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Home My WebLink AboutEHPR-3-10-4365.TIF THIS IS NOT A PERMIT Case # EHPR-3-10-4365 I~ ~ CATAWBA COUNTY HEALTH DEPARTMENT V Plan Review Application for Environmental Services 1842 Ski Environmental Health Plan Review - OSWP REPAIR APPLICANT OWNER CONTRACTOR JOSEPH KIJESKY JOSEPH KIJESKY 3179 PINKIE LN 3179 PINKIE LN NEWTON NC 28658 NEWTON NC 28658 704-494-2967 704-494-2967 NAME TO APPEAR ON PERMIT JOSEPH KIJESKY Pin#: 366903222879 SITE ADDRESS: 3179 PINKIE L,N, Newton, NC DIRECTIONS: 16S/ LEFT BALLS CREEK RD/ LEFT CORDIA CIR INTO BARRINGER WOODS / LEFT 3RD RD ON LEFT PINKIE LN/ 1 ST HOUSE ON LEFT NAME of SUBDIVISION: BARRINGER WOODS PH 2 Lot # 47 SectionBlock/Phase PROPERTY SIZE: Square Feet Acres 1.159 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure 30 X 60 Bedrooms 3 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: PVT INGROUND 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? NONE 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: IS / J Signature of Applicant or Agent An nvironmental Health Specialist will contact you within 2vworking 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 Front 30 FEE NAME DATE AMOUNT Side 10 Authorization to Construct Fee (New/Expansion) Fee 03/15/2010 $150.00 Rear 10 Improvement Permit Fee 03/15/2010 $150.00 Max Hght TOTAL FEES $300.00 *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 03/15/10 12:08 FROM Bank Of A- it - Home Loans CMON)MAR 75 2010 11:37/ST.11:37/NO.7500000574 P 1 THIS IS NOT A PERMIT WLS # CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services ' r` IP I- AC (X S.T. Rpr. F- S.T. Exp. F- Exist. S. T. F Well Permit Replacement Well 1. Name to Appear on Permit: Joseph Kijesky 2. Permit Requested By: Joseph & Belinda Kijesky Business Phone: 704-494-2967 Address: same as property Home Phone: 828-446-0994 3. Property Owner: Business Phone: same as property Address: - Home Phone: Barringer Woods 4. Name of Subdivision: Lot Section/Block/Phase: Property Address: 3179 Pinkie Lane, Newton NC 28658 Directions to Property: from newton take Hwy 16 South - left onto Balls Creek, left onto Cordia Circle-going into [Barringer Woods Subdivision. Take left on 3rd rd on left onto Pinkie Lane and 1 st house on left. 1661 F1.15 1999 5. Property Size: Square Feet Acres Date Platted/Recorded 6. TYPE OF FACILITY: C' House Mobile Nome Dimension of Structure 3ox6o Bedrooms*~ ~,y...,.,.,,ri• ..i , : i r ,iliii :ry` ;iii ntss .f,Y:n:+ ,ti ~n+e~- i,n~ ~ r: n n is i:tr a ,f ..I,~n, .,qr~ ....t t rm. u+,.: rn n ~"+fr,trr n.rt ~ errutk ~ t rv uune n..t...: •7r; r.... "An '(bOiT1°tFid jilt ~ t! l l Eitri~l t~iC S F t r 1 ~ ,ry}~,~{p,} a ! i ntl, t2 t m~ ~ tt ~ p~~ih S } 't ! ' 't tt {Ilrttfl9) ° tliyl r n4!(Nf. 4 1 t 1' I 4t II t m . ; I 1, tl f t I~ k. r!' F'1~ , M '!7>st i~t~ appltatibfl!~~FThe}nb I f ° t~..lti + !4 M1 { } y -i! G f I Ldff I;fIFI IflF1SV6;(~ a . i"ut `•t t I, t LtiA t t'" This ~~,aX P~"!S ,nnt:~ :~.:t,~. t: kr~~~ze;!!a4.: t, , ~'K ~.d t~' r~~13 i!I(~r.r ,4f r `i'~ '~yfj}~) 3° ! ,F I~kt1, 14~~ " • ~I, I u l~! i. ~ , f. ..:.r..._:.?..?,.~:~ er ".T ~ r«:ti. .rc ~:.~~~ii.llt, .tlr~>,>4AiI~ttE ~ ft~!!l C e ::,n.ra l:>: r..+~ {~f'4htt~ill~~tSlt`;1!~!~,:I».,~rsi l{ t:iSr.~lrits „dlkfll~tl 1~ „ L .}n1Uil!{It}}SI~tdF.1~ ~!