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HomeMy WebLinkAboutEHPR-08-2016-24596.TIF 4��A� THIS IS NOT A PERMIT Case# EHPR-08-2016-24596 t-tear;.; CATAWBA COUNTY HEALTH DEPARTMENT in i0 1ii, y PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES r: �t• 842 sM Environmental Health Plan Review - OSWP 4a 4 o r IMPROVEMENT ' f: .. r . ' 1 Applicant IOSIF DAN KALMAN-BACIU, PO BOX 1587, HICKORY NC 28603 C:8282173272 Land Owner ABERNETHY PARK LIMITED, 2850 SAINT GEORGE RD, WINSTON SALEM NC 27106 Paid By DAN VINICIUS KALMAN BARIU, PO BOX 1587, HICKORY NC 28603 C:8282173272 NAME TO APPEAR ON PERMIT IOSIF DAN KALMAN-BACIU SITE ADDRESS: 5148 MEADOW PARK LN, HICKORY NC 28602 PIN # 279012877475 NAME of SUBDIVISION: ABERNETHY PARK PH 12 Lot# 94 Section/Block PROPERTY SIZE: Square Feet 20,473.20 Acres 0.47 DIRECTIONS: Bethel Church Rd, Pittstown Rd, Left onto Abernathy Park Dr, Right onto Orchard Park Dr, Right onto Recent Parks Dr, Left onto Kensington Park Cl, House is on the Left. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 380 WATER SUPPLY: Public Water DE moot rc ase` 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? No 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: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF Vacant Lot EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 4 PROPOSED CONSTRUCTION NSTRUCTURE DIM:: House w/atttached Garage 57x56 OF-NEW BEDROOMS:: 3 # 3 AStMt NTT 140 BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-ehappl IcuGnn 08/25/2016 14:24 Page 1 of 4 Nom+ CATAWBA COUNTY Case# EHPR-08-2016-24596 v(....flit Public Htellh Department Subdivision ABERNETHY PARK PH 12 GJr H Environrncutal Hcalrh Division PINI# 279012877,475 w - YO 8m 389, 100-A Southn'est Blvd,Newton, NC 28658 m NAME ON PERMIT' ( IOSIF DAN KALMAN-BACIU),PO BOX 1587, HICKORY NC 28603 ( IOSIF DAN KALMAN-BACIU) Site Address: 5148 MEADOW PARK LN, HICKORY NC 28602 Property Size: Square Feet 20,473.20 Acres 0.47 Directions: Bethel church Rd, Pittstown Rd, Left onto Abernathy Park Dr, Right onto Orchard Park Dr, Right onto Recent Parks Dr, Left onto Kensington Park Ct, House is on the Left. Improvement Permits issued as a result of tnis 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 W 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 pand labeling of all property lines and corners and making the site accessible hat a complete sit evaluation can be performed. Date: 0 — 2-5 I co Signature ofApplicant or Agent 01i'^ 1- An Environmental Health Specialist will contact you n•ithin 5 working days of application date. If you need further information or assistance please call 828-466-7291 AREA2 tstks2Ittzt****Wtti2kk Y44k;3,Y5iA1iWi}II�attttttMt.y4*****44.M44trt441)**tk4"$W'rit....cw“..0*9MR1,01.