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HomeMy WebLinkAboutEHPR-07-2016-24325.TIF �g � THIS IS NOT A PERMIT Case # EHPR-07-2016-24325 CATAWBA COUNTY HEALTH DEPARTMENT 0j `FF- 0 Utb !�1� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ti' .1.841sM Environmental Health Plan Review - OSWP C11. U U+e iffy :: IMPROVEMENT- AUTH_CONST - EXPANSION -ir.Thi cii4C.ci.R Applicant BILL SELF, 361 DAVE PETERSON LN, VALE NC 28168 C:7042762100 Owner DIXIE BOAT CLUB, INC, 1804 CARRAS ST, CONOVER NC 28613-8318 NAME TO APPEAR ON PERMIT Dixie Boat Club, Inc SITE ADDRESS: 4173 54TH AVE NE, HICKORY NC 28601 PIN # 373512778143 • NAME of SUBDIVISION: Lot# 48 Section/Block PROPERTY SIZE: Square Feet 81,892.80 Acres 1.88 DIRECTIONS: Springs Rd, Left onto Sulphur Springs Rd, Left onto 54th St NE, All the way to the end of the Road on Left. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: IP, AC Expansion is for 4 additional sites. Additional 480 GPD. 12 total hookups to be tied into the system. Per Applicant/Part owner the 12 RV hookups are all that is on this septic system. 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? Yes 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: ** NO STRUCTURE SELECTED ** FACILITY TYPE: Other OTHER DESCRIPTION: DESCRIPTION OF 8 mobile homes, 12 Rv hookups, Pavillion, Bath house EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION 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 and labeliiag of alll,property lines and corners and making the site accessibbe��at a omp ete site evaluation can be performed. /9- /(eDate: 2_ /v- � Signature of Applicant or Agent An Environmental Health Specialist will contact you within 5 working s of application date. If you need further information or assistance please call 82 -466-7291 AREA2 E9-eliapplication 07/19/2016 16:25 Page 1 o14 CATAWBA COUNTY Case a EFIPR-07-2016-24325 Public Health Department Subdivision 6 Vit „'3s, Environmental Health Division PING 373512778143 bo PO Box 389. 100-A Southwest Blvd.Newton. NC 28658 1842 +u NAME ON PERMIT: DIXIE BOAT CLUB, INC ( ), 1804 CARRAS ST, CONOVER NC 28613-8318 Dixie Boat Club, Inc ( ) Site Address: 4173 54TH AVE NE, HICKORY NC 28601 Property Size: Square Feet 81,892.80 Acres 1'88 Directions: Springs Rd, Left onto Sulphur Springs Rd, Left onto 54th St NE, All the way to the end of the Road on Left. t,l111 111119 91011177111(1nii�. 1 p�1L FEENAMEi) liLLISLt.s.auii llstij �: flLDATE ik _FEE,AMOUNT 1 Authorization to Construct Fee (New/Expansion) 07/19/2016 $300.00 Fee Improvement Permit Fee 07/19/2016 $150.00 111,1 oTAt,FEEsCaN11IluilloGliflu i'1l Iitit s lI111 I011Il '11W,. 1i'I:1illl$aso 00 `,� 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) 09-ehapplicalion 07/19/2016 16:25 Page 2 of4 CATA\\ IN THIS IS NOT A PERMIT ►. COUNTY -----� -I% CATAWBA COUNTY HEALTH DEPARTMENT Page 1 ' ,,,....;:a-;--- a Application for Environmental Services g Improvement PermitAuthorization to Construct Septic Repair ❑ Septic Malfunction❑ Septic Expansion New Well Permit❑ Replacement Well ❑ Well Abandonment E.Well Rep r Li Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility Property Address '/ /1 7 3.-y . / v 1- 11‘, // ky Subdivision Lot#PIy7 t ,9 Acres 3 Section/Block/Phase } Driving Directions to Property /.'nn AQ� L r'a fW A- 14 -,A.' _fl St %4 add' d NAME TO APPEAR ON PERNIIT? Owner n Applicant ❑ Contractor Applicant Contact Information / Name A Id Se lf° Address 367 17.a „ p �P,f2j_542/ In vae_ J1 ,is/zs, Phone 70 4/. ,2_7t.)(a b 1 Cell Phone Owner Contact Info mation Name d� e,'tc l 3 o —L e, , 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 #of Bedrooms *'j' Structure Dimensions #of Occupants Basement ❑ Yes [ No Basement Fixtures ® Yes :i No The Applicant shall notify the local health depth lwent 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. C9 Yes loo Does the site contain any jurisdictional wetlands? 