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Home My WebLink AboutEHPR-6-11-11151.TIF �� :�3� Ca�kawba�Cc�iinty�;�Nor�h Carolfna, D�sburse�nent 1lo�ucher � �� P�� R�� Fascal�`Yea�r�2010��1 �; �� . �: �� ...?�� '` ,� .....,�..� ; ... .:v,�.�. , � �„��_ .; ....,.� �,,, , , „ ,.,,-: �,�e„ _ �_:,�,. Vendor No. Date 06/06/11 Kim Hirst ,�3�' � Voucher No(s). 9109 Alpine Ct ��' 1 �,,� Charlotte, NC 28270 � ,� U �� '"S'` � 1, �4 2 DESCRlPTION AMOUNT EHPR 6-11-11151 $300.00 customer requests refund, clog found in line repair not needed SUB-TOTAL $300.00 SALES TAX FREGHT TOTAL $300.00 � Fund ,.Cost'Center �Ob�ect Pro�ect � , ,-�Amount For,Accqunt�n Use`Onl � , .� ,. ,�ti. 9 Y � � TOTAL $0.00 The undersigned hereby certifies that the goods or services specified above have been received or performed. Payment has not be previously authorized and this expenditure is a proper charge to the appropriation indicated. The above charge is certified to you for payment. (Signature - Appropriate Official) (Signature - Appropriate Official) � �� o � �� CA'�'AW�A COLTI�T'�'Y v �� P O Box 389 - Newton, North Carolina 28658 -(828) 465-8270 - F� (828) 465-8276 - TDD (828) 465-8200 1g�2 SM Public Health — Environmental Health Division AiJ'I'HO�ZATION OF 1�FUN1� I)ate � � ��l Case # � �PR �p '�� = f Ir � � A��licant �� i��%' �2efund Aanount � ��° �� 12efund �2eason `1Z�r�C� . ,�,�. 4 � . �l� lx�� I RP. �� - � ` � Authorizing Signature R t �` Received �y Permit Center Staff "-�- C� �(.., I)ate �I � 1 � � .�� C�� CATAWBA COUNTY, NC ��'' ,� 100-A South West Blvd �/ � �/ ��'�� r.� Newton, NC 28658- ` � �� U :��, �' (828)465-8399 Monday, June 6, 2011 � �� 1$ 4Z sM www.catawbacountync.gov P�an case: EHPR-6-11-11151 �nvoice ►vumber: INV-6-11-276038 Environmental Health Plan Review Invoice Date: 06/03/2011 Site Address: 7572 BLACKWELDER R.D, Denver, NC APPLICANT OWNER CONTRACTOR KIM HIRST KIM HIRST ' 9109 ALPINE CT 9109 ALPINE CT CHARLOTTE NC 28270 CHARLOTTE NC 28270 (980)722-3908 (980)722-3908 Fee Name Fee Amount Authorization to Construct (Repair) Fee Adjustable $300.00 Total Fees Due: $300.00 PAYMENTS PAYER: KIM HIRST Date Pay Type Check Number Amount Paid ChangE 06/03/2011 Check 122 $300.00 $0.00 06/06/2011 Refund -1 ($300.00) $0.00 Total Paid: $0.00 Total Due: $0.00 p{an ceceipt 06I06/2011 15:37 A �$ C O THIS IS NOT A PERMIT Case # EHPR-6-11-11151 ��., . �. G� �. . �, � ; CATAWBA COUNTY HEALTH DEPARTMENT U u- "; °.;; ''S' Plan Review Application for Environmental Services 1 842 . ,: sM ' Environmental Health Plan Review - OSWP SEPT/C IVIALFUNCT/ON NAME TO APPEAR ON PERMIT KIIVI HIRST SITE ADDRESS: 7572 BLACKWELDER RD Denver, NC Pin#: 460604518956 NAME of SUBDIVISION: Lot# 2]3 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.699 DIRECTIONS: HWY 16 S, LEFT CAMPGROUND RD, TURNS INTO SLANTING BRIDGE, LEFT ON INDEPENDENCE , LEFT ON BLACKWELDER, FIRST HOUSE ON RIGHT APPLICANT OWNER CONTRACTOR KIM HIRST KIM HIRST 9109 ALPINE CT 9109 ALPINE CT CHARLOTTE NC 28270 CHARLOTTE NC 28270 (980)722-3908 (980)722-3908 PRIMARY CONTACT: Applicant APPLICATION