HomeMy WebLinkAboutEHPR-4-11-10469.TIF ��' C � THIS IS NOT A PERMIT Case # EHPR-4-1 1-1 0469
M a CATAWBA COUNTY HEALTH DEPARTMENT
V ,:;: '`C Plan Review Application for Environmental Services
I842 sM Environmental Health Plan Review - Septic Malfunction
P �� s�� �l � � �� + SEPTIC MALFUNCT/ON
CL'4��L�t dl�FZ� C�/1�yU NAME TO APPEAR ON PERMIT
GREGORY WYANT
sITE ADDRESS: 5753 VALLEY FIELD RD, Hickory, NC Pin#: 279010276046
NAME of SUBDIVISION: HOMESTEAD Lot # $ Section/Block/Phase
PROPERTY SIZE: Square Feet Acres 0.479
DIRECTIONS: HWY 10 TO HWY 127 TURN RIGHT INTO HOMESTEAD (VALLEYFIELD RD) HOUSE ON CORNER
BEFORE 1 ST RD TO RIGHT
APPLICANT OWNER CONTRACTOR
GREGORY WYANT CHARLIE WYANT LEATHERMAN SEPTIC TANK SVC INC
2860 BLACKBURN SCHOOL ROAD 3890 HICKORY LINCOLNTON HWY 8420 REEPSVILLE RD RDLINCOLTON
NEWTON NC 28658-8712 NEWTON NC 28658 NC 28092
828-3 81-1478 704462-1785 (704)462-2194
ACCOl1NT: 50131
PRIMARY CONTACT: Contractor APPLICATION FOR: Existing Structure
DIM EXISTING STRUCTURE: 30X60 EXISTING FACILITY TYPE: House
NUMBER OF EXISTING BEDROOMS: 3 SEWER TYP . eptic Tank�
NUMBER OF EXISTING OCCUPANTS: 4 EXISTING WATER SUPPLY IN USE: Public Water
CALCULATED DESIGN FLOW:
Public water IS available for this property.
PUBLIC WATER TYPE AVAILABLE: County/City/Township Water
DESCRIBE WORK: SEWAGE BACKING UP IN HOUSE, HAD SYSTEM PUMPED AND WAS TOLD IT WAS FAILING.
DESCRIPTION OF RANCH STYLE HOUSE
EXISTING STRUCTURES
ON SITE (IF ANY)
PROPOSED FUTURE ADDITIONS NONE
ORIMPROVEMENTS:
PROPERTY EASEMENTS: NONE
PROPOSED CONSTRUCTION
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 norrexpiring 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
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Minimum Setbacks Front: Side: Rear: Side St: Max Height:
FEE NAME DATE AMOUNT BALANCE DUE
Authorization to Construct (Repair) Fee 04/15/2011 $300.00 $0.00
TOTAL FEES $300.00 $0.00
04/18/11 11:35