19 Yes g9�No Does the site contain any existing wastewater systems? a_Y/Yes Ea !o Is any wastewater going to be generated on the site other than domestic sewage? cry es 0�Ng�o. Is the site subject to approval by any other public agency? C7 Yes C3"No Are there any easements or right of ways on this property? Describe Existing water supply in use WIndividual Well ❑ Community Well ❑ Semi-Public Well �� ❑ County/City/Township Water Line Is a public water supply available? ** [ Yes L/J 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 11 Alternative 0 Conventional ❑ Innovative 0 Other IgCny CO ` "\ 1 l'A THIS IS NOT A PERMIT . rounu , CATAWBA COUNTY HEALTH DEPARTMENT Lice.-- . � Application for Environmental Services Page 2 Proposed Facility Type I I Primary Residence New Residence n Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement n Yes ❑ No Basement Fixtures 0 Yes C2 No Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling n Yes n No Plumbing n Yes U 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 `a, Other Facility Type Specify �7 / . S �V If Church# of Seats Kitchen IT Yes IT 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 ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes n 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 Pe,nits 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. 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I �I 0111 I t IiII I� rs1ll tla _° 1 1 ri 1iAl i+, „j.,l l � t(a I illi� �F� 'I I i tt ...•, I� 11�`� t,t , 11 I t Il�"x l r a+1 I 1 Pr 4 i R � �. ro III �tt 1,, t at 1 q. y - ( I h t 11 1 - r a Yt i Ii ., f I� '1"I t, I { t I1 .iTil t h i i i'T r, p + •'i�I ti11h �� '< 1 , t nl .�J�I'I 7y t t t iii lt'" I I II n t @Ir .01-,t,;�I {g t -.i' Ilyl it .6..I itt,Rl i"' Jk11,i'IOI I(�`.av7n. 1„II li!!IIIJII �1I,1�� �: t:30.'a.' hIa �I V'' 'JOY.. 1• G4 •, II , y it l i•I tp.'':',' 4''.'4i .kd.m II'r�li t gl t tt1�Ws 11� Igf: N It II t Itll I It k tii�•�'. a ;1' ;. 4t � � �tl i ,I I. i queaH leluawuoalnuAiunoo egmelQQ Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 373512776182 Owner: DIXIE BOAT CLUB INC Parcel Address: 4169 54TH AVE NE Owner2: City: HICKORY, 28601 Address: 1804 CARRAS ST LRK(REID): 21344 Address2: Deed Book/Page: 2097/1645 City: CONOVER Subdivision: State/Zip: NC 28613-8318 Lots/Block: 47/ Last Sale: School Information: Plat Book/Page: 16/97 School District: COUNTY Legal: LOT 47 SEC 23 L 47 PL 16-97 PL 16-97 Elementary School: SNOW CREEK Middle School: ARNDT Calculated Acreage: 1.210 Tax Map: 0200 23047 High School: ST STEPHENS Township: CLINES School Map State Road #: TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: ST STEPHENS Zoningl: R-40 Building(s) Value: $1,000 Zoning2: Land Value: $148,100 Zoning3: Assessed Total Value: $149,100 Zoning Overlay: CRC-O,FPM-O Year Built/Remodeled: / Small Area: ST STEPHENS/OXFORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-12-18 Building Permits for this parcel. Firm Panel #: 3710373500K Building Details 2010 Census Block: 1000 WaterShed: 2010 Census Tract: 010301 Voter Precinct: P33 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. AM rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=373512776182&typ=P 7/19/2016 p' ° , CATAWBA COUNTY HEALTH DEPARTMENT /9:2(-11-04--' • • Telephone: (828)465-8270 T D: (828)465-8200 WLS a a q- 60(0 3 Improvement Permit x AC X Repa' Permit. Operitio rm' .V System Type�T6j Well Permit.)