FOR: Existing Structure DIM EXISTING STRUCTURE: 30 X 40 EXISTING FACILITY TYPE: House NUMBER OF EXISTING BEDROOMS: 2 SEWER TYPE: Septic Tank NUMBER OF EXISTING OCCUPANTS: 4 EXISTING WATER SUPPLY IN USE: Private Well CALCULATED DESIGN FLOW: 240 Public water is *"NOT** available for this property. PUBLIC WATER TYPE AVAILABLE: County/City/Township Water DESCRIBE WORK: SEPTIC MALFUNCTION DESCRIPTION OF SINGLE FAMILY DWELLING EXISTING STRUCTURES ON SITE (IF ANY) PROPOSED FUTURE ADDITIONS NONE OR IMPROVEMENTS: PROPERTY EASEMENTS: NO 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 Heaith 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 p4ans or intended use changes for the proposed facility. A Wel1 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: �� 3I I I Signature of Applicant or Agent G��{/YYt ��"V ll�fi 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 AREA1 *****************�*********�*******************************************�*********************************�**�********* Minimum Setbacks Front: Side: Rear: Side St: Max Height: FEE NAME DATE AMOUNT BALANCE DUE Authorization to Construct (Repair) F ee 06/03/2 $3 TOTAL FEES $300.00 06/03/11 15:05 �gA CATAWBA COUNTY Case # EHPR-6-11-11151 ¢ � Public Health Department 2 Subdivision .� Environmental Health Division - Plan Review . �=. �C ''C P o , 0 Box 389, 100-A Southwest Blvd, Newton, NC 28658 L�� 2�3 1g 2 +w PIN# 4606045189�6 Applicant/Owner KIM HIRST, 9109 ALPINE CT, CHARLOTTE NC 28270 Site Address: 7572 BLACKWELDER RD, Denver, NC Property Size: SF 0.699 ACRES Directions HWY 16 S, LEFT CAMPGROUND RD, TURNS INTO SLANTING BRIDGE, LEFT ON INDEPENDENCE , LEFT ON BLACKWELDER, FIRST HOUSE ON R[GHT CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 06/03/11 I5:05 ,��A THIS IS NOT A PERMIT ¢'� a CATAWBA COUNTY HEALTI� DEPARTMENT : ., ;�.�;: ,� Application for Environmental Services Page 1 �84 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 �5`�J`�, �j�C{�t,t)��.� Rd • Subdivision QQ(�v,(�/, r(�, a�� Lot # Acres SectionBlock/Phase Driving Directions to Property ��,c�u �(p Sc�t�'h (_,2-4~f �r� �' �}✓r�Oct �D�.t�nGj 7Z ��'U�v15 I n-�c jIC�.�; Y}i r� Y��liG�C� � i L2.��4-- 0r� �del.X-�C�E;t'�Le� �(.-C-( C�'1 p �)�ic:�l..>�(c��/ % -(� ��s� i�us� or� � i � h� . � W J Q, NAME TO APPEAR ON PERMIT? ❑ Owner Applicant ❑ Contractor � Applicant Contact Information � Name �)q � ( 5ir� W Address �I�p�l A�I�i� G/�,I� Gi��aflvl,�-L rlC.r �.`�� m �� , Phone Cell Phone qS3U- ��;�- 3�i o� = Owner Contact Information � Name K i m N-� ��'1 Z Address Gllpc� ) tn� � �'1C(Vl��k f'JL ��:a-'lt7 � Phone Cell Phone �j Q(� - 3�i �� Contractor Contact Information W Name � Address � = Phone Cell Phone � � WHO WILL BE THE PRIMARY CONTACT? ❑ Owner Applicant ❑ Contractor Description of Existing Structures on Site S� b�C�{-U 0 # of Bedrooms *�' a Structure Dimensions ?