* 4YtliYtiVWV pFr "rrELNAM4II '4', ,, • 1 - ' ,. Ili •,11'1, hI'm' IATF j rFFEAMOUNT Improvement Permit Fee 08/25/2016 5150.00 •{ ;v� I �,1 0AA1�lFEw's Nta?I�tulV;i$IIN Ylip41 1UIIr�li1N!iglat7. tAlltlill lIbHI KOKOl4 '; •i tmaWNlII1,t41117tl6iY5r1u7Y4rePWIR111yiGeLnl ttgll,ifl0lplllplNitIlUgtlIA1 yt'x6iitlFN4LEgILSJWad'IW'45fiili: 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-chappIitaunn 08/_5/2016 14:24 Page 2 of 4 qA G THIS IS NOTA PERMIT Case # EHPR-08-2016-24596 CATAWBA COUNTY HEALTH DEPARTMENT ❑' o tot- . c7109' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES r• � . r 1842 sM Environmental Health Plan Review - OSWP 0 _` ya o h IMPROVEMENT o 2 El Applicant IOSIF DAN KALMAN-BACIU, PO BOX 1587, HICKORY NC 28603 C:8282173272 Land Owner ABERNETHY PARK LIMITED,2850 SAINT GEORGE RD, WINSTON SALEM NC 27106 Paid By DAN VINICIUS KALMAN BARIU, PO BOX 1587, HICKORY NC 28603 C:8282173272 NAME TO APPEAR ON PERMIT IOSIF DAN KALMAN-BACIU SITE ADDRESS: 5148 MEADOW PARK LN, HICKORY NC 28602 PIN # 279012877475 NAME of SUBDIVISION: ABERNETHY PARK PH 12 Lot# 94 Section/Block PROPERTY SIZE: Square Feet 20,473.20 Acres 0.47 DIRECTIONS: Bethel Church Rd, Pittstown Rd, Left onto Abernathy Park Dr, Right onto Orchard Park Dr, Right onto Recent Parks Dr, Left onto Kensington Park Ct, House is on the Left. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Public Water DESCRIBE WORK: IP for Purchase* 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? No 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: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF Vacant Lot EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 4 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: House w/atttached Garage 57x56 #OF NEW BEDROOMS:: 4 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: E9-ehapplication 08/25/2016 13:29 Page 1 o114 OA . CATAWBA COUNTY Case it EHPR-08-2016-24596 /`-• :In t Public Health Department Subdivision ABERNETHY PARK PH 12 Q Y Environmental Health Division PIN/I 279012877475 1�� PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 842 sM NAME ON PERMIT: ( IOSIF DAN KALMAN-BACIU), PO BOX 1587, HICKORY NC 28603 ( IOSIF DAN KALMAN-BACIU) Site Address: 5148 MEADOW PARK LN, HICKORY NC 28602 Property Size: Square Feet 20,473.20 Acres 0.47 Directions: Bethel Church Rd, Pittstown Rd, Left onto Abernathy Park Dr, Right onto Orchard Park Dr, Right onto Recent Parks Dr, Left onto Kensington Park Ct, House is on the Left. 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 ite evaluation can be performed. Date: 2- z c- I Signature of Applicant or Agent Vh``'1(jti..1"� 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 *****44****4***444******44*444**4444***4**44.444444*4.4*4*4......444444444*4..44444.4444.44444...4.4.4..4*4. inn, ENAiME !' I' 1i �)r1it�I�Fu%., '.1PllJlll11th ;fI) i'-"!IfTII' n mP1111rr( Ji� i 6 Jlhil I�l�III,II ;I�! II . DATE: ,IIS ILFEEITAMOUNT Improvement Permit Fee 08/25/2016 $150.00 f � i, u, i , •ll • Ta ,���I�� ll„ �q �Iphls;roTA>J FE�Es�;Ilihil�Dluhbilll;�Ili,l1'�1i` � ll!��li4fl "�11111111fl ipilllti�+C��tsoloo,y ii `tire E s„al+)Ulinblikan ,. ,wrA,,w,cuanU94u„„„i„,„.,t '1 ,,I la'uh1L11f Illlt0 `iiiimilJiLiiL'Lilufitowili� FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 89-ehapplication 08/25/2016 13:29 Page 2 of 4 CA TAA CHIS IS NOT A PERMIT coouuNNTTYY „f..et�"'•v..,, CATAWBA COUNTY HEALTH DEPARTMENT Page 1 „e,„5,--, Application for Environmental Services Improvement Permit' Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction Septic Expansion ❑ New Well Permit❑ Replacement Well n Well Abandonment❑ Well Repair T Existing System Inspection (Pre-Approval Required) ❑ . Application is for New Construction Existing Facility 7 nn St Property Address 5I4$ 1eocfok/ Pot/k LN Subdivision /-1-b.ern-e1-h7 Pa_rR. t{fCkory / 1VL 2? coo-2. Lot# qj LI Acres . 