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HomeMy WebLinkAboutEHPR-08-2016-24636.TIF THIS IS NOT A PERMIT Case# EHPR-08-2016-24636 -, fi [9 y CATAWBA COUNTY HEALTH DEPARTMENT �' } tom d ,,�� few:* . . K201.1,`1.!, PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES }1 i 1842 sM Environmental Health Plan Review - Septic Malfunction tog ro o:: AUTH_CONST - SEPTIC MALFUNCTION o - Applicant IVAN FLYNN, 4326 SECTION HOUSE RD, HICKORY NC 28601 C:8284044258 Owner RICKY BOWMAN, 857 21ST AVE NE, HICKORY NC 28601 C:8285693155 NAME TO APPEAR ON PERMIT Ricky Bowman SITE ADDRESS: 4326 SECTION HOUSE RD, HICKORY NC 28601 PIN # 372312963092 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 46,173.60 Acres 1.06 DIRECTIONS: Springs Rd NE, Section House Rd NE, Go past Arrowhead Development, 3rd house on the Left past development. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: Backing up in home. Tank has been pumped twice in the last month. 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 32x43, Bldg 14x20 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 2 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: I J-ehappl icor ion 08/31/2016 16:13 Page 1 of 7 sv,• CATAWBA COUNTY Case# EHPR-08-2016-24636 d..7* ©G Public Health Department Subdivision 6 w�; �; Environmental Health Division PIN# 372312963092 a.yl_ PO Box 389. 100-A Southwest Blvd,Newton,NC 28658 /8. ,w NAME ON PERMIT: ( RICKY BOWMAN), 857 21ST AVE NE, HICKORY NC 28601 ( Ricky Bowman) Site Address: 4326 SECTION HOUSE RD, HICKORY NC 28601 Property Size: Square Feet 46,173.60 Acres 1.06 Directions: Springs Rd NE, Section House Rd NE, Go past Arrowhead Development, 3rd house on the Left past development. 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 identificaf} and labeling of all property lines and corners and making the site accessib so that mete site evaluation can be performed. Date: J f ft/ Signature of Applicant or Agent 42///L An Environmental Health Specialist will contact you within 5 working days of application date. If you need further information or assistance please call 828-466-729 t AREA2 1I E 'l4ll # � t;ilDi � 5plur ' lhtli l9hENAM ., " " ltt �I' J' l lDATEy; IgAMOUNTi Authorization to Construct (Repair) Fee 08/31/2016 $300.00 1 i��� I u I tIjl .1 II 11 �. f;rl Jl ti IF[ 1I II t"11 nl I I TOTAEWS �1 ' .f II 11 , , x l f o '"i� ;I,,+ ,�II�G I „!�, i ,I�, a,lw„u(li�iliu(I,Vi1,,. i��l Ir11141i Vil1� :$300:0011. L!ilt a l[��I. 114mki igia t11lik . .a d lti 3 r l .thfiLlWfItIP.l u Cilli nuIHIU•i 6 3 J.IW LtiWit i 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-eliappl i cation ii 08/31/2016 16:13 Page 2 of 7 CATAWBA THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT Ho.;e,oe Application for Environmental Services Page I Improvement Permit❑ Authorization to Construct❑ Septic Repair E Septic Malfunction Septic Expansion ❑ New Well Permit❑ Replacement Well E Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility Property Address 43e 6 Sic-{;(:),A (07,(, e Rd. Subdivision ‘C/tf� 11ND( (nnN ( Lot# Acres Section/Blo Pse Driving Directions to Property l) b 1,l N8S NAME TO APPEAR ON PERMIT? KOwner ❑ Applicant ❑ Contractor Applicant Contact Information Name `T 1�t1� `, L Lon { j Address—(439-b Srzciinn ^�iSC t2 lel'Cr 1 ., ,f)Li avk_2a6l Phone Cell Phone g L.