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Home My WebLink AboutEHPR-4-11-10591.TIF �� C THIS IS NOT A PERMIT Case # EHPR-4-11-10591 � �`' �� CATAWBA COUNTY HEALT�I DEt'ARTMENT v ;.�, `ti' Plan Review Application for Environmental Services � 842 sM Environmental Health Plan Review - OSWP EXS SYSTEM NAME TO APPEAR ON PERMIT David Proctor s�TE A��RESS: 4802 BETHEL CHURCH RD, Hickory, NC Pin#: 370005282595 NAME of SUBDIVISION:MOUNTAIN VIEW ESTATES Lot # � Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.37 DIRECTIONS: Hwy 127 south / Left Bethel Church Rd / on corner of Prince and Bethel APPLICANT OWNER CONTRACTOR David Proctor David Proctor 4802 Bethel Church RD 4802 Bethel Church RD Hickory NC 28602-8293 Hickory NC 28602-8293 828-3 l 0-7844 828-310-7844 PRIMARY CONTACT: Owner APPLIGATION FOR: New Construction DIM EXISTING STRUCTURE: 50 x 30 60 x 40 EXISTING FACILITY TYPE: House NUMBER OF EXISTING BEDROOMS: 2 SEWER TYPE: Septic Tank NUMBER OF EXISTING OCCUPANTS: 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: 10 x 16 Storage Building - no electrical DESCRIPTION OF SOx30 House 40 x 60 pool EXISTING STRUCTURES ON SITE (IF ANY) PROPERTY EASEMENTS: none PROPOSED CONSTRUCTION ACCESSORY STRUCTURES DESCRIPTION: 10 x 16 Storage building # OF NEW BEDROOMS: 0 STRUCTURE DIMENSIONS: 10 x 16 ACC DWELLING? PLUMBING? No # OF STRUCTURE OCCUPANTS: 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: Z 1� � Signature of Applicant or Age 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: 30 Side: 10 Rear: 5 Side St: Max Height: 04/2 I/ I 1 1� 29 ��,A CATAWBA COUNTY Case # EHPR-4-11- l 0591 � G Pubiic Health Department Subdivision Q a Environmentai Health Division - Plan Review MOUNTAIN VIEW ESTATE �a '�' PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 , ' Lot# � �� 2 �M PIN# 370005282595 ApplicantlOwner David Proctor, 4802 Bethel Church RD, Hickory NC 28602 Site Address: 4802 BETHEL CHURCH RD, Hickory, NC Property Size: SF 0.37 ACRES DireCtions: Hwy 127 south / Left Bethel Church Rd / on corner of Prince and Bethel FEE NAME DATE AMOUNT BALANCE DUE Existing Tank Check Fee 04/21/201 1 $80.00 TOTAL FEES $80.00 CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 04/2 I/ I I 15:29 `a �A THIS IS NOT A PERMIT Q � CATAWBA COUNTY HEALTH DEPARTMENT ��c Application for Environmental Services • , Page 1 l�Q�' SM Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit ❑ RePlacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required)� Application is for New Construction ❑ Existing Facility ❑ Property Address ��°� �/�c:�h-vL C'�. �Gf' Subdivision �.`G Ce �� C , � k� �� Lot # Acres SectionBlocWPhase Driving Directions to Property �,�� .-,� /�,,,,, , f�Z S L 13 � 7�� C G, �,c Q C t,✓�c� �� ' o2h Y/� D� (�"R ��,o F �,% 0 � W � a NAME TO APPEAR ON PERMIT? Owner ❑ Applicant ❑ Contractor C Applicant Contact Information O Name �,� � W Address m � Phone Cell Phone � Owner Contact Information � Name � � _ r c- o/` z Address �"l �S �' ' � -c � � � � �' L �� /�<` c, d 2 � L aZ--�ln � � Phone G �_ 3 1 v� � y Cell Phone � Contractor Contact Information W Name � Address � = Phone Cell Phone � Z WHO WILL BE THE PRIMARY CONTACT? �fJwner ❑ Applicant ❑ Contractor Description of Existing Structures on Site �u, - � Q # of Bedrooms *�' Structure Dimensions ,S�h 3 v # of Occupants �_ I� Basement ❑ Yes No Basement Fixtures ❑ Yes o � Planned Future Additions or Improvements (Building Permit NOT requested at this time) � Describe � Proposed Future Structure Dimensions # of Bedrooms *�' if applicable ? Are there easements or right-of-ways recorded on this property ❑ Yes No Describe Is a public water supply available on or adjacent to the above property ** Yes ❑ No Check type available ❑ Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line Existing