HomeMy WebLinkAboutEHPR-5-11-10895.TIF � .
,�� THIS IS NOT A PERMIT Case # EHPR-5-11-10895
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�' y CATAWBA COUNTY HEALTH DEPARTMENT
U , y� ''�' Plan Review Application for Environmental Services
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�nvironmental I�ealth Plan lteview - OSWP
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� _�_���j_� , (� e� IMF�RO!/EMENT
���- NAME TO APPEAR ON PERMIT
ROCKY & ANNJI REID
s�TE A��Ress: 3351 18TH AV NE, Hickory, NC Pir,�: 372311653760
NAME of SUBDIVISION:SHERWOOD FOREST Lot # 2 Section/Block/Phase
PROPERTY SIZE: Square Feet Acres 0.349
DIRECTIONS: SPRINGS RD/ TURN AT CRESTMONT/ 1ST PAVED RD TO LT/ GO TO END AT BALLPARK/ TAKE CURVE
TO RT/ 4TH HOUSE ON LT
APPLiCANT OWNER CONTRACTOR
ROCKY & ANNJI REID ROCKY & ANNJI REID EPI POOLS & SPAS
2840 HWY 321 SNEWTON NC 28658
82&465-1200
(828)234-4747 (828)234-4747
Mr Reid 800-222-1167 X1- Dia17160 Mr Reid 800-222-1167 X1- Dia17160
PRIMARY CONTACT: O @ APPLICATION FOR• xisting Structure
DIM EXISTING STRUCTURE: 5 x 50 EXISTING FACILITY TYPE: H�o�tse
NUIIABER OF EXISTING BE ROOMS: 3 SEWER TYPE: Septic Tank
NUINBER OF EXISTING OCCUPANTS 2 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: 15 X 30' ABOVE GROiJND SWIMMING POOL **Hickory Zoning
DESCRIPTION OF HOUSE
EXISTING STRUCTURES
ON SITE (IF ANY)
PROPERTY EASEMEN NO
PROPOSED CONSTRUCTIOIV
ACCESSORY STRUCTURES
DESCRIPTION: ABOVE GRD POOL W/DECK
# OF NEW BEDROOMS: STRUCTURE DIMENSIONS: 19 X 34 ACC DWELLING? No
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: 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
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M11911110198 SE�b�CkS: Front: 50 Side: 5 Rear: 5 Side St:20 Max Height:
OS/17/11 10:44
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Telephone (828) 465-�D (828) 465-8200 WLS # f�-�Q17
� IP�AC pr Pr ,. Opr Prmt. Sys Type Well Prmt. Replacement Well Well Rgr Prmt.
Owne gent Phone
Address Subdivision
Section/Block/Pha e Lot1/
Lot S' irections - L — r !M -c /lL —
L � v►. � � f
perty Address
Facility• House Mobile Home Busmess Multi-family Other� Pin Number ?j �
Other Zoning Approval t/
# Bedrooms �t Seats li Employees Application Rate GPD Flow
Hot Tub or Spa ye n p ial Fixtures Basement ye /no 100% Repair Area yes/no
Basement Plumbing s/no Water Suppl�� ivate Well Public� Semi-Public
���*r******�**r*** *�***s********s***********e*****r**�***�****�**�**s********* * s*****************r***�**************
� Type of System. Trench Bed� Pump Pump/Panel Panel LPP Other
Septic Tank Siz ^ I Pump Tank Size NitriFcation Field. Total Square Feet�O _ Depth of Sto W S �
Bed Size rench Width Total Length of All Trenches Number of Trenches �
Trench Length _/_/ /_/_/� Feet on Center Malcimum Trench Depth �� Distance of Nearest Well
*DO NOT INSTALL SEPTIC WHE�1 WET* *WELT. RECORD REQUIRED AT COMPLETIO�I*
**�***.*+*************�xs***s«****s***********************�*********�*******�r*********�**r*�****************�*�****s**r�*****
Topo % Slope �
Texture �
Structure �
Clay Min. �
� Soil Wetness " �
Soil Depth " �
Restric Hoz. at " �
Available space yes/no � L��
Overall Class S PS U �
� Comments � _ _ - - -- - - � ,. __ r _ � _ ,
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; Filter Required �
Riser required when � �
tank is more than 6 � ��� '
inches deep. (
**NO GUARANTEE OR WARRAIVTY IS IMPLIED OR GIVEN AS TO THE PERfiORMANCE OR LENGTH OF TIME THIS SYSTEM
WILL FUNCTION**
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*Improvement Permit has no elcpiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed
faciGty An Authorization to Construct is valid for (� �ve 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.
i 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 at any site by the Health Department. -
Permit Date 3'22�/-0Z n EH
Owner/ ent • , Septic Tank al d y Date � O
f EHS Well Installed By ut Approval Date
Well Hea rov 1 D e Date Sample Collected
Date of Re�ults Results -- = EHS
White O�ce Yellow - Ou�ner/Agen� Pink Building Inspection Authorization �o Construct