~,t... . ,4,.rlt~~pl{{~~~~~5 Basement: Yes No Water Using Fixtures in Basement: Yes No No" in Family: 2 Whirlpool Tub: (*-Yes (-No Gallon Capacity: 5 MULTIPLE FAMILY RESIDENCES: Units F Total Number of Bedrooms DAY CARE: Number of Children RESTAURANT: Seats F-Square Feet Dining Area F Square Feet Food Stand/Meat Market Floor Space F TYPE OF BUSINESS: ~ No. of Employees 1 st F- 2nd F-- 3rd F- OTHER : (Specify) 7. Do you anticipate any additions to Facility? Yes C" No If so describe FROM Bank Of A- i- Home U-- KMON)MAR 15 2010 11:37/ST.11:37/N- 75000OO574 R 2 8. Has any grading, removal, or addition of soil been done to this property? Yes XNo If so describe 9. Are there easements/right-of-ways recorded on this property? r Yes XNo 10. Is a public water supply available on or adjacent to the above property? (-.Yes r No Check type that is available: r Community Well l- Semi-public Well F County/City/Township waterline 11. Well Type Applying For: F- Individual Well F Community Well r Semi-public Well I Irrigation Well F_ Geothermal Well 12. Monitoring Well Request:(' Yes (-No # of Wells: Name of Site: I understand that this 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 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 set backs. "IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE IS AN ADDITIONAL CHARGE." Date: 3/15/2010 Signature of Owner or Agent: Belinda & Joseph Kijesky ?h Iji ji1N a 1~ ~F 1 iiN f! 17 7;~ •il )1 i ui ,;1 J i i i3a it , -6 t~fl Pr)nE F or 1 r, CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3669-03-22-2879 Name: KIJESKY JOSEPH FRANCES Name2: Address: 3179 PINKIE LN Address2: City: NEWTON State: NC Zip: 28658-8141 Account: 110180 Calc Acreage: 1.16 Tax Map: 001 CK 01047 LRK: 200046 Deed Book: 2123 Deed Page: 1962 Subdivision Name: BARRINGER WOODS PH 2 Subdivision Block: Lots: 47 Plat Book: 33 Plat Page: 117 Building Number: 3179 Street Name: PINKIE LN Site Zip: 28658 Township: CALDWELL Fire Code: BANDY'S City Code: COUNTY State Road: Total Bldgs Value: $156,000 Land Value: $19,900 Total Value: $175,900 Year Built: 1999 Year Remodeled: Last Sale Date: 1/1/1999 Last Sale Amount: $17,500 Neighborhood: 124 Watershed: . Watershed Split: Voter Precinct: P1 E911 District: COUNTY Zoning: R-40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: BALLS CREEK Middle School: MILL CREEK High School: BANDYS School Split: NO P&Z Case Number: Census Tract 2010: 011400 Census Block 2010: 3015 Small Area Plan: BALLS CREEK Agricultural District: PROXIMITY Printed: Monday, March 15, 2010 11:45 AM CAT-AWBA.000NTY Public Health Department Case # WLS2007-01477 Subdivision Environmental Health Division BARRINGER WOODS \Jt` PO Box 3K 100-A Southwest Blvd. Newton, NC 28638 Sect/BL/Ph/Lot # 47 (828) 463-8270 FAX (828) 163-8276 TDD (828) 463-8200 PIN# 366903222879 Applicant/Owner: JOSEPH KIJESKY Site Address: 3179 PINKIE LN NEWTON NC Property Size: SE 1.16 ACRES Directions: 16S/ LEFT BALLS CRK RD/ LEFT BARRINGER WOODS/ 3RD LEFT PINKIE LANE/ 1 ST HOUSE ON LEFT/ LOT 47 "`SEE WLS2007-01098 FOR EXISTING TANK CHECK" Catawba County Health Department Operation Permit Ga& loA~ lor< - r ~e~ privcwaY P►~ r ~ System Code System Type: Description: X-10 PJu 6 Types V and VI systems expird in 5 years. (In accordance with Table Va) Owner must contact health department 6 months prior to exiration for permit renewal. PERMIT CONDITIONS: 1. Performance: System shall perform in accordance with Rule .1961. II. Monitoring: As required by Rule. 1961. III. Maintenance: As required by Rule . 1961. Other: Subsurface system operator required? Yes No--,,/- If yes, see attached sheet for additional operation conditions, maintenance and reporting. IV. Operation: This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and All 9Qnditions of e Imp vement Permit and Construction Authorization VV4 S stem staller s a ion Date 1I ZJ b u U ize a e en Date of pe tion Permit Issurance Form F ,AT idemm 4\Furnr.rV wLSrmn. nrr ^p;~ CATAWBA COUNTY Public Health Department Case # WLS2007-01477 Environmental Health Division Subdivision BARRINGER WOODS \J\ ,1 PO Box 389. 