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Home My WebLink AboutEHPR-6-11-11144.TIF l�� " �� C p� THIS IS NOT A PERMIT Case # EHPR-6-11-11144 � � � � CATAWBA COUNTY HEALTH DEPARTMENT c� `��`Y�; •;;v ''C Plan Review Application far Environmental Services 1.842 S� Environmental Health Plan Review - Septic Malfunction SEPT/C MALFUNCTION NAME TO APPEAR ON PERMIT DAVID ELLER SITE ADDRESS: 4565 SALISBURY ST Hickory, NC Pin#: 372420917658 NAME of SUBDIVISION: Lot # Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.97 DIRECTIONS: SPRINGS RD TO KILLIANS HARDWARE, RIGHT ON SALISBURY ST. 4TH HOUSE ON RIGHT APPLICANT OWNER CONTRACTOR DAVID ELLER DAVID ELLER KELLY ISENHOUR 4853 SALISBURY ST 4853 SALISBURY ST 1535 VICTORIAN HILLS CIRCONOVER HICKORY NC 28601 HICKORY NC 28601 NC 28613-7774 828-322-2640 828-322-2640 828-217-1596 PRIMARY CONTACT: Contractor APPLICATION FOR: Existing Structure DIM EXISTING STRUCTURE: 30X40 EXISTING FACILITY TYPE: House NUMBER OF EXISTING BEDROOMS: 3 SEWER TYPE: Septic Tank NUMBER OF EXISTING OCCUPANTS: 5 EXISTING WATER SUPPLY IN USE: Private Well CALCULATED DESIGN FLOW: 360 Public water IS available for this property. PUBLIC WATER TYPE AVAILABLE: County/City/Township Water DESCRIBE WORK: SEPTIC IS BACKING UP IN HOUSE DESCRIPTION OF HOUSE EXISTING STRUCTURES ON SITE (IF ANY) PROPERTY EASEMENTS: N 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 t's property. An representation by you of house or structure location should conform to applicable setbacks. �.� � � Date: �n _��(}�' Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 working days f application date. If you need further information or assistance please call 828-466 �291 AREA2 *******************************************�*******************�*********�******************************************�* Minimum Setbacks Front: Side: Rear: Side St: Max Height: FEE NAME DATE AMOUNT BALANCE DUE Authorization to Construct (Repair) Fee 06/03/201 $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) 06/03/I 1 12:30 I I ,��A THIS IS NOT A PERMIT .� �� \�, CATAWBA COIJNTY HEAI,TH DEPARTMENT � ��;�'� ��:� � Application for Environmental Services Page 1 1 �54� sn+ 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 � , ��-J � �,iS3:.t � ��-- Subdivision L rZ OJ e-. v i Lot # Acres SectionBlocic/Phase Driving Directions to Property �� vt�Sc.— pPJ �l(�1`t} O� �Ati33u,�c� �� ..>�-- I'�l LLIA'�`'� ��+�2b�%��— � � �u �,. � a NAME TO APPEAR ON PERMIT? ' Owner ❑ Applicant ❑ Contractor O Applicant Contact Information V Name �iyy�� QS w n� W Address m � Phone Cell Phone j Owner Contact Information � Name �/av t t7 ��1Z. Z Address �� S�u.�� i �� -� re. Gv � e. 1 ( O Phone _�� v Cell Phone ;�3�-(g',3� � � Contractor Contact Information � U Na►ne � +(�-�,� Y�� 1 ��r�s N,��.�e �' r .� �i- �c,�, �� Address = Phone p2� - Cell Phone � Z WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant �Contractor Description of Existing Structures on Site �- -�C L.� , i �' � c..