( Replacement Well Owner/Agent VI X/C .cy:: � In C. - Phone Address Subdivision Secti°°�/,� Blo�ck/Phase Lott/ • / ite Dir�ections:•/�!1I i t J►i�tys/� , ' (/L Property Address ' ArtZ ._:,, Facility:House Mobile Home Business Multi-family x Other: Pin Number 373.6 1177 ,/3 z Other .Zoning Approval# #Bedrooms II Seats #Employees . Application Rate — GPD Flow 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 X. Type of System: Trench Bed Pump Pump/Panel Panel LPP Other Septic Tank Size 1500 Pump Tank Size 1600 Nitrification Field: Total Square Feet /zoo Depth of St r g/Ache' DOC.' Bed Size tench Width 3-P"- Total Length of All Trenches �U Number of Trenches Trench Length/bp//Ubt�// / /_Feet on Center 7 Maximum Trench Depth S -4'I Distance of Nearest Well 'f/CO/ *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* ******************************stc*******************************************************************************s** ****s* Topo % Slope Texture �• k�1 Structure N. v V , I C Clay Min. • \�� 3 I!' -� t. Soil Wetness `\��^ — ` 0 Soil Depth - .- Restric. Hoz. at " ` l l Available space yes/no Overall Class S PS U Comments: L____ ) p —Cxibb be bac. /l J-1 (Li I ‹`'- ff-- 6/ (; 1-.C3... G;)-- .1.-1- __......1 i+t - 6ti 3-,sof - • ,,. I-adt I /4/.1 kg 49 je UP Sf' agiii 1) e(114114 Filter Required r 4,517S- I l LI- /-3-1 i Clb Riser required when tank is more than 6 y-I, N Q / I /e inches deep. (�F- **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 inteed use changes for the proposed facility. An Authorization to Construct is valid for(5)five years from date issued and is not transferable. ell 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 f om possible s tees of contamination. No volume of water is guaranteed at any site by the Health Department. -7 411 Permit Date z--I Qr c� 3S{,O E . Owner/Agents "_`'_L,.a L,,,,) 7axt-7.3 Septic Tank Ins • '• By i` : , l 4 , Date y- )-c il EHS . Well Installed By ,. Well G • • ppro al I,ate Z'-' Well Head Approval Date Date Sample Collected Date of Results Results EHS Whtffice 6IleG - (� ` r/llo�r OAgent Pink-Building Inspection Authorization to Construct f =,�E,.\ CATAWI3A COUNTY /y°' G.\ Public Health 17epamuenl Case# WLS2007-00637 (.` En viromnemU Health Division Subdivision k / 1 c Box 389,100-A Southwest Blvd,Newton,NC 28658 Sect/BL/Ph/Lot# 47 wL;,i (828)465-8270 FAX(828)465-8276 TDD(828)465-8200 PI4# 373512776182 Applicant/Owner: JOHN F THORNBURG Site-Address: 4169 54TH AV NE HICKORY NC • Property size: SF L21 ACRES /1 Directions: SPRINGS RD/LT ON SULPHUR SP IMG rD1 LF ON 21ST I RT ON 54TH AV/ **GATE IS LOCKED/ WILKING TO CALL ABOVE T G �bV 1 5 SEPT SYSTE INSPECTION REPORT Site/Syst m Diagram rF ttryt oi47,- \ ' L"— - C—, t,- CH, k LI � i Lc, hi �/2 h Type of Facility; House Mobile Home X #Bedrooms 9 13usiness Specify Other Specify Proposed Additions/Accessory Structures: A ft Approved I, Not Approved Reason 4 Evidence of system malfunction: YES NO c System Type/Description II Authorized State Agent: P — P DATE: t )0— 07 Form E NOT FOR LOAN APPROVAL ,nndeu„n,tv'or„t,vma_ _Ii /SBA ? CATAWBA COUNTY an rli 100A SOUTHWEST BLVD RECEIPT �� NEWTON,NORTH CAROLINA 28658 REC T Qtrt nnir—^II Cgicso PHONE: 828.465.8399 CAildr, Tuesday, July 19, 2016 sp, 842 sii www.catawbacountync.gov PAYOR: Self, Bill PAYMENTS TRANSACTION NUMBER: TRC-741751-19-07-2016 PAYMENT DATE : 07/19/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 07-16-330665 Improvement Permit Fee $150.00 EN--n0665101- glil,yl,Illig, ;irg horiz tla on toi,Coristr'—uct1Eee1J1 fly . $30010' (New/Expansion) Fee TOTAL PAYMENTS : $450.00 EHPR-07-2016-24325 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 4173 54TH AVE NE, HICKORY NC 28601 Applicant BILL SELF, 361 DAVE PETERSON LN, VALE NC 28168 C:7042762100 **NO PEOPLESOET ACCOUNT ASSIGNED ** Owner DIXIE BOAT CLUB, INC. 1804 CARRAS ST,CONOVER NC 28613-8318 receipt 07/19/2016 16:24 Page 1 of I