4 4-P Section/Block/Phase ehaS2, (2 - 4 Driving Directions to Property of-4 3tt-he 1 Ch✓rCA ICG( f-ctKe a- ri 5 h.- 4-1,en 'ft' ke -4-r 5f 1-eider ) et-fr #-"i 59- e henK-C a- r rs 1'14 J Hn-411 -1-ctfre r'S-1 L� fro- /i--t- I-i. 51-0 e it, Re A 1 eve' av,at +ne pr-Per 5 w,"ut hc- al--I--ke -e-nit o-( NAME TO APPEAR ON PERMIT? ❑ Owner D'ipplicant ❑ Contractor r°aot art 1-0G<- Applicant Contact Information Name ..p.-0 5-;:i DA ; an 1C (nrn 820r v Address po C;o1c Ic - HrClerj , /C 24 coo Phone Cell Phone rd a k' _ 2/-y--3 z W---2- t, --zt. Owner Contact Information Name e-pe rn-e f-h j Pork I iµ^ite c AAddress 2 $5 o y er,`n4- 6eor5 e t ot Phone Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? E Owner ❑ Applicant ❑ Contractor Description of Existing Structures on SiteC.t t n-\ �� # of Bedrooms *j' Structure Dimensions #of Occupants Basement ❑ Yes ❑ No Basement Fixtures Q Yes CI No The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property�;Xi; question. If the answer to any question is "yes", applicant must attach supporting documentation. D `Y� Yes " Does the site contain any jurisdictional wetlands? In Yes I Does the site contain any existing wastewater systems? 0 Yes ®4co Is any wastewater going to be generated on the site other than domestic sewage? O Yes ffLNb Is the site subject to approval by any other public agency? ? Yes Are there any easements or right of ways on this property? Describe Existing w ter supply in use ❑ Individual Well ❑ Community Well ❑ Semi-Public Well 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) V 0 Accepted ❑ Alternative 0 Conventional 0 Innovative ❑ Other IRArty A C A rrAw17th L? A THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT „,„c;;;;;;-.--:, Application for Environmental Services Page 2 Proposed Facility Type • E Primary Residence filNew Residence ❑ Addition to Residence # of New Bedrooms *j Project Description Nov 5 C Structure Dimensions �5 7- K s4. # of Occupants t4 Basement Yes LI- N-o Basement Fixtures ® Yes fl No E Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ' No Plumbing E Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence # Units //Bedrooms per Unit*t Total # Bedrooms *1. 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 Ti Community Well Abandonment Type ❑ Drilled ❑ Bored Ti Dug ❑ Unknown Well Repair Requested Ti Yes —1 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. I 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 comers and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent Date. b 2- 5— (�� Printed Name of Owner or Agent oS D cyi kat", - (iu,(7-/ Catawba County Environmental Health 253.Oq Q Can O 4e :4 its 4111111 '11i toy. ibrit ,-.I .911���,�i'r G.4 y2 a M,I' �'it ,6 gal tv q:, loi�a hl1114it.,'1 ilii;NII. ,111101111111.1111..— — II 249.87 f- IIIIIJ U Z Q z 104.