water supply in use ❑ Individual Well ❑ Community Well ❑ Semi-Public Well � Coun /City/�ownship Water Line ❑ I WOULD LIKE TO SCHEDULE A COMBINED FLAGGING AND SOIL EVALUATION (SEE COMBINED EVALU PROCEDUES) � �aaA G THIS IS NOT A PERMIT � � � CATAWBA COUNTY HEALTH DEPARTMENT �` Application for Environrriental Services Page 2 is4� s�� Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *�' Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes ❑ No Accessory Structure(s) Describe � .' �`. )3 ` : � # of New Bedrooms *�' if applicable tructure Dimensions l��'/6 # of Occupants � Accessory Dwelling ❑ Yes�No Plumbing ❑ Yes �Io Describe Plumbing Needed � ❑ Multi-Family Residence # Units #Bedrooms per Unit* j' T # Bedrooms *�' Structure Dimensions ❑ Food Service Specify Type # Seats Floor Space -Entire Food Service Facility (Sq Ft) # Employees per Shift # o f S hifts Dining Area (Sq. Ft.) ❑ Business Specific Type of Business Retail Floor Space ' # o f Emp per Shift # of Shifts �� ❑ Other Facility Type Specify I If Daycare Specify Occupancy ' Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well ❑ Community Well ' Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ No Describe Calculated Design Flow, Commercial �' Additional information may be required to determine design flow from certain facilities. This value will be determined during consultation with on - site sta ff. I *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 permit issuance. This may prevent the need for septic system size increase in the future. tIf structure is plumbed but no bedrooms, calculated design flow is required. ** If No, a well permit must be issued with the Authorization to Construct. 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. 0 CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN � ADDITIONAL CHARGE (SEE FEE SCHEDULE) v I understand that this is a formal application for Environmental Services and authorize Catawba County Environmental a � Health 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 V specified conditions. Improvement Permits and Well Permits are transferrable, but may be revoked if this information, site W plans or intended use changes far the proposed facility. An Authorization to Construct issued by this department is valid for m (5) five years from the date issued and is not transferable � /� j Signature of Owner or Agent �/��--� �✓ � � Printed Name of Owner or Agent �� ' �;� a c 7�� " Date ��`� �- �� - �Vr f� . �" �,:;��n ��_�.n_��II YG�,t�l�.C� �` C��.� �;' �.1, , . .-�: � . . ¢ � ��j �� :j� r �'��. � .,5�.: r�.�n �_„� . 5 �� Si�-�� '��'�5'��,<<�lcr�� '�l� . � � �� b.� �e�� ►.�.��-� � �� _ o , a 5 �;� ,��.�� , � �- � Ft 3 � .� �,�,,� -� � � G��- �G��}�a� _.�"" � � Q r � F_ �,�� ,�' `` ' �� GZS VJoc�� -�� '✓.��C� (�'KS��,(�.c�:. � � �, E1, � t � ,� F � •. ; r.^. ' � VD�+f/,JlG ��'1� ' °r; , �� . ,<,;f �:':i6-•. I� �V r� . �C��t f � � � ; � � i � � � i ! a I � vJal�r (:� � I � � - -- � ! � ��>� 'f �I � � I ' � 5' �"'--�__"_ ' � 35 6 ' , � }�'?�,. + � � - �'` i . �`� s � � �,... t` , I � t�� I <----\ -/J � � � `�., - L �._.__� _._..--.. .............. � � � �C��l. C.E�� :�� CATAWBA COUN'TY Case # OP-5-10-6969 Public Hea(th Department Subdivision Q � Environmental Health Division ' MOLJi�ITAR�! VIEW ESTATE � PO Box 389, 100-A Southwest Blvd, Newtoq NC 28658 Lot # r 2 w PiN# 370005282595 ApplicanUOwner SETH KEENER �j l � Site Address; 4802 BETHEL CHURCI RD, Hickory, NC �`' �� `�� 79 � Property Size: SF ACRES Directions: Catawba County Health Department Operation Permit IIIG - OTHER NON-CONV TRENCH SYSTEMS System Type: (In accordance with Table Va) Description: 25% REDUCTION � W' � Types V and VI systems expire in 5 years. � Owner must contact health department 6 months prior to exiration for permit renewal. System