� �G � # of Bedrooms *�' � Structure Dimensions # of Occupants , F� Basement ❑ Yes [v]'No Basement Fixtures ❑ Yes ❑ No C 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 �'�10 Describe Is a public water supply available on or adjacent to the above property ** � Yes ❑ No Check type available ❑ Community Well ❑ Semi-Public Well 0'County/City/Township Water Line Existing water supply in use �' Individual Well ❑ Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line ❑ I WOULD LIKE TO SCHEDULE A COMBINED FLAGGING AND SOIL EVALUATION (SEE COMBINED EVALUATION PROCEDUES) ,,a� THIS IS NOT A PERMIT �� e � Y �; � CATAWBA COUNTY I�EALTH DEPARTIVIENT '� �` Application for Environmental Services Page 2 , 1 84 2 sM Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms * j' Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes ❑ No ❑ Accessory Structure(s) Describe # of New Bedrooms *�' if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence # Units #Bedrooms per Unit*�' Total # Bedrooms *�' Structure Dimensions ❑ Food Service Specify Type # Seats Floor Space -Entire Food Service Facility (Sq Ft) # Employees per Shift # of Shifts Dining Area (Sq. Ft.) ❑ Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Daycare Specify Occupancy Application for Wetl 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 staff. *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. �'If structure is plumbed but no bedrooms, calculated design flow is required. ** IfNo, 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) a I understand that this is a formal application for Environmental Services and authorize Catawba County Environmental � Health employees to go on this property for evaluation purposes. I certify the above information to be correct and understand 0 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 for the proposed facility. An Authorization to Construct issued by this department is valid for m � (5) five years from the date issued and is ot transf �abl � Signature of Owner or Agent - �' � � � i .. � Printed Name of Owner or Agent �J'+D,1� ��u- �� Date l� � � _ ac�1 � i � Catawba County, No�th Carolina N This map producl �vas prepared fi�om the Catawba Counry, NC, Geographic Information System. Ca�awba Coemry has made substnntra! eJforts m ensure the accuracy of location and la6elrng injormation contained on thrs map. Camwba Counry promotes and recommends the independent veriftcation of any data contained on this map prodtrct by the user. The Counry of Catcnvba, its employees, agents and personne/ disclaim, and shal/ no! be held /rab/e for any and al! damages, loss or lrabrliry, whedier direct, indirect or consequential which arises or may arise from lhis map product or the use thereof by any person or entity. Legend Selected Parcel Number: 3724-20-91-7658 1 inch = 60 feet Prepared for: ----�_.� � N 6 — _____ 4891' r' 1 �.._ ] y — — _` --J (339) ° � . -- � __ � � N 4879 r-- •-- � 7870 N � � � � � §� � r i € ',> �, ,�� ", ` + K ' ' � h ' r �- r "�7 i �. � � � �i i P ,� o ryn '� � � gro° t v �° +r � " [r � i �' i F�'S u d *' �;, k' t 4�� F u �lU �' � F�dk v�. � 6 F aa n i �� +�pm�� r�sY #�p�� {;� y �� '� �I I Y �'#N� iiil � � �� ' �� Y.l� �� ?,. 1e C �� ' h rs .a� r � � x r � � dq � i�� ro 4 a t� i �. x .� i r� � i"�{ a �+,,¢. l I I i I h' t � r� � 2,. e � �1 j iti ' 'i.a k� il i� sr rv� �. ��. � ul� � "� � . p I II II � k � � I ry�, �{rJ" Nul I III I I �" ,. y� y', �} r I �' : r y ''� r F �, f°�3 '. 