HomeMy WebLinkAboutEHPR-2-10-3725.TIF
BA C 5~.~ THIS IS NOT A PERMIT Case # EHPR-2-10-3725
CATAWBA COUNTY HEALTH DEPARTMENT
v Plan Review Application for Environmental Services
1842 SM Environmental Health Plan Review - OSWP
IMPROVEMENT - AUTH CONST -NEW WELL
APPLICANT OWNER CONTRACTOR
BALAN ADRIAN BALAN ADRIAN DECOR BUILDERS, INC
1359 SHADOWFAX WYND 1359 SHADOWFAX WYND 1055
HICKORY NC 28602 HICKORY NC 28602 20TH AVE NLN NW
828-962-6263 828-962-6263 HICKORY NC 28601
828-781-4292
NAME TO APPEAR ON PERMIT BALAN ADRIAN DECORB®IiOERSfiNQJ@&N9MO.COM
SITE ADDRESS: 1359 SHADOWFAX WYND, Hickory, NC
DIRECTIONS: S CENTER ST TO HWY 70/ TAKE RAMP ONTO 321 S/ CONTINUE ON 127 S/ RT ON DEERFIELD LN/ CONTINUE ON
FAWI N TRL/ RT ON SHIREBOURHN/ RT ON WILLOWBOrrOM RD/ RT ON SHADOWFAX WYND/ ON LT
NAME of SUBDIVISION: DEERFIELD 4 Lot # 48 Section/Block/Phase
PROPERTY SIZE: Square Feet Acres 1.23 Date Platted/Recorded
TYPE OF FACILITY: House X Mobile Home Dimension of Structure Bedrooms
Basement: No Water Using Fixtures in Basement:No No. in Family CA—, W14 F fLO1__1
Whirlpool Tub : Gal. Capacity: 4 2 ) (0 1 0
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: 65 X 60 RESIDENTIAL DWELLING
Has any grading, removal, or addition of soil been done to this property?
If so, describe
Are there easements/right-of-ways recorded on this property? NA
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 pro A rep ese tion by you house or structure
location should conform to applicable setbacks.
Date: (32 & 110 Signature of Applicant or Agent
An nvironmental Health Specialist will contact you within 2 working days of application date.
If you need further information or assistance please call 828-466-7291
(FOR OFFICE USE ONLY)
Zoning Approval: Yes No Zoning Approval ZOhI~ L'1 b - 3-7Z ~ UDO Zoning Form A
Minimum Setbacks
Front 30 FEE NAME DATE AMOUNT
Side 15 Authorization to Construct Fee (Newl02/04/2010 $275.00
Rear 30 Re-Trip or Redesign Fee 02/16/2010 $60.00
Max Hght
Well Permit & Inspection Fee 02/04/2010 $300.00
TOTAL FEES $635.00
*If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge
02/16/10 11:07
A
Cpl THIS IS NOT A PERMIT Case # EHPR-2-10-3725
CATAWBA COUNTY HEALTH DEPARTMENT
v Plan Review Application for Environmental Services
1842 SM Environmental Health Plan Review - OSWP
AUTH CONST- NEW WELL
APPLICANT OWNER CONTRACTOR
BALAN ADRIAN BALAN ADRIAN
1359 SHADOWFAX WYND 1359 SHADOWFAX WYND
HICKORY NC 28602 HICKORY NC 28602
828-962-6263 828-962-6263
NAME TO APPEAR ON PERMIT BALAN ADRIAN Pin#: 268902880978
SITE ADDRESS: 1359 SHADOWFAX WYND, Hickory, NC
DIRECTIONS: S CENTER ST TO HWY 70/ TAKE RAMP ONTO 321 S/ CONTINUE ON 127 S/ RT ON DEERFIELD LN/ CONTINUE ON
FAW14N TRL/ RT ON SHIREBOURHN/ RT ON WILLOWBOTTOM RD/ RT ON SHADOWFAX WYND/ ON LT
NAME of SUBDIVISION: DEERFIELD 4 Lot # 48 Section/Block/Phase
PROPERTY SIZE: Square Feet Acres 1.23 Date Platted/Recorded
TYPE OF FACILITY: House X Mobile Home Dimension of Structure Bedrooms 4
Basement: No Water Using Fixtures in Basement:No No. in Family
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 1st 2nd 3rd
OTHER: (Specify)
Do you aniticipate any additions to Facility?