�� Sk # of Occupants �G{ hq'n� I� Basement Yes ❑ No Basement Fixtures ❑ Yes �No � Planned Future Additions or Improvements (Building Permit NOT requested at this time) OC Describe ��1fJ � Proposed Future Structtu�e Dimensions # of Bedrooms *�' if applicable ? Are there easements or right-of-ways recorded on this property -=� es 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 ❑ County/City/Township ater Line ❑ I WOULD LIKE TO SCHEDULE A COMBINED FLAGGING AND SOIL EVALUATION (SEE CO MBINED EVALUATION PROCEDUES) �,�� THIS IS NOT A PERMIT ��' ; � � � s ,� � CATAWBA COUNTY HEALTH DEPARTIVIENT �� ` Application for Environmental Services •Page�2 � ' 1gc}2 sra 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 # 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 Sh # 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 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 d'etermine 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 futw 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. tlf structure is plumbed but no bedrooms, calcu(ated 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. � CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN � ADDITIONAL CHARGE (SEE FEE SCH�DULE) � 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 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 not transferable � Signature of Owner or Agent ��`� �—YV1�fi � Printed Name of Owner or Agent K�;� {�, {5-�— Date L� 3l I � � � Catavvba County, l�Torth Carolina N This niap product ivas prepared from the Catawba Coimty, NC, Geographic /njonnation System. Caiawba County has made substnntial e ff orts �o ensure the accuracy of locatron and labeling rnformation conlained on this map. Catawba Cotorty promotes and recommends the rndependent veriftcation ofany data conmined o�r thrs map prodtict by the vser. The Counq� of Catmvba, its employees, agents and personnel disclnim, and shal/ no� be held liable for a�ry and alJ damages, loss or liability, whether direct, indrrect or conseqt�entral tivlrich arises or may arlse from this n:ap producl or the use thereof by any person or entity. Legend Selected Parcel Number: 4606-04-51-8956 1 inch = 40 feet Prepared for: � � � � �t � ,,,, . V ' 12 �� : w 2 r� � �.. , �, , d t � �� , �� '"'' .� �.��,;,, � �� , � �ti�� a . �� " � 2 � �� , , F y � �. �# . ��'n � � � z � � s . � �r � a "` �� ♦ � ; d . ° b� u S �. a �. � .�� `'> , $' w � u � � , 4 4 �^� � �„, s�' � � t � � ��'w4 � �� . #' y . �,.2 .� r.'. r � 1� r�l� i .. �� ¢ � � �� k`�� u �f �' -� �� f !i o- x N i C �� u� f � ;; J t r I F ? i, � . r� � N� � ��i � �� ,. y ° � �. "� � � � i��"��„ t ' ��r � p w I i +� � s � ��K ° 8 -. 3 ' �� i � :� +.�r .' Illi{ �..: , � 4 X y _ /�� ,. � J � �. � � � �I ��I � 4 L * e� k � � ' ., ( �\ ^,:° C ` r i,'� I II ip �u �` � � l i � �' N�w��.��. � ��. { " . !I � .i 7, ( �. � 4�1 a I ��k r �, }� � �a:a � y'� � �4 � �� s�x � � �iul� li .:� 3 � �Y . � � , . 1 � q n » � � �. d Y '� ° �-' P � � ^ �� 4 ��' � Y � ■ x,. t * � 4 ti a � � .� ,. t q r Y I � �. ' �-`�' ,� � m a }^ t ,� '�`. + '' , �" �a s'�x �' ,� � ^" r 1 i c 1 a- � , } r�'� s a `: i S4 � ��7"',, �„. ��.� w , a � � t � � � � �.. v t � y i e � � r��'r� � . �iF�'' �. S. ,'S 1 � ^ '�� f+«� �4 }„ � I p M �•; � i Y., y t < - Y ! I I'N { .h3'� f.'4. � ��t� „��. F f 134!