HomeMy WebLinkAboutEHPR-3-11-9706.TIF BA C THIS IS NOT A PERMIT Case # EHPR - - 11 - 9706
Lc-' CATAWBA COUNTY HEALTH DEPARTMENT
0 Plan Review Application for Environmental Services
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Environmental Health Plan Review - OSWP
RAI � �� hi( f� k REPLACE WELL
oktia enly .3111 NAME TO APPEAR ON PERMIT
THURMAN ABERNETHY
SITE ADDRESS: 6193 GREEDY HWY, Hickory, NC Pin#: 268904823375
NAME of SUBDIVISION: Lot # Section/Block/Phase
PROPERTY SIZE: Square Feet Acres 6.969
DIRECTIONS: TURN RIGHT AT WAYNE'O, GO DOWN GREEDY HWY OVER BRIDGE 2ND HOUSE ON LEFT
APPLICANT OWNER CONTRACTOR
LOYD G HAGER THURMAN ABERNETHY
3931 DEER RUN DR NE 6193 GREEDY HWY
CONOVER NC 28613- HICKORY NC 28602
(828)612 -4638 828 - 324 -7815
PRIMARY CONTACT: Applicant APPLICATION FOR: Existing Structure
DIM EXISTING STRUCTURE: EXISTING FACILITY TYPE: House
NUMBER OF EXISTING BEDROOMS, SEWER TYPE: Septic Tank
NUMBER OF EXISTING OCCUPANT . 5 EXISTING WATER SUPPLY IN USE: Private Well
CALCULATED DESIGN FLOW:
Public water is **NOT ** available for this property.
PUBLIC WATER TYPE AVAILABLE:
DESCRIBE WORK: WATER IS MUDDY, WELL DRILLER SAID MAY HAVE RUST IN IT.
DESCRIPTION OF HOME
EXISTING STRUCTURES
ON SITE (IF ANY)
PROPOSED FUTURE ADDITIONS NONE
OR IMPROVEMENTS:
PROPERTY EASEMENTS: NONE
PROPOSED CONSTRUCTION
APPLICATION_FOR -WE L CONSTRUCTION /ABANDONMENT /REPAIR
PROPOSED WELL TYPE: individual Well ABANDONMENT TYPE:
WELL REPAI REQUESTED?"'
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: 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
AREA2
!Minimum Setbacks: Front: Side: Rear: Side St: Max Height:
03/08/11 09:01
z v,A CATAWBA COUNTY Case # EHPR -3 -11 -9706
eQ G Public Health Department
f Subdivision
Environmental Health Division - Plan Review
\ 0 PO Box 389, 100 -A Southwest Blvd, Newton, NC 28658 Lot#
\ 842 s" PIN# 268904823375
Applicant/Owner LOYD G HAGER, 3931 NE DEER RUN DR, CONOVER NC 28613 -
Site Address: 6193 GREEDY HWY, Hickory, NC
Property Size: SF 6.969 ACRES
Directions: TURN RIGHT AT WAYNE'O, GO DOWN GREEDY HWY OVER BRIDGE 2ND HOUSE ON LEFT
FEE NAME DATE AMOUNT BALANCE DUE
Well Permit & Inspection Fee 03/07/2011 $300.00 $0.00
TOTAL FEES $300.00 $0.00
CHANGE WORK ORDER REQUIRING REDESIGN AND /OR RETRIP WILL INCURE AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
03/08/11 09:01
I CATAWBA COUNTY HEALTH DEPARTMENT PERMIT
COMPLETION PERMIT FOR SEPTIC TANKS
(Ground Absorption Sewage Disposal System — G. S. 130 -13C) N? O 1 8 •
OWNER OR CONTRACTOR— / ins A.d4i 41_ l ' o .-�YL DAT i 6,/-79-.
ADDRESS R4. I 1 / - , /" ,c - / .
LOC ATION .___ OW A . ; X /22 We i/
Oil 0 / 2,4 /d, ' ? . i 6.410. NMI" ' i c /
SUBDIVISION NAME LOTS w; TO I:LOCK NO.
1 `\.
HOUSE (X MOBILE HOME ( —) BUSINESS ( —)
NO. BEDROOMS ( 3 ) NO. BATHROOMS (–•X______) ;o lik
GARBAGE DISPOSAL UNIT: Yes ( —) No (K. j99-9" 9'
SIZE OF TANK /000 Total G Ilons 86144)2'
NITRIFICATION FIELD 300 l 6 x / *� ) Ft. OD 9:3/1\911)
V
WATER SUPPLY: PRIVATE ( PUBLIC ( —) L0 D`XI y 1-
INSTALLED BY 44 est. 14..
CERTIFICATE OF COMPLETION BY e�3 MIN
DATE INSTALLED s.. 1 g y" Health Department HD 2-74
I