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HomeMy WebLinkAboutEHPR-08-2016-24597.TIF A.103A •G THIS IS NOTA PERMIT Case # EHPR-08-2016-24597 � � 2 Qz fi� CATAWBA COUNTY HEALTH DEPARTMENT 05 DV. .0 cJ 'ed y 440- PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 sM Environmental Health Plan Review - OSWP C o ,Ijk IMPROVEMENT 4 ~ y o ti o Applicant DAN VINICIUS KALMAN BARIU, PO BOX 1587, HICKORY NC 28603 C:8282173272 Owner ABERNETHY PARK LIMITED, 2850 SAINT GEORGE RD, WINSTON SALEM NC 27106 NAME TO APPEAR ON PERMIT Dan Vinicius Kalman Bariu SITE ADDRESS: 5144 MEADOW PARK LN, HICKORY NC 28602 PIN # 279012878472 NAME of SUBDIVISION: ABERNETHY PARK PH 12 Lot# 93 Section/Block PROPERTY SIZE: Square Feet 20,908.80 Acres 0.48 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: 360 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/Attached Garage 59x60 #OF NEW BEDROOMS:: 3 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: 09-chappl ication 08/25/2016 13:30 Page I of4 sCATAWBA COUNTY Cased EHPR-08-2016-24597 • .Q'Ili Public Health Department Subdivision ABERNETHY PARK PH 12 4 _ ti Environmental Health Division PINit 279012878472 �� PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 /g.2 sw NAME ON PERMIT: (DAN V INICIUS KALMAN BARIU), PO BOX 1587, HICKORY NC 28603 ( Dan Vinicius Kalman Bariu) Site Address: 5144 MEADOW PARK LN, HICKORY NC 28602 Property Size: Square Feet 20,908.80 Acres 0.48 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 o hat a complete site evaluation can be performed. Date: 2 - 2 S ' C L Signature of Applicant or Agent ll�(�/✓v. K 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 ,an111ior,i N 1' 1Ii a ,d Ili FEENAME' iCeGu��I�ht��l".`�..� maJ i i 4iu ����� 1DATE � , FEE'AMOUNTJ,i Improvement Permit Fee 08/25/2016 $150.00 NI t I'jll �iITOTAL'FE,ESf�IIIIIIITIl��111011911h? t ilPiil��ill�I, :pll�l��E �tll'I���$15010D� ".•' kI11t,LsLI!JLI��L.Vlhi°t. adtiMIII 11CN10 ra w WMPINIlli WilliWJa'>., a_j.4L laial1l11t11Iiii ..:111850 I'rfIGIL"Wiild.w6�.{p'lIll:4: 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 08/25/2016 13:30 Page 2 of 4 W CATAWBA THIS IS NOT A PERMIT coux�'', "ll�J� CATAWBA COUNTY HEALTH DEPARTMENT ND.7o,o Application for Environmental Services Page 1 Improvement Permit Authorization to Construct❑ Septic Repair n Septic Malfunction E Septic Expansion [ New Well Permit[ Replacement Well LI Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) D Application is for New Construction X Existing Facility ❑ Property Address Subdivision A-h-er rt. � P&-riz 5l%H MettdoW -PKfk LA Lot# q1 3 Acres , kP o thCkarg c PC 2?6OL SectionBlock(Phase Joh 4ct l2- Driving Directions to Property criq c-I p, C-(i-e. I ch'ral Rood +a.cce 0, r t5. ris-. 1 Lf +he- -Ltl'S-f- (?-1-1- i Ann At- S-Frr 4-4 Ge 4L r c`j h,4-. r I e 1-0,-e_ -0 rrS-- Olr- -t1-en ad- i-# itte# nffe /mak .0 a its. prop-e Ay C,,1/46t �e cs- ?nc'l NAME TO APPEAR ON PERMIT? ❑ Owner lad'Applicant ❑ Contractor 0=F P-ocia On- VAC . Applicant Contact Information Name f)CIA fin.JCI'S ( lncen. —tciCi " Address IPO Beg i0R-- poi/a,' I Nc. 2'6 03 Phone Cell Phone fLs5- 2,7-- Z2a-L Owner Contact Information fName 4b6.7,t fh7 Pour le th4,/-1-Pd I Address 28 so s U n.-- &tar � Rt.