�2 / 0 I- 0 ro _Z S N 2 t` N Y No ryp w 00,1 m • 14.73 SI •L as � 49.34 23.23 vs 9 MEADp"PARK LAI to 10 'Q 0 34.74 /05* co aco • q 3211 V) N-DS /7 N LP 3.05 Parcel: 279012877475, 5148 MEADOW PARK lin=50ft LN 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 08/25/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 279012877475 Owner: ABERNETHY PARK LIMITED Parcel Address: 5148 MEADOW PARK LN Owner2: City: HICKORY, 28602 Address: 2850 SAINT GEORGE RD LRK(REID): 607023 Address2: Deed Book/Page: City: WINSTON SALEM Subdivision: ABERNETHY PARK PH 12 State/Zip: NC 27106-5029 Lots/Block: 94/ School Information: Last Sale: School District: COUNTY Plat Book/Page: 74/59 Elementary School: MOUNTAIN VIEW Legal: LOT 94 PLAT 74-59 Middle School: JACOBS FORK Calculated Acreage: .470 High School: FRED T FOARD Tax Map: Township: HICKORY School Map State Road #: Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: MOUNTAIN VIEW Zoningl: R-40 Building(s) Value: $0 Zoning2: Land Value: $24,400 Zoning3: Assessed Total Value: $24,400 Zoning Overlay: WP-O Year Built/Remodeled: / Small Area: MOUNTAIN VIEW Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: Building Permits for this parcel. Firm Panel #: Building Details 2010 Census Block: 2002 WaterShed: WS-III Protected Area 2010 Census Tract: 011801 Voter Precinct: P23 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=279012877475&typ=P 8/25/2016 ti pA CATAWBA COUNTY ❑� +- rfQ Ce+se IMPV-03-2014-047646 Public Health Department �r a . } pSubdivision ABERNETHY PARK PH 12 Environmental Health Division PINI! 279008974976 1. z PO Box 389, 100-A Southwest Blvd,Newton, NC 28658 'y��' � � LOP/ 94 Li NAME ON PERMIT: ABERNETHY PARK LIMITED, 2850 SAINT GEORGE RD, WINSTON SALEM NC 27106 Site Address: 5148 MEADOW PARK LN, HICKORY NC 28602 Property Size: Square Feet 20,037.60 Acres .46 Directions: RFTIiFL CHURCH RD TO PITTSTOWN RD TO ABERNETHY PARK DR TO ORCHARD PARK DR TO REGENTS PARK DR TO KENSINGTON PARK DR TO MEADOW PARK LN Improvement Permit Facility: Primary Residence - house Permit Category: New Septic Bedrooms 4 WATER SUPPLY: Public Water Basement? No Basement Plumbing? No INITIAL SYSTEM SPECIFICATIONS Permit Valid: Expires In Five Years: _X_ No Expiration: Projected Daily Flow 480 g.p.d Proposed Wastewater System: 25% REDUCTION Type: ILIB -SYSTEM W/SINGLE EFFLUENT PUMP PUMP REQUIRED Permit Conditions: REPAIR SYSTEM SPECIFICATIONS Repair System Required? Required Proposed Wastewater System: 50% REDUCTION Type: IVA-ANY SYSTEM WITH LPP DISTRIBUTION PUMP REQUIRED ***** OPERATOR REQUIRED Landscaping or other site alterations that potentially divert groundwater or surface water toward the septic system, or prevent proper drainage away from the septic system, including the direction of gutter flows or foundation drains,is not approved, and may result in failure to approve the initial system installation,or the suspension/revocation of existing permits. 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 Sewage 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. Megen McBride 03/10/2014 AUTHORIZED STATE AGENT APPROVAL DATE Permit Expiration Date: 03/06/2019 No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department. E9-ehpermii 03/12/2014 09A3 Page 1 of 3 -IP L- IPR L-2o(3-1%356 511 ((1i,zct61o\a Pay k Lr), I-I14ory Pk ase 12, Lor- `VI 1,.64 1 .I!!'r , uf";1 n.