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HomeMy WebLinkAboutEHPR-11-09-2617.TIF THIS IS NOT A PERMIT Case # EHPR- 11-09-2617 CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services 1842 SM Environmental Health Plan Review - OSWP EXS_SYSTEM APPLICANT OWNER CONTRACTOR HENRIETTA HUFFMAN HENRIETTA HUFFMAN 7183 RH RD 7183 RH RD HICKORY NC 28602 HICKORY NC 28602 NAME TO APPEAR ON PERMIT HENRIETTA HUFFMAN Pin#: 277002881546 SITE ADDRESS: 7183 RH RD, Hickory, NC DIRECTIONS: OLD SHELBY RD - TURN RIGHT ONTO HENRY RIVER RD - TURN LEFT ONTO RH RD - 3RD ON LEFT NAME of SUBDIVISION: HENRIETTA HUFFMAN Lot # 2 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 2.00 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure 20 X 35 Bedrooms 2 Basement: No Water Using Fixtures in Basement:No No. in Family 2 Whirlpool Tub : Gal. Capacity: MULTIPLE FAMILY RESIDENCE: Units 1.00 Total Number of Bedrooms DAYCARE: Number of Children RESTAURANT: Seats Square Feet Dining Area Square Feet Foodstand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees Ist 2nd 3rd OTHER: (Specify) Do you aniticipate any additions to Facility? If so, describe: NO Has any grading, removal, or addition of soil been done to this property? If so, describe NO Are there easements/right-of-ways recorded on this property? No Type of Water Supply: Individual Well X Community Well Municipal Semi-Public I understand that this is a formal application for a well permit, 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 transferable and may be eligible for a non-expiring date, but may be revoked if this information, site plans or intended use changes for the proposed facility. A Well Permit and 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. Date: 1)-16- 0 9 Signature of Applicant or Agent ~(vkcL~. n Kc An Environmental Health Specialist will contact you within 2 working days of application date. If you need further information or assistance please call 828-466-7291 AREA2 (FOR OFFICE USE ONLY) Zoning Approval: _Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks AMOUNT Front FEE NAME DATE Side Existin:; Tank Check Fee 11/10/2009 $80.00 Rear TOTAL FEES $80.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional S60 charge 11/10/09 11:02 THIS IS NOT A PERMIT WLS # C~&&-1 6 1- z~ CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Expansion ❑ Existing Tank Check © New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ 1. Name to Appear on Permit Welvl~ a- ^Gc~- 2. Permit Requested By i nI-l i~ 4 U- MG~y' Business Phone 14f4 Address u / C 1 u. 2~UZ Home Phone 3. Property Owner e4,1r;-e a rya h Business Phone Al,q Address -11* :T IC-1-1 -eca o/ t lz A_/C- Z e6,0 Z- Home Phone 92-X- 3 2-1- t/G33 4. Name of St;~,dlvi ion - ovt Lot # Section/Block/Phase Property AQdres 7-4&T A-a '6111 ~10-:nj Vc- 2- Directions to Property: GtJ 71) A-VI / 2e Llda~t j STu-z/ U,✓ /-t_ 2~ .t 5. Property Size: Square Feet Acres Date Platted/Recorded /o 27 6. TYPE OF FACILITY: House Mobile Home Dimension of Structure -lOX ~J Bedrooms* -Z *Any room that Will beintended for sleepin at the time of construction or for future consideration should be noted asa 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 system size increase in the future. Basement: yes Water Using Fixtures in Basement: yes, to No. in Family Whirlpool Tub yes no Gallon Capacity MULTIPLE FAMILY RESIDENCES: Units 4/-I Total Number of Bedrooms /V4 DAY CARE: Number of Children (ice RESTAURANT: Seats Square Feet Dining Are, quare Feet Food stand/Meat Market Floor Space 44 TYPE OF BUSINESS: -A4- Number of Employees 1st VA 2nd 3rd IV%4 OTHER: (Specify) 14 7. Do you anticipate any additions to Facility? Yes If so, describe: A 8. Has any grading, removal, or addition of soil been done to this property? Yes / o If so, describe: 9. Are there easements/right-of-ways recorded on this property? Yes / o) 10. Is a public water supply available on or adjacent to the above property? Yes / No Check type that is available: [ ] Community well [ ] Semi-public well [ ] County/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 permit, 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 PROPERTY, .THERE 'ISA~N ADDITIONAL CHARGE.- Date Signature of Owner or Agent ~,f"1/.Cd2fLLJ (Tie Line Onl 5/8" EXISTING IRON ROD S63006'21- Y = 214838.631 METERS 138.61' DNS X = 389614.708 METERS ELEV = 372.171 METERS - CSF = 0.99984497 GROUND COORDINATE c • 31x1504 r-* v ~O N69°16 / - 6"E X136 N69°12'46"E ~~11 p35 ~NIZ 1/2" EXISTING 48'03 ~ '-IRON ROD tJ\ RAILROAD PP p 5'56 6~ • 1 N o e ~ ask ~ 3 U) 24" RCP SPIKE SET INS ME /OF SR 1125 N 21 'i 5\dev~ so s~bacKV~ cc 3139. 1/2" IRON ,p RAILROAD 00 ~P\/~ 6„E 1/2" IRON ROD SET jPOOI ® \ SPIKE SET IN 55 ON ® -CENTERLINE N~2°3O~ ,v -/N ROD SET 1 Asphalt \~9\esovse \ OF SR 1125 220 0 • / ~~cKN Well / Q Setback e O House \ c ~ pp Bo' \ N\ob\\e H°r9 \ \ \0 k 3/4" EXISTINI Oetal e • i a<a9 cZ,pp IRON PIPE v M 1„ EXISTING C' i PP . IRON PIPE O j I \ hC~ N\. \\.Me~'ad 1 a Wood m e v N i 1/z" a °o Playhouse 160 \\5~' I l e 'tii~ I EXISTING.k'er I c+.~'\ ✓ ~1 CO backUn -i IRON ROD g0,5et (NOT USED) •!JP. PP cr' vl I Z \ti.i Wood Frame PP re( PP I House ! h N ° e2ti, O' PP Wood ; , nbjlP <\~"'Q Shed ii ~~a 4~1di is • ^ r 0 C N r~ hiN ~L co re I i mim /\1 M o II Lr w /PP N QIO \ Q ' I 1/2" IRON ROD SET j.c Z (p ' NEW CORNER j O^ PERSIMMON TREE I u 3 (!j (n Vim- 5th Corner 1 11 a W to Q ! II D.B. 575, Pg. 265 0 -4 11 I z I ~ ~ I ~ B..S7 I~'92 P9. I I 3/4" SQUARE PIPE • I Lo Q 16 4g2 ' I ~j`~ (Tie Line) • 6j j ; i j c~-° , o 5e:~a S73026'34"E o a! 3' ~5`b 621 194.33' ti~a 1/2" IRC kRRY DEAN CHURCH ROD SEl eed Book 2014, Page 793 ! ~yJ ~ti ~~0~ Plat Book 61, Page 147 ' i oot F Plat Book 41, Page 129 / ~e * c pQ s0 co cv v oFh CIO Sgal OFD S Setback \\ne, 1/2" IRON ON ROD SET / PP 204,-NEW CORNER N1 1$~ 3~ / JOHNNY H. HUFFMAN 1/2" IRON ROD SET 11N Deed Book 1911, Page 369 NEW CORNER N 1/2" EXISTING Lr IRON ROD • I / /t ~ 1 / I 1 / ~ A CMG CATAWBA COUNTY, NC 100-A South West Blvd PLAN RECEIPT Newton, NC 28658- 0 (828)465-8399 Tuesday, November 10, 2009 184 sM wsvw.catawbacountync.gov Plan Case: EHPR-11-09-2617 Invoice Number: INV-11-09-257135 Environmental Health Plan Review Invoice Date: 11/10/2009 Fee Name Fee Amount Existing Tank Check Fee Fixed $80.00 Total Fees Due: $80.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 11/10/2009 Check 8520 $80.00 $0.00 Total Paid: $80.00 Total Due: $0.00 J;.n ic~c pt !41)r] dhO.i-dRI5-o1:j07-ae78-ahb51f,76 a 4a; rpi 11/10/2009 11:02