HomeMy WebLinkAboutEHPR-3-10-4418.TIF
THIS IS NOT A PERMIT Case # EHPR-3-10-4418
r CATAWBA COUNTY HEALTH DEPARTMENT
a
Plan Review Application for Environmental Services
1842 5M Environmental Health Plan Review - OSWP
EXS_SYSTEM
APPLICANT OWNER CONTRACTOR
NOAH SMITH NOAH SMITH
1315 JAMES FARM RD 1315 JAMES FARM RD
HICKORY NC 28602 HICKORY NC 28602
828-294-6813 828-294-6813
NAME TO APPEAR ON PERMIT NOAH SMITH Pin#: 370020803891
SITE ADDRESS: 1315 JAMES FARM RD, Hickory, NC
DIRECTIONS: ZION CHURCH RD/ TO JAMES FARM RD/ LAST HOUSE ON RIGHT
NAME of SUBDIVISION: RAINBOW HILLS Lot # PT75&PT-// Section/Block/Phase
PROPERTY SIZE: Square Feet Acres 2.99 Date Platted/Recorded
TYPE OF FACILITY: House X Mobile Home Dimension of Structure 70 X 70 Bedrooms 4
Basement: Yes Water Using Fixtures in Basement:Yes No. in Family 6
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 POOL 16 X 32
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 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 a date issued and is not transferable.
Note: You must obtain Zoning Approval prior to locating a home or structure on this property. ;'y representatio y u f house or structure
location should conform to applicable setbacks.
Date: D 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
Front 30 FEE NAME DATE AMOUNT
Side to Existing Tank Check Fee 03/17/2010 $80.00
Rear 10 TOTAL FEES
Max Hght $80.00
*If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge
03/17/10 16:04
THIS IS NOT A PERMIT WLS #
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 l>f
2. Permit Requested B Al Business Phone
Address 15 Co Z Home Phone %
3. Property Owner SrN '4 Er Business Phone
Address Home Phone
4. Name of Subdivision L,4_1J Lot # Section/Block/Phase
Property Address A
Directions to Property: ` AVI -CkJ-„yt.t o- Arty fin. U~ J 17- *-J& 5. Property Size: Square Feet Acres Date Platted/Recorded _
6. TYPE OF FACILITY: House Mobile Home Dimension of Structure 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 per ' 'ssuance. This may prevent the need for system size increase in the future.
Basement: es Water Using Fixtures in Basemen . yes no No. in Family ~l
Whirlpool Tu ye'/no Gallon Capacity
MULTIPLE FAMILY RESIDENCES: nits 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 / o
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? es 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.
R
E IS AN ADDITIONAL CHARGE.**
**IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MA 7t77~7
Date 1 / 0 Signature of Owner or Agent
I ~1 *
Catawba County, North Carolina
N This map product was prepared from the Catavba County, NC, Geographic Information System.
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 nap product by the user. The Comty of Cata}vba, its employees, agents and 1
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 a• the use thereof by any person or entity. Legend
"Selected Parcel Number: 3700-20-80-3891
1 inch = 100 feet
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THIS IS NOT A LEGAL DOCUMENT ......::::Wednesday, March 17, 2010 03:39 PM \
CATAWBA COUNTY HEALTH DEPARTMENT
/ Telephone: (828) 465-8270 TDD: (828) 465-8200 WLS # a 006 00 15 0
Improvement Permit /AC V Repair Permit._ Operation Permit. System Typ Well Permit. Replacement Well
Owner/Agent ah Phone )_y y - a (,d
Address 1335 C-r(--, \i L n 4 Ns, o$-oO• Subdivision Rc~,'^j.,o ,,,J f; I Is
Section/Block/Phase Lot# "IS
Lot Size 2., 9 Directions: w 0 i o Lt - i n too w t l l s S 4
-T AL-' {'C Ldc-SC.- LoT on t-
Property Address 1316' 7, \,S ha r M d -I l L 4
Facility: House Mobile Home Business Multi-family Other: Pin Number 3-7 00 2 o h 0 3 89 1
Other . Zoning Approval #
# Bedrooms- # Seats # Employees . Application Rate GPD Flow t ($O
Hot Tub or Spa yes/'' Special Fixtures Basemen yes o . 100% Repair Areatye no
Basement Plumbing ye no Water Sup-ply: Private Well Publics Semi-Public
Type of System: Trench_,,,/ Bed Pump Pump/Panel Panel LPP Other 0:5 rf o Qe,) U ':+l u
Septic Tank Size Da Pump Tank Size Nitrification Field: Total Square Feet 12- O Depth of Stone
r
Bed Size Trench Width 31 Total Length of All Trenches iq 00 Number of Trenches
Trench Length q / X /_LL~/_/_/_ Feet on Center 9 1 Maximum Trench Depth it Distance of Nearest Well u o
r
*DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION*
Topo % Slope J`t y a 7 t
Texture
Structure P 1i C m +J
Clay Min. N ~U yP c D O
Soil Wetness
Soil Depth
Restric. Hoz. at
Available space yes/no I o~ ` a a 14.("e-
Overall Class S PS U ` o q . ° i -t a
n O \ r t
Comments: P a' V7 0 f`
P ~
Z O-I- v l 6 I' 3 0
-4-
A SY M 3
~(ZALtJ AL r d
Q- Q. P a. i I (k r•rJ r? 3e-p4 ic. rr, , i) . q
Q
I I o 0 r a nn y W I t I tJ r ra rr P e-a F r+y I, A QL-j 4
Filter Required n
Riser required when I`~ r ~rO`~ ~a ~Q' ► Poaf 1 5or tro rr loco nc.h
tank is more than6 ~~`Zns~cll ~,^Q,, o~ C.on~-oar IDo na+ 9r~c)c- ~C) riVQ., zr
inches deep.
**NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM
WILL FUNCTION** ~t 1 1 uvnc S S}~in c, r tQ.pa,r ~ k2.e.p 5y-14c.m V~ II Gs c_.lose 4-o In•rv\Q
As o•%5
1 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 County 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 possible sources of contamination. No volume of
water is guaranteed It si by the Health Department.
ermit Date EHS
caner/Age - Septic T Installed B 1 e~( Date d;
EHS Well Installed By Well Grout Approval Date . Well H4d,. !A
Approval at Date Sample Collected 6 k y_ : ,
aAG..
Date of Res Vs Results EHS
White - Office Yellow - Owner/Agent Pink - Building Inspection Authorization to Construct
CATAWBA COUNTY
Case # WLS2'006-00150
Public Health Department
y Q G Subdivision RAINBOW HILLS
Environmental Health Division
PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Sect/BL/Ph/Lot # 75/6
(828) 465-8270 FAX (828) 465-8276 TDD (828) 465-8200 PIN' 370020803891
Applicant/Owner: NOAH SMITH
Site Address: 1315 JAMES FARM RD HICKORY NC
Property Size: SF 2.99 ACRES
Directions: HWY 10 W/ RT ZION CHURCH RD/ LF INTO RAINBOW HILLS/ LAST LOT ON RT / PART OF 75 AND 76 LOT
Catawba County Health Department Operation Permit G-7
~TG 73 IZ uV 501•
u (4)
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System Code.
System Type: Lu ^ Description: aS So r'/Types V and VI systems expire in 5 years.
(In accordance with Table a) 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 conditions of the Improvement Permit and Construction Authorization.
~ ;n,\ . 11, r J /8 /0 7
System Installer installation a e
onze a e gen Date of Operation Permit Issurance
For/m F
r; Mdemarkl Fnrm.vVW/.SAnn. mt
Catawba County, North Carolina
N This map product was prepared from the Cataii+ba County, NC, Geographic Information System.
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 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: 3700-20-80-3891
1 inch = 100 feet Prepared for:
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Alt . fHIS IS NOT A LEGAL DOCUMENT Wednesday, March 17, 2010 03:39 PNI
c vv ~a
CATAWBA COUNT`{ NC - Parcel Report
Information Regarding Selected Parcel(s)
Parcel ID.- 3700-20-80-3891
Name: SMITH NOAH D
Name2: SMITH DEBORAH E I D
Address: 1315 JAMES FARM RD J `
Address2:
City: HICKORY
State: NC
Zip: 28602-9567
Account: 173846
Calc Acreage: 2.99
Tax Map:
LRK: 601994
Deed Book: 2523
Deed Page: 1396
Subdivision Name: RAINBOW HILLS
Subdivision Block:
Lots: PT75&PT76
Plat Book: 43
Plat Page: 55
Building Number: 1315
Street Name: JAMES FARM RD
Site Zip: 28602
Township: HICKORY
Fire Code: MOUNTAIN VIEW
City Code: COUNTY
State Road:
Total Bldgs Value: $397,700
Land Value: $73,300
Total Value: $471,000
Year Built: 2006
Year Remodeled:
Last Sale Date: 10/16/2003
Last Sale Amount: $67,500
Neighborhood: 79
Watershed: WS-III Protected Area
Watershed Split: NO
Voter Precinct: P23
E911 District: COUNTY
Zoning: R-20
Zoning2:
Zoning3:
Zoning Split: N
Zoning Overlay: ED-O,WP-O,FPM-O
Zoning District: COUNTY
Split Zoning Dist: N
Split Zoning Dist(1):0
Split Zoning Dist(2): 0
School District: COUNTY
Elementary School: BLACKBURN
Middle School: JACOBS FORK
High School: FRED T FOARD
School Split: NO
P&Z Case Number:
Census Tract 2010: 011801
Census Block 2010: 3000
Small Area Plan: MOUNTAIN VIEW
Agricultural District:
Printed: Wednesday, March 17, 2010 03:36 PM
~~'A Cpl CATAWBA COUNTY, NC
r. 100-A South West Blvd
PLAN INVOICE
Newton, NC 28658-
V (828)465-8399 Wednesday, March 17, 2010
84 sM www.catawbacountync.gov
Plan Case: EHPR-3-10-4418 Invoice Number: INV-3-10-260554
Environmental Health Plan Review Invoice Date: 03/17/2010
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
03/17/2010 Check 2933 $80.00 $0.00
Total Paid: $80.00
Total Due: $0.00
planinwlicc;raUl' StBf'hala-Ic?6-8cJ~-Id0~7 r13~3c;.rpt 03/17/2010 16:02