HomeMy WebLinkAboutEHPR-10-09-2410.TIF
THIS IS NOT A PERMIT WLS%/I~~~
CATAWBA COUNTY HEALTH DEPARTMENT
Application for Environmental Services
Improvement Permit ❑ uthorization to Construct ❑ Septic Repair ❑ Septic Expansion ❑
Existing Tank Check ZNew Well Permit ❑ Replacement Well ❑ Well Abandonment ❑
1. Name to Appear on Permit
2. Permit Requested By 't~9 4° Business Phone 3zz / 'Fe-y
Address / 3 5- 4 / 6 ""'1 5 T 1-11,1y AJ U Home Phone ~S i 9 z ~t--
3. Property Owner / Th Business Phone
ZS-O~
Address A7 7 /U (lc 2 .up Home Phone -IP-41
4. Name of Subdivision Lot # Section/Block/Phase
Property Address 4 ~/o (J,5-41 iyo.cJ
Directions to Property:
.~7 X /-/bh~r tZ°i9 T-~t ~oU r,c~7z5 ~y~! GHQt~L i2
Ca4e
r~ i9 Q l7cGU 5 o.~ T/~ ^7211Z? 57 C0eFoe.c.)0,s! D,; 6:o ~r~2o s?
Ai%LLOGs~f ~S Q~~ / ~7P ~C= 1~J
5. Property Size: Square Feet Acres Date Platted/Recorded
6. TYPE OF FACILITY: House Mobile Home- Dimension of Structure _ Bedrooms*
NIIV room that I I I be Intended tol sIji~, ,ii the;tinle O1 ':oll~11lIC( l,~11 01, .101' 1utoI: o)iI>ldcrat1011 ~hOUld the iit tod as a
~~cdroonl a»d count d ~n all al~j~li~:iti~~n>. I h~ r1niilber'Ofb«Irv~nl~_~~~ by :-6oms idl iitificd.on h I~e plans a
hedroonl-at the tn>>', o1'builditj ha,rMIL is ul~c This maN pi \ nt the nr,~l 1u-)i in the--'inure.
Basement: yes/ Water Using Fixtures in Basement: yes/19 No. in Family
Whirlpool Tub yes/no Gallon Capacity
MULTIPLE FAMILY RESIDENCES: Units Total Number of Bedrooms
DAY CARE: Number of Children
RESTAURANT: Seats Square Feet Dining Area _Square Feet Food stand/Meat Market Floor Space
TYPE OF BUSINESS: Number of Employees 1 st 2nd 3rd
OTHER: (Specify)
7. Do you anticipate any additions to Facility? es No
If so, describe: yv~ ~-a~ 1 ti
8. Has any grading, removal, or addition of soil been done to this property? Yes No
If so, describe:
9. Are there easements/right-of-ways recorded on this property? Yes /
10. Is a public water supply available on or adjacent to the above property? Ye No
Check type that is available: [ ] Community well [ ] Semi-public well [4-1!5ounty/City/Township water line
**If No, a Well Permit must be issued with the Septic Permit.**
11. Well Type Applying For: [ ] Individual well [ ] Community well [ ] Semi-Public well
I understand that this is a formal application for a well pennit, Improvement Permit or Authorization to Construct a ground absorption sewage
disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on
this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a
result of this information is valid for 5 years or may be non-expiring under certain specified conditions. Improvement Permits and Well
Permits are transferable, but may be revoked if this information, site plans or intended use changes for the proposed facility. An Authorization
to Construct issued by this department is valid for (5) five years from the date issued and is not transferable.
Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or
structure location should conform to applicable setbacks.
**IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE P OPERTY, THERE I A DDITIONAL CHARGE"
Date /G Signature of Owner or Agen -u
re Kee
-SAT
AWBA COUNTY HEAL`" -D T ENT N°_ 629$
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I Sr
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11111), Pm` ~ut±i, t, tpi: Prt It ~O i Pvo t. -ti 15i, - Rpr_ Punli.
r\djte» ur~►'I.._.~ ~cA et' Phone
1.
ti. °1 l {a r 'v P - Subdi~ io11
sGUlo:' 1cc a;e Lot„ -
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Lut Size .0 Directions 1 -
-'---lG).C?[r_....._... _t ri..l i~~~ C..•v~~ jJi. J~ -~,~3' _fjus,,ysry~, r..f I~ N ~ C~C 1~ i'i~
Facility: douse Mobile Home 131tsrness ~tulti-tamil~Other: Tax Map or Pill Number JS LZ -~_-Z
Other . Zowril- Approval 6' ' f1C.,ea S 7 _
# B drooulS _ Scats # Employees Appllcauon Rate GPD 1!u.~ _E_Ca
Hot Tub of Spa yes;i u pcc al Fixtures lia c meat 1oo RepriI AI. 1 es no ~
I3asernentPlunnlring yeslr 11attr Supply: private lVeil Public semi Public
.t nkr#**6*k*~-#k4.#%***#'_ ~###'k#k.k#a. r•V:d x:fi K:.:k:+k:ism:k:l..h:kt.+F•F•.k.r:k~~i-d::F.h.i:++.kw.#•i.d:>k+r.k.i':.kt.a.~::k=k.K#~###*.k'•k:k~-~tri:.'n+~#A::+:k M:i. i.MFh:+#4#:+r##Y#+#t#####
Type of System: Trench - Bed - Pump-- Pump/Panel Panel ~ L.PP )thee' S
rte ~------r
Septic. Tank Size ( Pump Tani: Size Nitrification Field: Total Square Feet---] Depth of Stone fj/ f~
Bed size French Wid11'1-- - Total L neth of All Trenches Number of Trenches ~
Trench 1.enotliall S' 1 -)5 l ~S / i Feet on Cemcr-CC Maximum Trench D pth_ _ Djsuaiicc: ol'N arest Well X71:
°1)(:) \O T 1Nti'i Al,l, SE '1` "ViIL;N Yi'f"P'k "ES'EL-1_ R"CORD RE(ZUlldl;l) AT C011Ill- F;`I'lf)\
#k#*###~##~k#A:~#F#;k#*1#*:k **>k rk k'k W*>k:kX:k:k:i:;i::i::k:k:k:k:k:+'r::K:Kx:kT;:::k:kM'm::k:k;i::k:i:;i::k:k:r:k:%:ic%k:;:k'+rt>b;K:R'r*+F4::k#;F#rMik#3; kx i.ki;k ai i~N r: i;k a:ka i#+k M+n'#+k#w##+
Toposlope
Texture ~ ~ N~~ i
Structure
Clay Min. l 6 r. D
Soil WC[r1eSS ~J~1... T1 (,..,n il;
Soil DcptliV i j,11 V 1 7 " r
lZc'Stl'1C. Ho%, tli L! I~~" ~
-w -
Available space rno „t ti
Overall Class S ' ti jj ~ r /sf
f
t.ontunclus: ~ t
-AL
'76 -0
l~ Id 5 ~i u
i'~ ~ t ~•~al S
Filter Rcquirc.'d
laser ra:yuzrrcl +tiherr ( .
tatlk is more Illan ti
inches (deep. ~ ~'o T uL
"NO GLIARAN'!'FE t : ; ~rni3T r;-c3~=~'+~,il: f FiF~ b tb'1'E ib:
WILL FtiNC:T10N**
#i#'+#*i##'k####k~#####~:##f.:k#kfir.k:f.f.:k.r:f=#-.+~.K +k A::+F'#5:*e fink oA:r1T*#k*#*M%kMa+ix#k+r%i*d::+a::k~:+'r•#:~##.:F<+k:k,{::k#,e:+kM++fTt :A:k +k++•e#-TTr+#kr#+r#*##
'liniTl'1:i 4'Crneli[ Permit has no expiration date and is t ratisfertlhle. bat Iliav he revoked if site plaits or intended use chutiges fur the projlosed
l wiliiY. A;I Authorization ion cou'striutt is valid ror t:21 tier vc.irs from d;jjc issue d and is not tratisrerable. Well Permit valid for 5 1'i•ars
provided .sily ronditirm,,; do aim dionge. Well location, installation, and protection must meet state and local regulations, and must be
ul. pJwet d and appruvvd I,ry a represatttalive of the Cata[wha Couritl Health Dcpa,rtaat•tai hi'fore any portion of the installation is put into ti.w.