( 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 Site �i Vy A col- #of Bedrooms *j Structure Dimensions #of Occupants . Basement ❑ Yes 40145 Basement Fixtures Q Yes El 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 o Does the site contain any jurisdictional wetlands? CI Yes RPM Does the site contain any existing wastewater systems? 0 Yes CIA Is any wastewater going to be generated on the site other than domestic sewage? ECI Yes GAco Is the site subject to approval by any other public agency? 0 Yes Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well ❑ Community Well ❑ Semi-Public Well 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) 0 Accepted 0 Alternative 0 Conventional ❑ Innovative ❑ Other ny cATAt [ TBA THIS IS NOT A PERMIT COUNTY ,�. , CATAWBA COUNTY HEALTH DEPARTMENT N, hie Application for Environmental Services Page 2 Proposed Facility Type • ❑ Primary Residence ©' ew Residence ❑ Addition to Residence # of New Bedrooms *1. Project Description UU S 6 Structure Dimensions 0j K (9O # of Occupants C1 Basement E. Yes 0.-No Basement Fixtures ® Yes fl No ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes No Plumbing ❑ Yes ❑ No Describe Plumbing Needed FI Multi-Family Residence#Units #Bedrooms per Unit*j 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 El 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 ❑ Community Well Abandonment Type ❑ Drilled El Bored ❑ Dug 7 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. 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 comers and making the site accessible so that a complete site evaluation can be performed. P)- Signature of Owner or Agent 'k t— Date. Z S _ ( i"Printed Name of Owner or Agent D an V kiru (i✓S k ovi vvt,o,n (5q c Catawba County Environmental Health 9s � p° SE lf ll l�1 'dery I'1' 'l t Ilio" ':"jais'04 12 • PSE Ii, 1 93 r rya, f La ;IP m rr A , 45 166 \ 49.34 23.23 v9 \ 9 \ MEq�w PARK LN 61 SE o o o \ C 92 N \ 5 1� 62.36 A \ Parcel: 279012878472, 5144 MEADOW PARK 1 in=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: 279012878472 Owner: ABERNETHY PARK LIMITED Parcel Address: 5144 MEADOW PARK LN Owner2: City: HICKORY, 28602 Address: 2850 SAINT GEORGE RD LRK(REID): 607022 Address2: Deed Book/Page: City: WINSTON SALEM Subdivision: ABERNETHY PARK PH 12 State/Zip: NC 27106-5029 Lots/Block: 93/ School Information: Last Sale: School District: COUNTY Plat Book/Page: 74/59 Elementary School: MOUNTAIN VIEW Legal: LOT 93 PLAT 74-59 Middle School: JACOBS FORK Calculated Acreage: .480 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 Zoning1: R-40 Building(s) Value: $0 Zoning2: Land Value: $24,800 Zoning3: Assessed Total Value: $24,800 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 Goospatial 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 hold 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=279012878472&typ=P 8/25/2016 tr• s55• CA'fAWBACOUNTy Qe # r Case i! IMPV-03-2014-047645 Public Health Department f. ..11•1/4. -i.0 sSubdivision ABERNETHY PARK PH 12 4 Environmental Health Division• 1PINI! 279008974976 ` Y PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 • �_ , LOT# 93 /g.2 ,v ti + !! • • c. G ;OY I° E . NAME ON PERMIT: ABERNETHY PARK LIMITED, 2850 SAINT GEORGE RD, WINSTON SALEM NC 27106 Site Address: 5144 MEADOW PARK LN, HICKORY NC 28602 