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Home My WebLink AboutEHPR-3-10-4125.TIF A fig' C THIS IS NOT A PERMIT Case # EHPR-3-10-4125 CATAWBA COUNTY HEALTH DEPARTMENT v ~;~0 ^C Plan Review Application for Environmental Services 1842 sM Environmental Health Plan Review - OSWP REPLACE WELL APPLIC ANT 1OWNER 7 CONTRACTOR "[ERN ESf L WILSON ERNEST LWILSON t CHURCH RD ~ '4,909. BETHEL CHURCH- RD 490q ,BE, HICKORY NC 28602-8294 HICKORY NC 28602=8294 NAME TO APPEAR ON PERMIT ERNEST L WILSON Pin#: 278001363082 SITE ADDRESS: 1305 BROOKSOUTH DR, Hickory, NC DIRECTIONS: FIWY 127 S, RIGHT ON MOUNTAIN GROVE CHURCH RD, 1 1/2 TO 2 MILES TURN LEFT ON MACHINE SHOP RD, PROPERTY IS APPROX 3/4 MILE ON LEFT NAME of SUBDIVISION: Lot # III. Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.769 Date Platted/Recorded TYPE OF FACILITY: House Mobile Home Dimension of Structure 65 x 25 Bedrooms 4 Basement: No Water Using Fixtures in Basement:No No. in Family 2 Whirlpool Tub : Sal.,Cap'acity: . MULTIPLE FAMILY RESIDENCE: Units 2.00 1 Total Nuniber of Bedrooms DAYCARE: Number of Children l" r RESTAURANT: Seats Square Feet Dining'Area ..'Square Feet Foodstand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees `t 1st 2nd 3rd OTHER: (Specify) Do you aniticipate any additions to Facility? rte 1 If so, describe: NO Has any grading, removal, or addition of soil lieen-done to this propertyy? If so, describe NO Are there easements/right-of-waYs recorded on this proPertY• NO t ?fir;; ' L Type of Water Supply: Individual Well X' , Community" Well i 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: 2 1D Signature of Applicant or Agent 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 AREA 2 (FOR OFFICE USE ONLY) Zoning Approval: _Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks ~ AMOUNT Front FEE NAME DATE spection Fee 03/02/20 ~ rmi Side I 'Well Pe 10 ~ ' $300.00 77 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 03/02/10 13:04 THIS IS NOT A PERMIT W LS # CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit ❑ Authorization to Construct El Septic Repair Septic Expansion ❑ Existing Tank Check E] New Well Permit E] Replacement Well [io Well Abandonment ❑ 1. Name to Appear on Permit LJ;a_ o-1 2. Permit Requested By 9PyoE5r- L_jzz_f&j Business Phone SZS -,294-015D Address 4902 Cyr. Q. 2jxrCve.Y. 4-to. 2&Cl?- Home Phone 62T-294 -0150 3. Property Owner E tsr L )a:5C j Business Phone 628-2434-04&L Address SOS- 1307 (3rtcxa.tSoyM nrrv/,s_ Y _t C_ ~6 N• C 2&oOZ Home Phone 4. Name of Subdivision Lot # Section/Block/Phase Property Address Directions to Property: Kt x(..» X27 TOiJget7 OwQsr- CaoisensK ?/rj c Moc1n►-T ~ C;rtose exua r RD e':,e 1&- 2 Mss T;, J & F r oU rt~dPtVJL 5.0 P 2a, Trt~ OF Mal U.~ L Fr' p20R-jffV 1 s AfP2ox 34 5. Property Size: Square Feet Acres Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home -Dimension of Structure 657123 Bedrooms* 4 I*A om that wilin 6e tc ncled for sleeping at th_,_t"i ~ of construction or`fo~ fufu Con c1~iaticin should b'noted as bedroom and counted on all application, 'I he nnnbe`r of bedrooms ill be ~onfiri i~d bi~o~ins identified) on house plansas a bdroom+,at the time ofbuilding,permit issuance. This inay.prevent the need-for system-st'ze„increase ~n the tuturef Basement: Ono Water Using Fixtures in Basement: ye no No. in Family Whirlpool Tub yes/no Gallon Capacity + MULTIPLE FAMILY RESIDENCES: Units 2 Total Number of Bedrooms 4- R7 f 1 Z P~ 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 / N 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 Check type that is available: [ ] Community well [ ] Semi-public well [ ] County/City/Township water line **If No, a Well Pen-nit must be issued with the Septic Permit.** 11. Well Type Applying For: [vf 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 IS AN ADDITIONAL CHARGE.