(6 (4- L{ S,7c Owner ntact Information Name ciV- uJ{ kety\ )J. Address ieJf f � - u e ete N� cte tilt) Ly f V L ps< 6 n Phone 6? < 4 �o l ' [55, Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner Applicant In Contractor Description of Existing Structures on Site f -- # of Bedrooms *t —5 Structure Dimensions #of Occupants 2, —i Basement El Yes �o Basement Fixtures 0 Yes O'No le c, )(La__ The Applicant shall notify the local health department upon submittal of this applicati f any of the following apply to the property in estion. If the answer to any question is "yes", applicant must attach supporting documentation. CI Yes o Does the site contain any jurisdictional wetlands? C Yes No Does the site contain any existing wastewater systems? C Yes S94o 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? C Yes ISKO Are there any easements or right of ways on this property? Describe Existing w r supply in use U Individual Well ❑ Community Well E Semi-Public Well ounty/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 0 Innovative 0 Other 0 Any CATAWBA THIS IS NOT A PERMIT eCOUNTY CATAWBA COUNTY HEALTH DEPARTMENT „,,,7;; Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ® Yes ® 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 ❑ Multi-Family Residence# Units #Bedrooms per Unit*j Total#Bedrooms *Ii Structure Dimensions El 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 In Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ 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 ail 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 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 lam 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 . / � s s ate 31 — I 4Printed Name of Owner or Agent 1 n� li".1�p(\e 1 Lip Catawba County Environmental Health U•---- —S • \ \ 8 / 0451 1721 \ i . /1 •• GS° \ \ \ Wei \ 10 \ $ 2611 • N \ 151 lik a l N0 1 � 1 • re---------\ v 'c \ e- d \ \ ....e. 111411 . N° • iiii° °� / . 186 Z° C. Nf i 13i 12$51 O \ \, , ilef r \ \/ 1 \ At Parcel: 372312963092, 4326 SECTION HOUSE 1in=50ft RD HICKORY, 28601 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 08/31/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 372312963092 Owner: BOWMAN RICKY DALE Parcel Address: 4326 SECTION HOUSE RD Owner2: City: HICKORY, 28601 Address: 4326 SECTION HOUSE RD LRK(REID): 63622 Address2: Deed Book/Page: 2375/0386 City: HICKORY Subdivision: State/Zip: NC 28601-9397 Lots/Block: / Last Sale: School Information: School District: COUNTY Plat Book/Page: Elementary School: SNOW CREEK Legal: Middle School: ARNDT Calculated Acreage: 1.060 Tax Map: 2116 01001 High School: ST STEPHENS Township: CLINES School Map State Road #: 1491 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: ST STEPHENS Zonings: R-20 Building(s) Value: $52,000 Zoning2: Land Value: $17,500 Zoning3: Assessed Total Value: $69,500 Zoning Overlay: Year Built/Remodeled: 1955/ Small Area: ST STEPHENS/OXFORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710372300J Building Details 2010 Census Block: 2102 WaterShed: 2010 Census Tract: 010202 Voter Precinct: P33 Agricultural District: Proximity 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. NI3GA- http://gis.catawbacountync.gov/nomap/parcel_report.php?key=372312963092&typ=P 8/31/2016 �A C CATAWBA COUNTY o ;/71 �f� � �� 100A SOUTHWEST BLVD ;, � y NEWTON, NORTH CAROLINA 28658 RECEIPT teaP PHONE: 828.465.8399 V � yvw1' C Wednesday, August 31, 2016 "-1842 sm www.catawbacountync.gov PAYOR: Flynn, Ivan PAYMENTS TRANSACTION NUMBER: TRC-810583-31-08-2016 PAYMENT DATE : 08/3I/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-332217 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-08-2016-24636 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 4326 SECTION HOUSE RD, HICKORY NC 28601 Applicant IVAN FLYNN, 4326 SECTION HOUSE RD, HICKORY NC 28601 C:8284044258 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner RICKY BOWMAN, 857 21ST AVE NE, HICKORY NC 28601 C:8285693155 receipt 08/31/2016 16:13 Page 1 ori