442.80 Acres 0.63 DIRECTIONS: Hwy 70, Startown Rd, Go through 1st intersection (Catawba Valley Blvd), 4th house on the Right, across from Scronce's Pump House. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: Starting to back up in the pipes. Having to pump the tank a lot. 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, Carport, 2 Bldg EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: House 35x50, Carport 8x8, Bldgs: 8x12, 10x12 NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 2 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-ehapplianloo 06/23/2016 09:44 Page 1 of 7 y,A CATAWBACOUNTY Case# EHPR-06-2016-24160 G Public Health Department Subdivision < 61i1� �- Environmental Health Division �'�f � PINH 372109053559 's�� PO Box 389. 100-A Southwest Blvd, Newton.NC 28658 1342 5* NAME ON PERMIT: ( PATSY SMITH-CALDWELL),2019 STARTOWN RD, HICKORY NC 28602-8308 ( PATSY SMITH-CALDWELL) Site Address: 2019 STARTOWN RD, HICKORY NC 28602 Property Size: Square Feet 27,442.80 Acres 0.63 Directions: Hwy 70, Startown Rd, Go through 1st intersection (Catawba Valley Blvd), 4th house on the Right, across from Scronce's Pump House. 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:— Signature of Applicant or Agent 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 {M 7 rn'e 1 I1 i m 1 i t r 9 i i i t 1 rlt ir(< 1 -._ r V ' DUI) �i 1.��1V �IhllhthL t:Hl itl �., iIII Iq , i Ili I,;l ija b�iIPFEENAMFtuI i��--��,w.�1l���u�up�0t�u�i d'_�� .�u�u�atl����DATE FEEAMOUNT,��� Authorization to Construct (Repair) Fee 06/23/2016 $300.00 �TOTAL FECSI r I i `,',I H lllj'7 I'nyi i ry : $300 001(1 )1 .2A% . I,.,.lL . ,64!1 11 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) 1 9-ehapplication 06/23/2016 09:44 Page 2 of 7 g / , THIS IS NOT A PERMIT �L flL \—`' ° CATAWBA COUNTY HEALTH DEPARTMENT counr� ;.. Page 1 %„ � Application for Environmental Services g Improvement Permit n Authorization to Construct ❑ Septic Repair n Septic Malfunctions Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment U Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ - Application is for New Construction ❑ Existing Facility Property Address 0/!p c(faaiLaw✓ gel Subdivision Al Lo2 y AK. 0-2/Z Q -2 Lot# Acres Section/Block/Phase Driving Directions to Property , 0 t. / - / L, O Or • /1 " ,/) /- e /:o,✓ ? 71-/r 6_ ' / //Z 24A y ., C, OW e. h — 4CC(-0 sc -/nr .c7C/2Dr/fe . ,P6(ell, /44" C NAME TO APPEAR ON PERMIT?Owner n Applicant ] Contractor Applicant Contact Information I Name Address Phone Cell Phone Owner Contact Information Name r/.)f n/o S �n lc>/�c.,�71/� Address 49/9 Situ/toi.,✓ /22: AZ,-ctory It/C' Phone g Ag-- 3yy'- (,Sfn Cell Phone ��r 308- 02 7,5-7 Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? n Owner Applicant I I Contractor Description of Existing Structures on Site . L9 _ #of Occupants# of Bedrooms *'� Structure Dimensions P Basement I es No Basement Fixtures CI Yes ; No 9,y12 , 10)-I Z The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property m estion. If the answer to any question is "yes", applicant must attach supporting documentation. O Yes no Does the site contain any jurisdictional wetlands? s ®No Does the site contain any existing wastewater systems? 