100-A Southwest Blvd, Newton, NC 28658 Sect/BL/Ph/Lot # 47 (828) 465-8270 FAX (828) 465-8276 TDD (828) 465-8200 PIN# 366903222879 Applicant/Owner JOSEPH KIJESKY Site Address: 3179 PINKIE LN NEWTON NC Property Size: SF 1.16 ACRES Directions: 16S/ LEFT BALLS CRK RD/ LEFT BARRINGER WOODS/ 3RD LEFT PINKIE LANE/ 1 ST HOUSE ON LEFT/ LOT 47 "'SEE WLS2007-01098 FOR EXISTING TANK CHECK` Improvement Permit Permit Valid For: Five years No Expiration Facility (Residential): House House X Mobile Home Multi-Family Bedrooms -3- New? - Addition? Projected Daily Flow g.p.d Water Supply Private Well? Public? Semi-Public? Basement: N Basement Plumbing: N I-iotTub/Spa: N Special Fixtures (explain): Proposed Wastewater System: Type: Proposed Repair: Permit Conditions: Owner or Legal Representative Signature: Date: Authorized State Agent: Date: The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the applicant/property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are met. This Improvement Permit is subject to revocation if the site plan, plat or the intended use changes, or if site conditions are altered. The Improvement Pernut is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina 'Laws and Rules for Sewage Treatment and Disposal Systems' (15A NCAC 18A .1900). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for any given period of time. Authorization to Construct Wastewater System (Required for Building Permit) See site plan and additional attachments ( Proposed Wastewater System: 25 % bJ0G 1 6yx Type: Q astewater Flow ~0 g.p.d New 14eia4Qr ktatn je ✓ Expansion _ Soil LTAR. J g.p.d./ft2 Type of Facility: Yoorri Basement: N Basement Plumbing: N HotTLib/Spa: N Special Fixtures (explain): Wastewater System Requirements Tank Size: Septic Tank p.K(= gal Pump Tank gal Grease Trap gal Drainfield: Total Area: sq ft Total LengtAW2S ft Maximum Trench Depth in Trench Width 3_ ft / Minimum Soil Coy er (2 in Minimum Trench Seperation ft Distribution: Distribution Box Serial Distribution Pressure Manifold LPP Other Additional Specifications:Tb_q raJ4 V-CQ Nttd SC~baCQt~- _ rd tom, k rt ° [A os I on e C ti c b►~ t rte ,'e fn o W L c e f- n v n a e Oce rrt l'at n e Wt l1 e. Z 7o rPduChon . Authorized State Agent: Date: Sa_ Permit Expiration Date: I~ v / have rend and accept the specifications and c ll conditioiu of this permit as iirdicated. Owner or Legal Representative Signature: Date: 11 11b lt-7 Form B r\Tiden wk\Furrn ~VIVLSnmc n V CAYAWBA COUNTY Case # WLS2007-01477 Public Health Department ab } Environmental Health Division Subdivision BARRINGER WOODS PO Box 389, 100-A Southwest Blvd. Newton. NC 28668 SeeUBL/Ph/Lot # 47 (82S) 465-8270 FAX (828) 465-8276 TDD (828) 465-8200 PIN# 366903222879 Applicant/Owner JOSEPH KIJESKY Site Address: 3179 PINKIE LN NEWTON NC Property Si SF 1.16 ACRES Directions: 16S/ LEFT BALLS CRK RD/ LEFT BARRINGER WOODS/ 3RD LEFT PINKIE LANE/ 1ST HOUSE ON LEFT/ LOT 47 "`SEE WLS2007-01098 FOR EXISTING TANK CHECK" ® Improvement Permit Authorization To Construct Well Permit SITE PLAN V4 ct~ ~sfi~ 3 6~ a v, SFD ~ `r Deck ~ 1rrx3o EN P~~ '~~sco~'~ Stt iarorj 3 x /00 Ad' d 3,_ _ (X51 Pd 75, 10, r}rect M ~ . OI Scale System components represent approximate contours only. The contractor must flag the system prior to beginning the installation to ensure that proper grade is maintained. Do not install system under wet conditions. This permit is subject of rev cation if the si plan or site,co ndittions are altered. Auth zed State Agent Date Form C ,ATWonnrk\F,,-iV IVLS(I UD. wi CATAWBA COUNTY HEALTH DEPARTMENT NO 5 3 4 - Ll Telephone (828) 465-827 DD (828) 465?8Q0 Imp Prmt, V• Auth. to Const. ~ Rpr Prmt. Opr Prmt.Sys Type ~ - Well Prmt.K_Well Rpr Prmt. Owner/Agent L P-J . Phone 50,~ Address. ~S S SST' IJ L Subdivision_ $r-,r l.