• ( ft fel)(1 �.._.M, . 1, rA.b3 4:.) f `(n i_. S;.. p Flci ,.'-> _nC 1S5°O, P9! C... AG re ; -. b U %I.b-i (3.1-Mi..-! 0 ,ra'!LC CA-. OV. , : 0\1-6A/ Co -.4-i ; -^J •v zi,. y D`V(., ''�ij\ , rant}+h i ",'- ,f.:;_3 vio:.;,-`v• 1.0.5.,.D5-- --SII 107I its, SeF',i L n ica rD. 1�� P I Zni�ia.,- Pure 57n iet . \1 s flet,:ii- Noir 5io'= rd. Ur Io :-> 6- 6 ` o '—',', 56. 1---17) -7"----------- i S 1 C I Qvvorsed I 4V-5O' \)1 . ic 1 S'. 11:7W \k �p41 LI- ti DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES Sheet_of__ DIVISION OF ENVIRONMENTAL HEALTH PROPERTY ID#: ,ON-SITE WASTEWATERSECIlON COUNTY: SOIL/Sfl'E EVALUATION ff1i��``11 __++ II for ONSITE WASTEWATER SYSTEM u y OWNER R IaZVNAT1ti' Pay . LI M 11-rd APPLICATION DATE 11131113 a R r U-- 2015- 18356 ADDRESS: 1 DATE EVALUATED: 2141!4 PROPOSED FACILITY: 11 MC 11 MSQ. PROPOSED DESIGN FLOW(.1 49): W g 0 . PROPERTY SILL: O.lib 0Cr1 S LOCATION OF SHL, 5148 M&uw ha dcrk L-h, tirrkDry 14 PROPERTY RECORDED: WATER SUPPLY: 0 Private 151 Pub& 0 Weil 0 Spring I 0 Other EVALUATION METHOD: 0 Auger Boring VI Pit 0 Cut • TYPE OFWASTEWATER: 11 Sewage 0IndusmalProCss 0 lazed i pi]• : ="=_'s - = -:::::_::: _...................__.._......._.............._ _........__..__._ ":""-_sae ::K. _:- :-::::::::._ 3,..,-.:.._::,:-::-..........:......:-::..,..'._:---'''''''''::::::::::::::::Q...........R._........_-...._........---''...._......-------- : _.. _..3 .... YTc kP oT(iC �?dHHR. . ` _,,,..,,„.. _.. _., !T.:1.1;3941)........._...._...----.__......._... ITFl7:FIf F Cr3RS:::::::::.::::.:::-:::::::.-::.:::_::: �.";::::::" ;"" i.art t —_ P+ .8QB7. .1448 ,:SE�JITF.- =ZON :: _1941 ., S941 SQ1;L,:,. 1?.. .956 ;i4.44 .ntorLE- _-' le POSrIIONG. DErm .STdt(JMitigt. .. ....[OKSIST.ENCF1..::: tStl.N.P Si SOIL = Pa0 54 € R 'gTIr LAss SLOY& .:t Y K..... T luRE .. .KINEg OGr CQI:OR - Dge@gi_ cG7iss :.:.... .? 0-N6 C1-,5 -&.c . Sexa 1- . 1 � ��� �fb _ p � i • I Saye r 2 I — y6 ' - 0 3 • a rye- QS 3 y6` — _- 0,22 I 4 pESCRIP'I1O)l ItcrITAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): Available Spam(.945) PS P5 SITE CLASSIFICATION(.1948):( (� �J de- S}rst-m Type(c) �-p�-�,R �1T7- EVALUATED BY: ' ilfAil9 `r-'-) I t� Eel O1HER(S)PRESENT: U . Site LIAR 0,3 o.3 COMMENTS: i F ' r X15 m A 3o' • • IPQ �/. Iae. v 1, SZ / /1 / 5 --C'") ! / S ( 30% DI / , NjXj ,n cc15t \ ` / I I \\& 0 44'A ate CATAWBA COUNTY ET i ��7- 100ASOUI'HWESTBLVD Q � �I NEWTON, NORTH CAROLINA 28658 RECEIPT a!g' 10210 PHONE: 828.465.8399 U yid.; vitzv. Thursday, August 25, 2016 • ar184!ms,- /8 4 rio 2 sn+ www.catawbacountync.gov PAYOR: Kalman Bariu, Dan Vinicius PAYMENTS TRANSACTION NUMBER: TRC-800139-25-08-2016 PAYMENT DATE: 08/25/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-332028 Improvement Permit Fee $150.00 TOTAL PAYMENTS : S150.00 EHPR-08-2016-24596 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 5148 MEADOW PARK LN, HICKORY NC 28602 Applicant IOSIF DAN KALMAN-BACIU, PO BOX 1587, HICKORY NC 28603 C:8282173272 Land Owner ABERNETHY PARK LIMITED, 2850 SAINT GEORGE RD, WINSTON SALEM NC 27106 Paid By DAN VINICIUS KALMAN BARIU, PO BOX 1587, HICKORY NC 28603 C:8282173272 ** NO PEOPLESOFTACCOUNTASSIGNED ** receipt 08/25/2016 13:29 Page I of 1