0 Yes pQ 1E Is any wastewater going to be generated on the site other than domestic sewage? CI Yes Q�-K� Is the site subject to approval by any other public agency? --G- ' ICA-N o Are there any easements or right of ways on this property? Describe Existing water supply in use ®-Individual Well ❑ Community 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): v/ (systems can be ranked in order of your preference) � �/ ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other �' y �`�' ti THIS IS NOT A PERMIT �� CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type Primary Residence ❑ New Residence n Addition to Residence # of New Bedrooms *1' Project Description Structure Dimensions # of Occupants Basement ❑ Yes Li No Basement Fixtures in Yes n No n Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling n Yes n No Plumbing n Yes ❑ No Describe Plumbing Needed I Multi-Family Residence#Units #Bedrooms per Unit*j' Total#Bedrooms *t Structure Dimensions n 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 n 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 n Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled n 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. ( 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 maybe 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. ignature of Owner or Agent , i�ism ��//� Date Ca — n2�-o?.D/6 rinted Name of Owner or Agent D e-it/„,. J ���L�f Catawba County Environmental Health 34.02 / 1 / / / `*... / / / / / + / / / _ •. cs...%j_____77..___,,,,,,...________.:Th/ / /--,,,, ", / / / 9Rrp / ryti / • / /y R� / / • / s's / / / / ) . !. , !a / /.r.-".".N.s.:/ /// / ``A / / / / / / / / / / ✓ / `� / N / / / / / / / / i 7,ki I� A / / / / ! 1`]1 0 ./ / 1 �` / / / / / / / r / / 4 :h \/ / / / / • / / p h / > ryp_ / / CC'/ / `ry\ / / / / / / / :"Thi/ / / / / / / / / , / /r\ , <, i/ f 'ti Parcel: 372109053559, 2019 STARTOWN RD tin=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 06/23/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 372109053559 Owner: SMITH PATSY R Parcel Address: 2019 STARTOWN RD Owner2: null City: HICKORY, 28602 Address: 2019 STARTOWN RD LRK(REID): 47643 Address2: null Deed Book/Page: 1999/0923 City: HICKORY Subdivision: State/Zip: NC 28602-8308 Lots/Block: N B Last Sale: School Information: School District: COUNTY Plat Book/Page: 40/170 Legal: LOT A A BLK B PL 40-170 PL 40-170 Elementary School: BLACKBURN Middle School: JACOBS FORK Calculated Acreage: .630 Tax Map: 130H 05004 High School: FRED T FOARD Township: HICKORY School Map State Road #: 1005 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: HICKORY RURAL Zoningl: R-20 Building(s) Value: $73,800 Zoning2: 01 Land Value: $16,000 Zoning3: Assessed Total Value: $89,800 Zoning Overlay: Year Built/Remodeled: 1950/null Small Area: MOUNTAIN VIEW Current Tax Bill Split Zoning Districts: COUNTY/HICKORY Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710372100J Building Details 2010 Census Block: 3009 WaterShed: null 2010 Census Tract: 011102 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. ©2016, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=372109053559&typ=P 6/23/2016 CATAWBA COUNTY HEALTH DEPARTMENT // `/ Telephone: (828)465-8270pTDD: (828) 465-8200 WLS # )0(73 — 00860 IP V AC Rpr.Prmt. Opr. Prmt. Sys. Type jt r I Well Prmt. Replacement Well Well Rpr. Prmt Owner/Agent tet}`s, q .5 PIN if IN Phone 3 — balq Address a0Iq , k-cr4-o ,Jn R.1 Hickory NIG. a$6oa - R3o? Subdivision Section/Block/Phase Loci/ Lot Size r (D3 Directions: Fro " Hiray '10 J PS" 5-F-e.r�own (U 3rd 4,ovz- 0n Rt 5r,cc, wnw5., twl! Wk,{-e_ cs..rfor'1' LLLru5S iro.r St,eo,nLt. p V aNAQ 5 k0 / Property Address Cr r'.. 6 2. Facility: House ,/ Mobile Home Business Multi-family . Other: Pin Number 3/ a 10 905 35S1 Other . Zoning Approval N N Bedrooms rR q Seats N Employees _ . Application Rate , 3 GPD Flow a LI a Hot Tub or Spa yes/no Special Fixtures Basement yes/no . 