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E t , � � i , ��. t;� a� x, ,.0 d ^ 1 r #' � y �,iilw� �s S � ,.d^c � � i ii ''s� n2�� Ilf{u�ll� � �!� u3 t� � ,�"�' �3 �i� 1 ii �� 4�6� �- tY ,� r. °�� '� p� k � �V ia �, r� "r I� iN +� ,# ' � i �` x @,k � �' 'P �z � i t l'�. i I� x 9Fk P i III iill� '3 G .r P ti l i p. yt �" 1� aC �'+ 1� � I i�s f i� I ,� . �' . � i�d� z y � � � � ik a � i �{ "'�' r rx �� '� •b � I� i kqh i r m �� i Ill . s 1 i i��, I r ,rv I Wmu�t s rG � � r ,� ! S t ir-. * 1 �' a^ 4 u 9, � e� r i - x .,.�' a i 7 i� � p�l � � � ; a�' � '4 �� .,sa+,;"' �e ��; �;°w ,,� ;�a �� , "� � r� � .! u i � i� i �� la°�iN p IIII�II�°� . �� «5 ' � � � �� 3�� t, as. - X-.�:'L�t w• � S � i r i�l�ii�l� ��L �� i� � 4^� ��.,, �'4 . i�`''�`i $��' i 1�, fl� ;i�s� .,�"s "e c ,{ «� u � r a � n i ,, ! � i" .. Y" p . � �v ��. z�,'E i �„�,�� § �. � �„ il,r�, ,,. . ' �°+�a'� � Y- � � 5�"� ��rq�l � R a�� 3 �� '� aFr��i��N ji��""v �3"� � �.� �.;'� �� m �, y ,r �� . � -_/ � .�: w � ��.,,, s ��'tiry��tN�''. -J N N ��' / r' ��:_4853 ��26 �''� ^o -� �� ti ,^- ; � (!�72}' � THIS IS NOT A LEGAL DOCUMENT Friday, June 03, 2011 12:20 PM � �, � i CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) ParcellD: 3724-20-91-7658 Name:� � ELLER DAVID JEFFREY Name2: Address: 4853 SALISBURY ST NE Address2: City: HICKORY Sta1e: NC Zip: 28601-7757 Account: 19710570 Calc Acreage: 0.97 Tax Map: 1420 02010 LRK: 50607 Deed Book: 2446 Deed Page: 1439 Subdivision Name: Subdivision Block: Lots: Plat Book: Plat Page: Building Number: 4865 Street Name: SALISBURY ST Site Zip: 28601 Township: CLINES Fire Code: ST. STEPHENS City Code: COUNTY State Road: 1503 Total Bldgs Value: $55,000 Land Value: $16,300 Total Value: $71,300 Year Built: 1949 Year Remodeled: 1996 Last Sale Date: Last Sale Amount: Neighborhood: 58 Watershed: Watershed Split: Voter Precinct: P29 E911 District: COUNTY Zoning: R-20 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: Zoning District: COUNTY Split Zoning Dist: N SplitZoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: SNOW CREEK Middle School: ARNDT High School: ST STEPHENS School Split: NO P&Z Case Number: Census Tract 2010: 010303 Census Block 2010: 2002 Small Area Plan: ST STEPHENS/OXFORD Agricultural District: Printed: Friday, June 03, 2011 12:20 PM � I .y�$ Cp� CATAWBA COUNTY, NC �,� �,��, ' oa-A South WeSt B�"d PL�411 f RECEI PT � � Newton, NC 28658- U •'-�� - �' (828)465-8399 Friday, June 3, 2011 �� 1$ [�Z sM www.catawbacountync.gov P�an �ase: EHPR-6-11-11144 �nvoice Number: INV-6-11-276024 Environmental Health Plan Review Invoice Date: 06/03/2011 Site Address: 4865 SALISBURY ST, Hickory, NC APPLICANT OWNER CONTRACTOR DAVID ELLER DAV[D ELLER KELLY ISENHOUR 4853 SALISBURY ST 4853 SALISBURY ST CONOVER NC 28613-7774 HICKORY NC 28601 HICKORY NC 28601 828-217-1596 828-3 828-322-2640 Fee Name Fee Amount Authorization to Construct (Repair) Fee Adjustable $300.00 Total Fees Due: $300.00 PAYMENTS PAYER: DAVID ELLER Date Pay Type Check Number Amount Paid Change 06/03/2011 Cash -1 $300.00 $0.00 Total Paid: $300.0� Total Due: $0.00 pl:ut receipt O6/03/201 I 1229