If so. describe: 65 X 60 RESIDENTIAL DWELLING
Has any grading, removal, or addition of soil been done to this property?
If so, describe
Are there easements/right-of-ways recorded on this property? NA
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. An by you of house or structure
location should conform to applicable setbacks.
Date: 2-Vi + 1 U Signature of Applicant or Agent
An Environmental Health Specialist will contact you within T working days of application date.
If you need further information or assistance please call 828-466-7291
(FOR OFFICE USE ONLY)
Zoning Approval: Yes No Zoning Approval UDO Zoning Form A
Minimum Setbacks
Front 30 FEE NAME DATE AMOUNT
Side 15 Authorization to Construct Fee (New/ 02/04/2010 $275.00
Rear 30 Well Permit & Inspection Fee 02/04/2010 $300.00
Max Hght
TOTAL FEES $575.00
*If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge
02/04/10 11:36
THIS IS NOT A PERMIT WLS #
CATAWBA COUNTY HEALTH DEPARTMENT
Application for Environmental Services
Improvement Permit 's Authorization to Constru t [V Septic Repair ❑ Septic Expansion ❑
Existing Tank Check ❑ New Well Permit Replacement Well ❑ Well Abandonment El
1. Name to Appear on Permit A,L Ar`t ~N (rp Z °~i~3
2. Permit Requested By McIIaO ` cs~lac~ Business Phone
Address A cvc.J O '?6c r 1 NC 226D2-Home Phone
3. Property Owner #44 rUr\ r?~ AOT1 Business Phone
Address anoLl G le. ?Io C • V_-as 22602- Home Phone
4. Name of Subdivision Lot #-LIS SectionlBlock/Phase
Property Address l :Ck~i L 2
Directions to Property: ;a
127 L_/'J I
5. Property Size: Square Feet -Acres I -213 Date Platted/Recorded -
6. TYPE OF FACILITY: House Mobile Home Dimension of Structure (4 X (aO Bedrooms*
*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 system size increase in the future.
Basement: ye no Water Using Fixtures in Basement: ye no No. in Family
Whirlpool Tub yes/no Gallon Capacity
MULTIPLE FAMILY RESIDENCES: Units cc 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 1st 2nd 3rd
OTHER: (Specify)
7. Do you anticipate any additions to Facility? Yes /No
If so, describe:
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 / No
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 [ ] Cotmty/City/Township water line
**If No, a Well Permit must be ' ued 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 OP TY, T 'ERE IS AN ADDITIONAL CHARGE"
l 10 Signature of Owner or Agent
Date Qqb
Catawba County, North Carolina
This neap product eras prepared f •onn the Catawba County, NC, Geographic h fornnation 3tstcnr.
N Catawba County has made substantial efforts to ensure the accuracy of location and laheling information
coruained on this neap. Catawba County promotes and recommends the independent rerificanon of only
'Joan contained on this nap product by the user. The Count ofCatmrba, its enrplolees, agents and
personnel disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect
or consequenttial which arises or may arise front this map pn»duct at- the use thereof by arm person or entity.
