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Home My WebLink AboutEHPR-4-11-10575.TIF .,��'� ° THIS IS NOT A PERMIT Case # EHPR-4-11-10575 (^y ' , �'� y CATAWBA COUNTY HEALTH DEPARTMENT v :� '�' Plan Review Application for Environmental Services 1gq�2 sM Environmental I�ealth Plan Review - OSWP �� P a�d � b Sca� ll�!lPROV��IIEMT �� I� Der CCn�C(S�tic� �% NAME TO APPEAR ON PERMIT ��d�� Thornas Prayer House SITE ADDRESS: 5264 HOPE RD Vale, NC Pir,�: 269702659579 NAME of SUBDIVISION: Lot # p Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.569 DIRECTIONS: Hwy 10 / Left onPlateau / Lf Scronce / Rt on Hope APPLICANT OWNER CONTRACTOR Elouise Farley Thomas Prayer House 5284 Hope RD 5264 Hope RD Vale NC 28168- Vale NC 28168-6753 (704)462-2648 7044622648 PRIMARY CONTACT: Applicant APPLICATION FOR: New Construction DIM EXISTING STRUCTURE: 23 x 66 EXISTING FACILITY TYPE: Church NUMBER OF EXISTING BEDROOMS: SEWER TYPE: Septic Tank NUMBER OF EXISTING OCCUPANT : 90 EXISTING WATER SUPPLY IN USE: Private Well CALCULATED DESIGN FLOW: Public water is *'`NOT** available for this property. PUBLIC WATER TYPE AVAILABLE: N/A DESCRIBE WORK: New 12 x 56 Modular Classroom DESCRIPTION OF Church Vinyl Siding EXISTING STRUCTURES ON SITE (IF ANY) PROPERTY EASEMENTS: none PROPOSED CONSTRUCTION ACCESSORY STRUCTURES DESCRIPTION: Modular Classroom under 30 people # OF NEW BEDROOMS: STRUCTURE DIMENSIOPIS: 12 x 56 ACC DWELLING? P'LUMBING? No # OF STRUCTURE OCCUPANTS: I understand that this is a formal application for a well permit, Improvement permit or Authorization to Construet a ground absorption sewage disposal . sjrstem 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 nor�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:,j (p _,� Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 working days of ap ication date. If you need further information or assistance please call 828-466- 91 A1�A2 **�**�**�************�*�****************�**************************�*��********* ************************************* Mon�mu9t� S�ib�cks Front: 30 Side: 10 Rear: 5 Side St: Max Height: 04/25/11 16:37 Environmental Health Additional Fee Collection Notice The following additional fees as checked below must be collected prior to further action by our department � Repair Permit Application Q Permit revision (re-draw) � Well Permit Authorization to Construct (system upgrades, etc) Other (please explain below) . ILG.� c�(.�'� .�l'�`d- �01fJc � �� EHS � G �l� Date `7 o�s I � y � °r' �; "�' �� 02413 PERMiT FEE: C1 � , 1 �r,RML'1' Nu. ---- ��L'�� C� L�t"'' FEFt`fiT VOI ArT ER 3 MO ��THS CATAWBA COUNTY HEALTH DEPARTMEDIT � ` IMPROVEMENT PEF��IIT OWNER OR CONTRACTOR: cZ � 2•��-- i�,�'s -� DATE: ~��`(J O ADDRESS: � I 15 . C f :'. �,/' , . '�'�/' " . PHONE: ��, - ?�`�� LO CA� I ON : � � �;� 'r 7-�t,, c7' E��,7' �,C -- �'t 1�- �'_'C�' � �1 C'- �c� .�` � � l� l` C� ��-Cl� C� —'� SUBDIVISION: LOT �� SEGTION OR BLOC�C: LOT SIZE: Notified to check with Zoning Yes ( o( ) Zoning A�oval �� ' j�-I� House () Mobile Home () Business () Other ��j��J Flow Rate: gpd Bedrooms: Bathrooms: Special Fixtures: 'C?