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Home My WebLink AboutEHPR-2-10-3963.TIF A Cpl THIS IS NOT A PERMIT Case # EHPR-2-10-3963 CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services 1842 SM Environmental Health Plan Review - Septic Malfunction SEPTIC-MALFUNCTION APPLICANT OWNER 'CONTRACTOR ANNA JENKINS ANNA JENKINS 2351 SE HICKORY AV 2351 SE HICKORY AV HICKORY NC 28602- HICKORY NC 28602- 828-256-8745 828-256-8745 NAME TO APPEAR ON PERMIT ANNA JENKINS Pin#: 371212867844 SITE ADDRESS: 2131 SE 511-1 AV, Hickory, NC DIRECTIONS: FROM HWY 70 TURN RIGHT ONTO SWEET WATER RD, GO TO 5TH AV SE TURN RIGHT. HOUSE IS 1ST HOUSE ON LEFT. NAME of SUBDIVISION: Lot # Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.389 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure 38X32 Bedrooms 2 Basement: No Water Using Fixtures in Basement:No No. in Family 0 Whirlpool Tub : Gal. Capacity: MULTIPLE FAMILY RESIDENCE: Units 0.00 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: oZ ".1,9- f t) Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 working day-/s/of application date. If you need further information or assistance please call 828-466-7291 AREA 2 (FOR OFFICE USE ONLY) Zoning Approval: Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front FEE NAME DATE AMOUNT Side Authorization to Construct (Repair) F,02/19/2010 $300.00 Rear TOTAL FEES $300.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 02/19/10 1129 EHPR- a-io- iw 3 THIS IS NOT A PERMIT W47s-* CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit El Authorization to Construct El Septic Repair ❑ Septic Expansion El Existing Tank Check ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment E] 1. Name to Appear on Permit A A rN !S!' . __V e ~ n s 2. Permit Requested By in ri c4 _-It- A t , ns Business Phone Address ~1'6 j/ S~ (6c- '5, E • I~ ~KL Il)•G t51 oQ Home Phone 3. Property Owner Ann q e Z te n rc n 5 Business Phone Address a :316 I ~"K ~ AV, -:5=c Ka 4y /VC :l e6d- Home Phone 4. Name of Subdivision Lot # Section/Block/Phase Property Address 5}`1 Ve Directions to Property: ita 70 o - lam- 1 tiY- cvi . . 5. Property Size: Square Feet Acres Date Platted/Recorded _ 6. TYPE OF FACILITY: House Mobile Home Dimension of Structure 3~ x_ 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 nU Water Using Fixtures in Basement: ye<~) No. in Family Whirlpool Tub yes 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 I st _ 2nd 3rd OTHER: (Specify) 7. Do you anticipate any additions to Facility? Yes If so, describe: _ 8. Has any grading, removal, or addition of soil been done to this property? Yes <TTo_j If so, describe: 9. Are there easements/right-of-ways recorded on this property? Yes "L"J 10. Is a public water supply available on or adjacent to the above property? Yes / 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: [ lridividual well [ ] Community well [ ] Semi-Public well I understand that this is a fonnal application for a well permit, Improvement Pen-nit 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 infonmation, 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 IS AN ADDITIONAL CHARGE." Date Signature of Owner or Agent LZ -$A _'j QL"'6~ r ~ Catawba County, North Carolina This map product was prepared ft om the Catawba County, NC, Geographic Information Svstem. N Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map. Catawba Countypromotes and recommends the independent verification ofany data contained on this map 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 product or the use thereof by any person or entity. Legend Selected Parcel Number: 3712-12-86-7844 1 inch = 40 feet Prepared for: 13 !~1 1 p0 7 $ 8849 ~ 7844 A ~o? 06 THIS IS NOT A LEGAL DOCUMENT Friday, February 19, 2010 10:57 AM CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3712-12-86-7844 Name: JENKINS ANNA FLOWERS Name2: Address: 2351 26TH ST NE Address2: City: HICKORY State: NC Zip: 28601-9196 Account: 194316 Calc Acreage: 0.39 Tax Map: 123H 02054 LRK: 47130 Deed Book: 2568 Deed Page: 0767 Subdivision Name: Subdivision Block: Lots: Plat Book: Plat Page: Building Number: 2131 Street Name: 5TH AV SE Site Zip: 28602 Township: HICKORY Fire Code: HICKORY RURAL City Code: COUNTY State Road: Total Bldgs Value: $32,900 Land Value: $17,000 Total Value: $49,900 Year Built: 1948 Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 53 Watershed: Watershed Split: Voter Precinct: P35 E911 District: HICKORY Zoning: 1-1 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: Zoning District: HICKORY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: ST STEPHENS Middle School: ARNDT High School: ST STEPHENS School Split: NO P&Z Case Number: Census Tract 2010: 011000 Census Block 2010: 3012 Small Area Plan: Agricultural District: Printed: Friday, February 19, 2010 10:57 AM r = °CATAWBA-LINCOLN-ALEXANDER DISTRICT HEALTH DEPARTMENT HICKORY, N. C.-NEWTON,-N.-C. LINCOLNTON, N C.-TAYLORSVILLE, N. C. . ,Phones Diamond 5-3883 INgersol-4-2011 REgent 5-5521.4 MElrose 24101 PERMIT TO. INSTALL SEPTIC TANK E i PERMIT PERMIT DATE- 19 Owner Andress 1 Tenant µw t Address I-nstalled; by. - : Addres Loc do ` f ^ProP, y 4 _ , Kind of tankSize. 'Leng i of trench. . NOTIFY 'HEALTH DEPARTMENT AT=;yT.EAST EIGHT HOURS BEFORE TANK IS TO 14E INSPECTED Final Inspection ~,.r 19 ",.-Approved ( Disapproved ( ) j Remarks:: . First five feet 'of line from outlet from house should be-of cast iron soil pipe. ti Sanitarian:. 1 ' i Sketch of tank and line showing dis 7 f ' tance from dwelling and well on subject property and on adjoining property I s ' ~ it a~ i ~ _ r ' ~ - ~ ~ : i. _ i _ .~.3 _ - j ~ _ _ ~ _ ~ f :i ~ t L - . 1 t _ 1 - _ - - ~ r ~ - _ n r _ - - LF k t I i i L__~F. -a. _ a - _ _ _ _ _ 0 A CATAWBA COUNTY, NC I00-A South West Blvd PLAN RECEIPT F-] Newton, NC 28658- 0 (828)465-8399 Friday, February 19, 2010 184 2 SM www.catawbacountync.gov Plan Case: EHPR-2-10-3963 Invoice Number: INV-2-10-259738 Environmental Health Plan Review Invoice Date: 02/19/2010 Site Address: 2131 SE 5TH AV, Hickory, NC APPLICANT OWNER ANNA JENKINS ANNA JENKINS NC NC 828-256-8745 828-256-8745 Fee Name Fee Amount Authorization to Construct (Repair) Fee Adjustable $300.00 Total Fees Due: $300.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 02/19/2010 Credit Card -1 $300.00 $0.00 Total Paid: $300.00 Payer: ANNA JENKINS Total Due: $0.00 plan receipt ; h~eF10h?-b3d6-dGd?-a I 1 a-~ It?hdta~~6p~.rp~ 02/19/2010 11:17