Legend
Selected Parcel Number: 2689-02-83-0978
I inch = 60 feet Prepared for:
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THIS IS NOT A LEGAL DOCUMENT Monday, November 02, 2009 03:06 AlI = v
CATAWBA COUNTY NC - Parcel Report
Information Regarding Selected Parcel(s)
Parcel ID: 2689-02-88-0978
Name: ABERNETHY AVERY MARK
Name2: ABERNETHY GARY JAMES
Address: 825 3RD AVE NW
Address2:
City: HICKORY
State: NC
Zip: 28601-4806
Account: 161179
Calc Acreage: 1.23
Tax Map: 002AB 01048
LRK: 90705
Deed Book: 1712
Deed Page: 0151
Subdivision Name: DEERFIELD 4
Subdivision Block:
Lots: 48
Plat Book: 29
Plat Page: 13
Building Number: 1359
Street Name: SHADOWFAX WYND
Site Zip: 28602
Township: BANDY'S
Fire Code: MOUNTAIN VIEW
City Code: COUNTY
State Road:
Total Bldgs Value:
Land Value: $27,500
Total Value: $27,500
Year Built:
Year Remodeled:
Last Sale Date:
Last Sale Amount:
Neighborhood: 82
Watershed: WS-III Protected Area
Watershed Split: NO
Voter Precinct: P24
E911 District: COUNTY
Zoning: R-40
Zoning2:
Zoning3:
Zoning Split: N
Zoning Overlay: WP-O
Zoning District: COUNTY
Split Zoning Dist: N
Split Zoning Dist(1): 0
Split Zoning Dist(2): 0
School District: COUNTY
Elementary School: MOUNTAIN VIEW
Middle School: JACOBS FORK
High School: FRED T FOARD
School Split: NO
P&Z Case Number:
Census Tract 2010: 011801
Census Block 2010: 1023
Small Area Plan: MOUNTAIN VIEW
Agricultural District:
Printed: Monday, November 02, 2009 08:00 AM
IMPROVEMENT PERMIT W % .,Illy
4-1 Catawba County Public Health Department CDP File Number 3 6 4 4 5
1 ` t't County ID Number. EHPR 11 09 2447
I Environmental Health Division
O P.O Box 389, 100-A Southwest Blvd Evaluated For: NEW
Newton NC 28658 Township:
Phone: (828)-465-8270 Fax: (828) 465-8276 r1t ~Q - ~~3U
PERMIT VALID UNTIL: 11/24/2014
"NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit.
Applicant: Adrian Balan Property Owner. Adrian Balan
Address:
6004 Glenwood PL CT Address: 6004 Glenwood PL CT
City: Hickory City: Hickory
State/Zip: NC 28602 State/Zip: NC 28602
Phone: (828)) 962-6263 Phone:
Property Si Site Information
r ddress/Road Subdivision: Deerfield Phase. Lot: 48
1359 Shadowfax Wynd Dr
Hickory NC 28602 Directions
Structure: SINGLE FAMILY
of Bedrooms: 4
of People:
'Water Supply: NEW WELL
System Specifications
Initial System
'Site Classification: PS Minimum Trench Depth: Inches ti
Design Flow: 4 8 0 Maximum Trench Depth: 2 4 Inches
Soil Application Rate: Septic Tank: 1 0 0 0
3 5 Gallons
1-Piece: QYes (tNo
System Classification/Description: Pum Required:
Yes No
TYPE III G. OTHER NON-CONY. TRENCH SYSTEMS p O O May Be Required
Pump Tank: 1 5 0 0 Gallons
'Proposed System: 25% REDUCTION 1-Piece: ()Yes No
Repair System Required: Yes ONo ONo, but has Available Space
Repair System
`Site Classification: PS Minimum Trench Depth: Inches
Soil Application Rate: 3 Maximum Trench Depth: Inches
Pump Required: Yes O No Q May be Required
System Classification/Description:
TYPE 111 E. PPBPS GRAVITY DOSED SYSTEM Pump Tank: 1 5 0 0 Gallons
'PfOpOSed System: 50%REDUCTION i
Page 1 of 3
v ur rue ivumuer County ID Number:
"Site Modifications ❑ Open Fill Sheet
No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department.
"Permit Conditions
The issuance of this permit bythe Health Department in no way guarantees the issuance of other permits. The permit holder
is responsible for checking with appropriate governing bodies in meeting their requirements.