� S' Other: Basement - Yes O No (�xtures in Basemen - Yes O No O Pump Sv em Yes( ) No (; ------------------------------------------- e ----------------------- ----- ---------------- Garbage Disposa ( No (L-}- Water Supply• Private Public ( ) TANK SIZE ��llons ��^�,t7 Co�nents/Special Instructions: NITRIFICATION FIELD: � r-►s ;��' � S Number of Lines � i�� G � Length and width of Lines System must be installed as shown. An}� (a) Bed System changes will be made only with prior Health . (b) Trench System 36" X ,.s ^ Department approval. If unforeseen proole�s or Trench System 30" X /- arise during installation, contr.actor must ' Total Sauare Fontage �_e t ��Q��_`_� ___call Health_Department__�_____�___________ ----------------- ------ ------ I CERT T I AA��VE �EWED AND AGREE TO P VISIO ON PERMI �� ' � t" , Owner gent� ..' Sani ian Final approval of this septic tank system shall in n �way be taken as a guarantee that the system will functiog satisfactorily for any given period of (time. l SITE AND SEPTIC TANK PLAN � t / � y �� _ �—� ,�, F _ �� )a � �, ��'� �� ., �, s , ��.. �,� � T�.-.�-.. � � � � . <-- �, 1 � � � � 1 � � �° ! � . � � , ( ( � Health Department Copy� Site Factor: oi7 roup �Soil Text�re Class Appl=c.ation Rate Slope and Landscap� Position S-<PS�- U � .�'y:� K� �.� Soil Drainage S-�S = U �Sandy Clay dR� Soil Depth S-�� U III Fine �—• 0.6-0.4 � Restrictive Horizon S- PS r U Loam Clay �n Available Space S-�S U Silty Clay Other S - PS - U (Specify) Sandy Clay Soil Characteristics: S- PS .iJ IV Clays Silty Clay 0.4-0.2 R�e air, Area Required: Yes ( ) No (�� '' � Clay *Bed systems are allowed only in soil GTOL� III, Catawba County, North�Carolina �- Voucher Vendor No. Date 04/28/11 A Make Payment To: �.� c O G Voucher No(s). Thomas Prayer House F,� � 'Z 5284 Hope Rd c�j � � Vale, NC 28168 ?g q,rJi ATTACNMENT Description Amount Work not completed on original evaluation $150.00 Sub-Total $ 150.00 Food Tax � Sales Tax Total $ 150.00 ' ' , For Accounting� Account � � Fund, . ` O�gan Project ;,; ' ; '' Use;.Only , ' Total - The undersigned hereby certifies that the goods or services specified above have been received or perFormed. Payment has not been previously authorized and this expenditure is a proper charge to the appropriation indicated. The above charge is certified to you for payment. (SIGNATURE - APPROPRIATE OFFICIAL) � � �o � � �� CATAWBA COUNTY v �i► '� P O Box 389 - Newton, North Carolina 28658 -(828) 465-8270 - Fax (828) 465-8276 - TDD (828) 465-8200 1g 42 SM Public Health — Environmental Health Division AUTHORIZATION OF REFUND Date 7 � c) 11 Case # ( ' ' � Applicant �,'t �� Refund Amount �/Sa. �0 Refund Reason � 4� i' ' •' ,P t/u �c�.e�r Authorizing Signature Received By Permit Center Staff '��- ��l �i Date �a��►l .� CQ� CATAWBA COUNTY, NC �,� ,� 100-A South West Blvd PLA N RECEI PT � ►—] Newton, NC 28658- U ,� �� ' (828)465-8399 Thursda A ril 28 2011 �► Y� p , I$ t�'Z sM www.catawbacountync.gov P�an case: EHPR-4-11-10575 �nvoice Number: INV-4-11-274466 Environmental Health Pian Review Invoice Date: 04/20/2011 Site Address: 5264 HOPE RD, Vale, NC APPLICANT OWNER CONTRACTOR Elouise Farley Thomas Prayer House 5284 Hope RD 5264 Hope RD Vale NC 28168- Vale NC 28168-6753 (704)462-2648 7044622648 Fee Name Fee Amount improvement Permit Fee Fixed $150.00 Total Fees Due: $150.00 PAYMENTS PAYER: Date Pay Type Check Number Amount Paid Change 04/28/2011 Refund -1 ($150.00) $0.00 04/20/2011 Check 1023 $150.00 $0.00 Total Paid: $0.00 Total Due: $0.00 plan receipt 04/28/2011 08:53