100% Repair Area yes/no Basement Plumbing yes/no Water Supply: Private Well Public Semi-Public *********************************** *****************************t********************************************************* Type of System: Trench Bed '� Pum. Pump/Panel Panel LPP Other Septic Tank Size I 0 0 '"' j'q' �9T i',•iz�''y, Nitrification Field: 'Total Square Feet 9 b0 Depth of Stone 0 4 �� Bed Size c0 t Xla Ot 4renchi I 1 I'Vp. Total Length of All Trenches Number of Trenches r Trench Length /_/_/_/ / Feet on Center Maximum Trench Depth Distance of Nearest Well .J O f *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* iii************************************************************************************************************************ Topo I. . ? %n Slope a 141%.,0 ii 1'0 r ( � Texture . )96. '16 S+c r+ow ,1 P Q,�P 91 perks o - Structure r nt��g¢J '/ �1c..„) 3YJ4t.- M ,n . , Clay Min. /y (}� T Soil Soil Depth to Wetness i " 1 Q k-�.S ' ; ro r n r 5 0/ 1 ��Resaic. Ho.. a[ " �, ~� 1 'i. we.. )Available s ace es/no h ' t Az Q n Overall Class S PS U i m :` 1 I ur t-to M pro pa-r fy 0 Comments: u t„lo,1, P �_ v°- f t n't-1l A fib 5' �ro'vx k o rn z -a 1000 3. S �e — 5c, tIor pr..-c.,st -�4nk v ,s lj j-P ne.eoe� o� I161o3 • �/ ( i P cxls4-l�� 1-......, Ic ij l� t J .� . 1 s' * Cka.c-k d t'si-r,6„i-15n Filter Required v,C, f-e.P)°Ce'd I ks r� n 0{- 11 Riser required when 11 +D EX lST'n 13p'e) FD r tank is more than 6 bQ-L e1 Le-c-�iv'n` 4 n a- Prlv�'n� g; ) j �jloc,k'c,�2 p, vJ '( 6f 1-0-ink 6v esitttie nY inches deep. /1 Z +22 I n 8}c 1 er **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** *************************************************************************************************************************** *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility. An Authorization to Construct is valid for (5) five years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. The siting of the well by the Health Department staff is to provide protection from known possible sources of contamination. No volume of water is guaranteed a any site by the Health Department. �rPermit Date S//IA/ •3 EHS r�r fS� � \Owner/Agent rig ,__ A,,, __ , Septic Tank Installed By Date HS i Well Installed By Well Grout Approval Date Well Head Approval Date Date Sample Collected Date of Results Results EHS White-Office Yellow-Owner/Agent Pink-Building Inspection Authorization to Construct /�A CATAWBA COUNTY �/ �0 100A SOUTI-IWEST BLVD Q ti NEWTON, NORTH CAROLINA 28658 RECEIPT svr2'i PHONE: 828.465.8399 U 'Itll Jv Thursday, June 23, 2016 1842 SKI www.catawbacountync.gov PAYOR: Caldwell.Dennis PAYMENTS TRANSACTION NUMBER: TRC-700 3 23-2 3-06-20 1 6 PAYMENT DATE : 06/23/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 06-16-329781 Authorization to Construct (Repair) 5200.00 Fee TOTAL PAYMENTS : S200.00 EHPR-06-2016-24160 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 2019 STARTOWN RD, HICKORY NC 28602 Applicant DENNIS CALDWELL, 2019 STARTOWN RD, HICKORY NC 28602 H:8283456580C:8283082758 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner PATSY SMITH -CALDWELL,2019 STARTOWN RD, HICKORY NC 28602-8308 H:8283456580 receipt 06/23/2016 09:43 Page 1 of 1 1"A CATAWBA COUNTY ��� 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT QMs...P... ,4,„ H 1v v� PHONE: 828.465.8399 \ 1�A"Td� Thursday, June 23, 2016 is L2 sm www.catawbacountync.gov PAYOR: Caldwell, Dennis PAYMENTS TRANSACTION NUMBER: TRC-700324-23-06-2016 PAYMENT DATE : 06/23/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 06-16-329781 Authorization to Construct (Repair) $100.00 Fee TOTAL PAYMENTS : 5100.00 THPR-06-20 1 6-24 1 6 0 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 2019 STARTOWN RD, HICKORY NC 28602 Applicant DENNIS CALDWELL, 2019 STARTOWN RD, HICKORY NC 28602 H:8283456580C:8283082758 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner PATSY SMITH -CALDWELL, 2019 STARTOWN RD, HICKORY NC 28602-8308 H:8283456580 receipt 06/23/2016 09:44 Page 1 of 1