~aC? S Section/Block/Phase Lot#- 4.7 Lot Size Directions S L a//r ~Ryrr l1J c/ GtiC onr r` ~i " L U ~c e d Av e- „u G.v Facility- House '9(_ Mobile Home Business Multi-family Other- Tax Map or Pin Number / C/C Other Zoning Approval # :Z j /y i# Bedrooms__ # Seats Employees Application Rate GPD Flow Hot Tub or Spa yesip Special Fixtures Basement yes t§t 100% Repair Area(!gs/no Basement Plumbing yes/rig Water Supply: Private Well--9,_ Public Semi-Public ****K ~c**yc************+k**Ac*~k ~k#k**+k~k*k*%****~k k*k ~K*~k i**~k:k*******k***~k ~k k*********~k ~k***Y~~k ~k**'k*~k ~k*k+F*~K*~k*K'k*%k*k***~K ~k ~K***~k+k ~k****~k:k Type of System. Trench V Bed Pump Pump/Panel . Panel LPP Other Septic Tank Size 66'd Ai Pump Tank Size Nitrification Field. Total Square Feet 9Oy Depth of Stone . l Z. Bed Size Trench Width 3~o Total Length of All Trenches O 7 Number of Trenches -13 Trench Length L/A/ f~/_F o.2 Distance of Nearest Well /OC_ *DO NOT INSTALL SEPTIC WHEN WET* ~L *WELL RECORD REQUIRED AT COMPLETION* Topo S=ao % Slope Texture l e Structure Clay Min. ~S I - Soil Wetness Soil Depth Restric Hoz. at- Available space no i \ Overall Class SW U Comments I ~ 3~ S I I I I I ~ ` 7S Filter Requ{bred ~ L Riser required svheA W tank is mo}'e than inches deelk 0134 I **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS. SYSTEM WILL FUNCTION** C~ *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the p*oposed facility An Authorization to Construct is valid for (5) five years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba Countv Health Department before any portion of the installation is put into use. The siting of the well by the Health Department staff is to provide protection from known poss' sources of contamination. No volume of water is guaranteed at any, site b the Health Department. Permit Date EHS Z- Owner/Ag t Septic Tpak ns d Date EHS. Well Installed By Well Grout Approval bat 5-- 5' Well Head App vaI ate Date Sample Collected Date of Results Results EHS White - Office Blue - Building Inspection Operation Permit Yellow - Owner/Agent Green - Building Inspection Authorization to Construct Catawba County, North Carolina N This map product was prepared from the Catawba County, NC, Geographic Information Svstem. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map. Catcnvba County promotes and recommends the independent verification of any 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: 3669-03-22-2879 1 inch = 60 feet Prepared for: 136.00 93• 13 3 7.0 93.60 135.00 4075 cs 46 UA 0 1.01 1.16A 1.01A 59%W 43 f 2879 1-848 0 > . d o 0 3 00 48 47 150.00 (214 U'bP 42 125.6 8 0 THIS IS NOT A LEGAL DOCUMENT Monday, March 15, 2010 11:45 AM V CATAWBA COUNTY, NC South West Blvd PLAN INVOICE Newton, NC 28658- ~ 0 (828)465-8399 Monday, March 15, 2010 1842 sM www.catawbacountync.gov Plan Case: EHPR-3-10-4365 Invoice Number: INV-3-10-260447 Environmental Health Plan Review Invoice Date: 03/15/2010 Fee Name Fee Amount Improvement Permit Fee Fixed $150.00 Authorization to Construct Fee Adjustable $150.00 (New/Expansion) Fee Total Fees Due: $300.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 03/15/2010 Check 1246 $300.00 $0.00 Total Paid: $300.00 Total Due: $0.00 plan invoice :1t)730794-IR56- 0c I -hhe9-cbc8a3377105 ; .rpt 03/15/2010 12:07