Site Plan The improvement Permit shag be valid for 5 years from date of issue with a site plan (means a drawing not necessarily drawn to
N scale that shows the existing and proposed property lines with dimensions, the location of the facility and appurtenances, the
site for the proposed Wastewater system, and the location of water supplies and surface waters).
Plat The Improvement Permit shag be valid without expiration with plat (means a property surveyed prepared, by a registered land
surveyor, drawn to a scale of one inch equals no more than so feet, that includes: the specific location of the proposed facility
0 and appurtenances, the site for the proposed Wastewater system, and the location of water supplies and surface waters. Plat
also means, for subdivision lots approved by the local planning authority and recorded with the county register of deeds, a copy
of the recorded subdivisions platthat is accompanied by a site plan that is drawn to scale).
The Department and Local Health Department may impose conditions on the issuance and may revoke the permits for failure of
the system to satisfy the conditions, the rules, or this article: This permit is subject to revocation if the site plan, plat, or intended
use changes (NCGS 13DA335(Q). The person owning or controlling the system shall be responsible for assuring compliance
with the laws, rules, and permit conditions regarding system location, installation, operation, maintenance; monitoring,
reetx"ng, and repair (.1938(b)}
Applicant/Legal Reps. Signature Required S
Applicant/Legal Reps. Signature: Date:
`Issued By: 1896 - Lucas Sears Date of Issue: 1 1 / D 4 / a 0 0 9
Authorized State Agent: .ll OValid without Expiration?
Hand Drawing Olmport Drawing
**Site Plan/Drawing attached.,** Total Time:(HH:MM)
0 0 Hours rl inutes
Page 2 of 3
CDP.File Number: 36445 County File Number: EHPR-11-09-2447
Drawing Type: Improvement Permit Date: 1 1/ x 4/ 0 0 9
O Inch
Scale: QBIock = ft.
Drawing QN/A
PA
_ 96U5
H
A QQc o-vA
M
Page 3 of 3
Catawba Cou- ,:North Carolina, Disbursement voueher;.
Vendor No.: Date February 22, 2010
ADRIAN BALAN Voucher No(s).
6004 GLENWOOD PL CT t
HICKORY, NC 28602
DESCRIPTION AMOUNT
EF PR-2-10-3725 - Project change. Went from 4 bedrooms to 3 bedrooms. Okay to
refund $125.00 per Ed Rivers. $125.00
SUB-TOTAL $125.00
7% SALES TAX
FREIGHT
TOTAL $125.00
Fund Cost Center Object Project Amount For Accounting
Use Only
110 580200 66300
$125.00 _
TOTAL $125.00
The undersigned hereby certifies that the goods or services specified above have been received or performed. Payment has not
been previously authorized and this expenditure is a proper charge to the appropriation indicated. The above charge is certified
to you for payment.
DJK (Signature - Appropriate Official)
(Processed By)
(Signature - Appropriate Official)
(Checked By)
CATAWBA COUNTY, NC
r 100-A South West Blvd INVOICE
Newton, NC 28658- PLAN (828)465-8399 Thursday, February 25, 2010
V t•
j84 sM www.catawbacountync.gov
Plan Case: EHPR-2-10-3725 Invoice Number: INV-2-10-259316
Environmental Health Plan Review Invoice Date: 02/04/2010
Fee Name Fee Amount
Authorization to Construct Fee Adjustable $275.00
(New/Expansion) Fee
Well Permit & Inspection Fee Fixed $300.00
Total Fees Due: $575.00
PAYMENTS
Date Pay Type Check Number Amount Paid Change
02/04/2010 Credit Card -1 $575.00 $0.00
02/25/2010 Refund -1 ($125.00) $0.00
Total Paid: $450.00
Total Due: $0.00.
plan invoice f442ee2cl-1710-4add-6194-126c3ea7239c;.rpt 02/25/2010 14:06
al~~l~d