Installation Comments: GST 1000 Gallon, STB 160 I I/3/09 PERMIT CONDITIONS: 1. All maintenance, monitoring, and performance requirements shall be in accordance with 15A NCAC 18.1900, Rule .1961 2. Operation & Maintenance Specifics: Subsurface system operator required? Yes No If yes, see attached sheet for additional operation conditions, maintenance and reporting. This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and Ail conditions of the Improvement Permit and Construction Authorization. Kelly Isenhour # 1099 04/27/2010 SYSTEM INSTALLER INSTALLATION DATE Megen McBride - #2246 04/27/2010 AUTHORI"LED STA'1'E AGEN"f DATE OF OPERATION PERMIT ISSUANCE For(n F 05/06/10 08:19 Catawba County, North Carolina N This map product was prepared jram the Catcnvba Counry, NC, Geographic lnjormadon System. Catawbu Counry has mude sirbsfuntiu( eJjor�s to ensure !he accuracy of location and labeling informutlon contained ai rhrs map. Catawba Counry promotes and recommends the independent verrfrcation oJany dura contained on thrs mup product by the user. The Counry ojCatmvba, rts employees, agen�s and personnel disclaim, and shal! not be he/d lrable for any and ul/ dumuges, loss ur liabi/iry, whelher direct, rndrrecr or consequentiul which arises or mcry arise jrom rhrs map product or the use thereojby mrv person or entiry. Legend Selected Parcel Number: 3700-OS-28-2595 1 inch = 60 feet Prepared for: . r ,,�� 3 � ,^ ��`�� a � - s � ,,�'�' � � .�.a.! F ' rw.c� 1—F��,x Y P i a t* .;m �' R.� v �.� � x �,, u { �,, � '� � ��. �� 1 ; �= "4��4.1dY��rf,��s� � e� �y i� i �At r ,� F �+''~•.� � c'' � � �t ' � 3 s � aa � � :l !, l� 1 � t � t� `� ss� � .,.�� d r� "� .;j. `'� 't� � ' ,% �"'_ � ^�'.aa��: !�' � . �, � � "� � � �1 �� ` ,,� ` �- s x f � / 1 �' � ., �{ J � 41 �, �.-3�, ° p . 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O y . ^ � �' Y �, : r a> ti c�& `l � j J . � Qf ��. �'' y '�' t r . ` i� � T� � O �, � M�.. t U ,y��`.'yy"L P "- I ,� � 4 � r� �� vr' � ' , ��'F° �i � " r ,"� .: . �_ � tl �;� � � � � � �� f r � � .r,e 3 . - '�' -2- 1 j ! . a /� Y `.. ti I , ~ Y ..._ ------- --..--;��--.� 0 , , `� � � �� t > �rr� � � �`l, � � � ,�,� `� �. � 00 c ,� W �� J�ti � � � " � ��i � „ r � ' : �` Sl ��'' � ° a 1'�.�,� ' � ��k�� 1 � ..� �_ � 9 -"� - - --<.�'.�„�____..._.___._.__. � •— ; ----- ; / / ,r-___.. .__....__ r :Z.:.�._ _ � � !, '� r r' ' `�'��: y%�""` ---.�. - - — -- —.�+ `j j� fr; � � R-40 .LL- ..... , i' , ,/ �---�'_° �...,,� - --- ,�''" 9 ��r� _. ....-- THIS IS NOT A LEGAL DOCUMENT / f r Thursday, April 21, 2011 03:03 PM � ,�. % � J � � CATAWBA COUNTY NC - Parcel Report � Information Regarding Selected Parcel(s) Parcel ID: 3700-05-28-2595 • ' ' Name: PROCTOR DAVID A Name2: � Address: 4802 BETHEL CHURCH RD Address2: City: FiICKORY State: NC Zip: 28602-8293 Account: 159761901 Calc Acreage: 0.37 Tax Map: 173H 02072 LRK: 58913 Deed Book: 3024 Deed Page: 0149 Subdivision Name: MOUNTAIN VIEW ESTATES Subdivision Block: Lots: 7 Plat Book: 17 Plat Page: 220 Bui4ding Number: 4802 Street Name: BETHEL CHURCH RD Site Zip: 28602 Township: HICKORY Fire Code: MOUNTAIN VIEW City Code: COUNTY State Road: 1176 Total Bidgs Value: $63,600 Land Value: $12,000 Total Value: $75,600 Year Built: 1982 Year Remodeled: Last Sale Date: 5/3l2010 Last Sale Amount: $84,500 Neighborhood: 77 Watershed: Watershed Split: Voter Precinct: P23 E911 District: COUNTY Zoning: R-20 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: ED-O Zoning District: COUNTY Split Zoning Dist: N SpiitZoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: BLACKBURN Middle School: JACOBS FORK High Schooi: FRED T FOARD School Split: NO P&Z Case Number: Census Tract 2010: 011102 Census Block 2010: 2031 Small Area Plan: MOUNTAIN VIEW Agricultural District: Printed: Thursday, April 21, 2011 03:03 PM