I'lae shin,; of the well by 117e lieallli itt.p;v[nlcn[ Suitt is to prm ide pratcetion from known possible sources of comainilia[ion. No tuturnr of
iaizt Ill, iriialailt t! Illy site vJlcIlealthDul itii7t:at, !
Permit Date l~- C El1S t
Owner/Agcl Septic Tailk Installed By - G- i Date /
LHS - Well Installed Well C -out Approval na! Date---
Welt Heat} A> ici a! l.)atc - - Date Sample Collec:1.ec m F
Dare of Results Results _ EI _
White Urti:e- - tih,r- C eil m. bi 1, a:iui7 1.I7:ntiion ilcTnui }dli~~ Uwnc~r%t1 cni iirrai lluitain~-;a>.>I>o.riC ❑ 1
1 : nL'lu[tlaiti;tt UJ corUCU_i
Catawba County, North Carolina
This map product was prepared from the Catawba County, ABC, Geographic Information System.
N Catmaba County has made substantial efforts to ensure the accuracy of location and labeling information
contained on this map. Catawba County promotes and recommends the independent verification ofany
data contained on this map product by the user. The Count), 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 product or the use thereof by anv person or entity. Legend
Selected Parcel Number: 3734-18-30-9096
1 inch = 60 feet Prepared for:
6--4 9 8 - 1279
_ 2
10 ~ -
J-
!82 ` - - 7 160 81
~O L - - 11
80 160
12 ,
7
L N 79
-0109 13 N - _ 78
UJ - - 14
° - - 77
160 LOO 76
- ~ .....y_ 11160
J- `O
R-20 - ~ ° - - ~ - 74
R- 0 9096x 18 N
73
.8 JL - 19 172 - ' - y
60 16u
_ `'71
60 21~
70 160.
22~ _y-
69 _
N -
r _ - - 9994 23 -N - 6~
i_ 8
- 24 67 - 1952-
-
-
25 -
-o ' 60 66 - - -
2i6 -
THIS IS NOT A LEGAL DOCUMENT ! f Thursday, October 29, 2009 09:30 AM
5
CATAWBA COUNTY NC -,Parcel Report
Informaftri Regarding Selected Parcel(s)
Parcel ID: 3734-18-30-9096
Name: BAKER KEITH S
Name2: KENWORTHY KEELY L
Address: 4710 VERNON DR
Address2: 4
City: CONOVER
State: NC s
Zip: 28613-9752
Account: 130857
t
Calc Acreage: 0.46 i v
Tax Map: 1517 05007 r
LRK: 52952
Deed Book: 2192
Deed Page: 0826
Subdivision Name: BUMGARNER GARDENS
Subdivision Block: H
Lots: 16-20
Plat Book: 14
Plat Page: 61
Building Number: 4 10
Street Name: VERNON DR
Site Zip: 28613
Township:, C
Fire Code: ST. STEPHENS
City Code: COUNTY
State Road:
Total Bldgs Value: $119,200
Land Value: $16,200
Total Value: $135,400
Year Built: 1999
Year Remodeled:
Last Sale Date: 2/17/2000
Last Sale Amount: $128,000
Neighborhood: 59
Watershed:
Watershed Split:
Voter Precinct: P33
E911 District, COUNTY
Zoning: R-20
Zoning2~-•-
Zoning3:
Zoning Split: N
Zoning Overlay:
Zoning District AUNTY
Split Zoning Dist: N
Split Zoning Dist(1): 0
Split Zoning Dist(2): 0
School District: COUNTY
Elementary School: SNOW CREEK
Middle School: ARNDT
High School: ST STEPHENS
School Split: NO
P&Z Case Number:
Census Tract 2010: 010202
Census Block 2010: 1011
Small Area Plan: ST STEPHENS/OXFORD
Agricultural District:
Printed: Thursday, October 29, 2009 09:26 AM