** Date 3 2 2010 Signature of Owner or Agent ~iC, L[~~~o~1 Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geographic Information System. N Catawba 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 of any data contained on this map product by the user. The County of Cataivba, 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 J4 Selected Parcel Number: 2780-01-35-4967 1 inch = 50 feet Prepared for: (8 0 w co 34) 60 - co c - - O c ":zt 3082 Cpl - 1~ 6931% 0~ M_j c5\ cn 56 THIS IS NOT A LEGAL DOCUMENT Tuesday, March 02, 2010 12:43 PM n CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 2780-01-35-4967 Name: WILSON ERNEST L Name2: WILSON SUSAN W Address: 4909 BETHEL CHURCH RD Address2: City: HICKORY State: NC Zip: 28602-8294 Account: 159758258 Calc Acreage: 0.74 Tax Map: 135H 01009C LRK: 91705 Deed Book: 3005 Deed Page: 1173 Subdivision Name: Subdivision Block: Lots: 11 Plat Book: 32 Plat Page: 54 Building Number: 1303 Street Name: BROOKSOUTH DR Site Zip: 28602 Township: HICKORY Fire Code: MOUNTAIN VIEW City Code: COUNTY State Road: Total Bldgs Value: $98,200 Land Value: $10,800 Total Value: $109,000 Year Built: 1993 Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 78 Watershed: Watershed Split: Voter Precinct: P24 E911 District: COUNTY Zoning: R-20 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: DWMH-0 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: 1008 Small Area Plan: MOUNTAIN VIEW Agricultural District: Printed: Tuesday, March 02, 2010 12:43 PM CATAWBA COUNTY, NC 100-A South West Blvd PLAN RECEIPT Newton, NC 28658- ~~P® (828)465-8399 Tuesday, March 2 2010 184 sM www.catawbacountync.gov Plan Case: EHPR-3-10-4125 Invoice Number: INV-3-10-259988 Environmental Health Plan Review Invoice Date: 03/02/2010 Site Address: 1313 BROOKSOUTH DR, Hickory, NC APPLICANT OWNER ERNEST L WILSON ERNEST L WILSON 4909 BETHEL CHURCH RD 4909 BETHEL CHURCH RD HICKORY NC 28602-8294 HICKORY NC 28602-8294 Fee Name Fee Amount Well Permit & Inspection Fee Fixed $300.00 Total Fees Due: $300.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 03/02/2010 Check 515 $300.00 $0.00 Total Paid: $300.00 Payer: ERNEST L WILSON Total Due: $0.00 pl,tn receipt ; 6(106c I t0- I d72-4964-82d'-8d2801'ea34e9 ; .rpt 03/02/2010 13:01 ° 05039' C A T A W B A C O V !J rrY HEALTH D E P A R T M E N T (704) 465-8270 Lot Eval._,I( Improve. Permit-X Repair Permit Cert. of Comp. Permit oper. Permit Owner/Agent C1,1460- 51 ~5d+~ Phone 29y - 4509 Address 2 r ) Box ►4tn Subdivision ' " kakv &j C- Section/Block/Phase Lot# Z. Lot Size 3 Directions: ffit:U Z,5 et, c A% r e,, w-e Facility: House Mobile Home Business Other: Zonin App~ovallyeit/no # Multi-family Other O.Dtex Tax Map # q1K Bedrooms Seats Employees Application Rate•q GPD Flow_Y.W _ Hot Tub or Spa yes o Special Fixtures 100% Repair Area yes/no REPAIR ND'FICB: Basement yes/&% Basement Plumbing yes/no REPAIRS MIST BE WITH33 30 DA'Y'S OR Water Supply: Private X Public DAYS FROM DATE OF PERlQT. rrrrr!l~rfi~t!#t#!►~tlRl~#AQ~+.FNIR*~Frr►#r►#*#rMrr1t11r#1!'1r!!r##R1►r#r#+Rf r11r9!*#!F##1!#A#r#rA#r*rAA#r! Type of System: Trench -X Bed Pump Pump/Panel Panel LPP Other Tank Size: Septic Tank 1h6e) ~a~I Pump Tank Nitrification Field: Total Square Feet l?AQ Depth of Stone t Z•" Bed Size Trench Width t_ Total Length of All Trenches 406 Number of Trenches 3 Individual Trench Length/L/+34/ Feet on Center max mum Trench Depth Z-9' Distance of Nearest Well /00 Lot u on: Approved d*/no Void After 24 months) *t###rrererrete#ref##rs*#!###!#e####e## # eeRr#rArrrrrrrreelrre r#!####r#####r##re*## Togo S Slope I Sketch of lot E alu Site -System Desi - Final Texture jh§ I I ~ Structure j%rAy I I Clay Min. I Soil Wetness 1 Soil Depth t Restric. Hoz. at Available space /not Overall Class U Comments: I I l I (k ~,30(t I Septic Tank Contractors MIST contact the I Sanitarian BEFORE changing permit. **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN THRO NCE OF THIS PERMIT'' ###errs#erssrrrsrrrsrssr#rrr#+#rerrrerresr#errrrrrrr*#tat#r#eerrrrr##r#erersrrrrrr#rwrrerr Permit Date (Improvement Permit vo after 60 months) Owner/Agent S itaria. .1 ~~Z Installed By Date San tars ote y angel/informatio red or by sketch on b ck) *******3:F A PEwfrT To BE REDESIGM AND/OR RBTRIPS FIDE To THE PROPERTY. 'i'E~Rgeererr#~ IS AN ADDITIONAL $25 CEARGB. r White-Office Blue-Bldg. Insp. Comp. Yellow-Owner/Agent Green-Bldg. Insp. I.P. 14.67 A 4JaAxo L . 3'j `.tea N i8- zs - s z ►.r /ao. oo' 'Jfr.~•r S6. Sa' z 39, 9G' 'h Rl sifs'~t ~ P Sy V `°`3 w a T f G.. cam:,. s Tian /.Z7L Gr.!>•iv W ~ M Q f1 o. 9S? r~ ; r~ m S N N ~ ` h J \ 4 r ` J np V-,Z f ` r 3 r R L ~~`o pr/ G Pis ass, sae/ rb ~ . 3a/ua C, AJ.i.~aKar J3l;