Property Size: Square Feet 20,908.80 Acres 0.48 Directions: BETHEL 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: IIIG -OTHER NON-CONN TRENCH SYSTEMS PUMP *MAY BE* REQUIRED Permit Conditions: REPAIR SYSTEM SPECIFICATIONS Repair System Required? Required Proposed Wastewater System: 50% REDUCTION Type: WA-ANY SYSTEM WITH LPP DISTR]BUTION 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' (15A 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 03/06/2019 Permit Expiration Date: No grading or construction activity is allowed in areas designatedfar system and repair without approval of the Health Department. IY-ehperntit 03/12/2014 09:47 Page 1 of 3 i P ink'(&-)2-2013-it357 1-14 PA 'nci.s 13, LO 13 ' 5 i i ! e ! u. . C ,'LH _ C(it p7ir.,, t ivoi) , o-I 1 i- v.,,. 0 -- 1:. 11 �)7 1 ��,'( t) --0,4 v •iii LJ 1/,i, t y 1 !7 I . fi �r.•t; r)r ). di' .0 - !0 i i�� 4 t W�\r" SC .;-4-.',. 'ter iP.:p • /\ ///r \ - - .___. . . Kph' - ..\ i. %�3, C.7 g5 -� Se[l Ic, rill i eta \ s. o 4 _ )S) a, (hj" .�. ,7, i Repr;tiic- SOi ieci. /� , 1 6 �`', l5' 0 c • ! It coOf, i 1 "[D. Lig,-7g• �i}eaC}o�,�� ni;,�ti;. . 1 „ 53, LO" q3 DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES _ Sheet of DIVISION OF ENVIRONMENTAL HEALTH PROPERTY ID#: ,ON-SITE WASTEWATER SECTION COUNTY: SOIL/Sll'h EVALUATION n II � pp for.ON—SITE WASTEWATER SYSTEM ,, OWNER Aleet('IR Ill IGYIC LPA1-1-(4 _APPLICATION DATE ILI3I I 13 tett N." )2-20I3`fg357 , ADDRESS: / DATE EVALUATED: 2I'Ity PROPOSED FACILITY. H$t- FINS& PROPOSED RESIGN FLOW(.1949): Lip) . PROPERTY SIZE: 0•48acret ' LOCATION OF Slit: 514L1 IvSti nvu Yrar V_Lai 'ksW. S'1 PROPERTY RECORDED: WATER SUPPLY: 0 Private (0 Public 0 Well D ifini 0 Other EVALUATION METHOD: 0m Auger Baring El Pk (1 Cut • (4 TYPE OF WASTEWATER: Sewage 0 Industrial Process 0 Mixed t (1'x41} PiOI+TFAi 00125 -Lp. EO&T 194 iSEAyf< � '�_zoN 194L_ -- 19th --: ,,St?U... 79QT _ ,;g56::::::;1:::“::::::::::::--:- lit . 144 .,TcOE11a�: F POSmo r II1;PTR s UCTURXE co9'SISTENCFl .' Wtm£SS/ Soak - S.AfaO: trr¢'Yfc CLASS = gfri74 ii ...... TE)Tivi ffiiQi . :MSN>RAi:OGY :: COLOR: DEFTE:' CLASS ._ROIIZ SFL`AR.`-. 0-t U- shy- -�Y,ss, soxe �S L . 1Llt — _ Ui3 • 1 0-la . Ci::: SCK. _ : :. I -fry,ss, soap 2 I > j — 0'3 1 1 6-gel 56K- -Fri 5f. S€A9 03 I - H DESCRIPTION 'INITIAL SYST�d ) REPAIR SYSTEM OTHER FACTORS(.1946): < > Available Spa= 194 Pl 5 I PSITE CLASSIFICATION(.1948): M t ITC,‘ �� EVALUATED BY: MQ%Z✓II"--. 10,(P� System TYP-Yt) \ OTHER(S)PRESENT: v Site LIAR 0'3 \\\ 0,3 COMMENTS: - C tt t) Ma"' br r . EQUu(9 I 1 t K3A CATAWBA COUNTY a' •2 IOOA SOUTHWEST BLVD dCts,495) � V I NEWTON, NORTH CAROLINA 28658 RECEIPT PHONE: 828.465.8399Thursday, August 25, 201684rnvw.catawbacountync.gov PAYOR: Kalman Bari', Dan Vinicius PAYMENTS TRANSACTION NUMBER: TRC-800185-25-08-2016 PAYMENT DATE : 08/25/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-332029 Improvement Permit Fee $150.00 TOTAL PAYMENTS : S150.00 EHPR-08-2016-24597 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 5144 MEADOW PARK LN, HICKORY NC 28602 Applicant DAN VINICIUS KALMAN BARIU, PO BOX 1587, HICKORY NC 28603 C:8282173272 ** NO PEOPLESOFTACCOUNTASSIGNED ** Owner ABERNETHY PARK LIMITED, 2850 SAINT GEORGE RD, WINSTON SALEM NC 27106 receipt 08/25/2016 13:30 Page 1 or 1