� :�;�' g � � � ` � � �_ � `E�r,�. � � r�� 4 ��, � t r ^t �'i�? ^r s�.S'� d r . �� g � � a l.r .r� k � a r� i i r �' ' s�, x� Yli y¢ q. s ��"'��'',� k h�. `'�'� � �� ` � 7" i i % �,'� .,,,,7 '��•# ,� a �`,y� � }� �� ,^ � .s' � x , a t � � eY �li d y t �. ,.,` � � � { �ir [ r re *s ��, .� s' � � , ... i t .�'t . � d � � M � 5 !;` ..'ik k. # S 4V^I . �TF?i . ♦ � d� ��M� $+ Fl£ �� a'�e �� r 4 * �� . �b r �,�t II s . � k � G »�' � ' G � ,€, � Q "�,3 r � E �' � � � � �§ � ' �� i � Vil � u � , � � - j �.. � %' ' �� , � � �� ,� �.' �+ e��M� ��V a i i � z �+, � x � � � �' ° � � k. �� r � r� i1ti�i � � I a �„ ' 3 ri �a ,�Y t,�.'� akl�i', � i 'rF i ,� y �� 0 ab � ' �� i ' " �'S � K'� � lai �r�Y �x� ��'� ^ � .��'� � �t.° �. � I�f+ i �l ;r ti 4� t � { �� ° � � � �k.r , '�� , 1 �4 � ', � .� i il '�� h �� r a r V i� l�hl i �u :.. �♦ �� ;� J �'' ,t � ?�� , l � "y � � �'!� �� ,� � � r r�E p_.z � ' � k� 'X `` A ., �es � � " �x :, a ,, Y Y� � �, � ':, {a� f .G Cil �r4 4 i , d%z� #� � �� . " u� j � 2 � .� �� r. 3 ti � �.� � � � Y �,E �� ' �� °�� `r��'�ia�p�� '°� , y d , P.. ` vr' � �h6�k� SsF�a!v m °ly rr � u"i h ; " T. . ', �� a�� NI 4I � I ° `$ ,f ' r � �`' �i � I I�II�� a v ? � � ;``�` %�,,, ioi II�I I i:, r � �iit��,.,'{� i+� � � THIS IS NOT A LEGAL DOCUMENT Friday, June 03, 2011 03:11 PM CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) ParcellD; 4606-04-51-8956 Name: � ' ' HIRST KIM WINGATE Name2: PORTERFIELD AMY Address: 9109 ALPINE CIR Address2: City: CHARLOTTE State: NC Zip: 28270-0672 Account: 159764395 Calc Acreage: 0.7 Tax Map: 017 X 34213 LRK: 18005 Deed Book: 2010E Deed Page: 0727 Subdivision Name: Subdivision Block: Lots: 213 Plat Book: 16 Plat Page: 81 Building Number: 7572 Street Name: BLACKWELDER RD Site Zip: 28037 Township: MOUNTAIN CREEK Fire Code: SHERRILLS FORD City Code: COUNTY State Road: Total Bldgs Value: $181,700 Land Value: $124,600 Total Value: $306,300 Year Built: 1988 � Year Remodeled: C.G�f ' u�-�l� Last Sale Date: Last Sale Amount: � �pA� Neighborhood: 129 / `' . / `''�'"��'�/�� Watershed: WS IV Critical Area Watershed Split: NO �� Voter Precinct: P41 �r�' E911 District: COUNTY Zoning: R-30 'A /'' Zoning2: �� /L�d,,�t,�,t, l�y�-� Zoning3: 1"� (/ Zoning Split: N Zoning Overlay: CRC-O,WP-O,FPM-O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: SHERRILLS FORD Middle School: MILL CREEK High School: BANDYS School Split: NO P&Z Case Number: Census Tract 2010: 011502 Census Block 2010: 4019 Small Area Plan: SHERRILLS FORD Agricultural District: Printed: Friday, June 03, 2011 03:11 PM I .��A �o� CATAWBA COUNTY Nc � ,�y ,�^ � 100-A South West Blvd pLA1V RECEIPT � E—] Newton, NC 28658- V "`, �� ' (828)465-8399 Friday, June 3, 2011 �� 1842 srn www.catawbacountync.gov P�an case: EHPR-6-11-11151 �nvoice Number: INV-6-11-276038 Environmental Health Plan Review Invoice Date: 06/03/2011 Site Address: �572 BLACKWELDER RD, Denver, NC APPLICANT OWNER CONTRACTOR KIM HIRST KIM HIRST 9109 ALPINE CT 9109 ALPINE CT CHARLOTTE NC 28270 CHARLOTTE NC 28270 (980)722-3908 ( 980)722-3908 Fee Name Fee Amount Authorization to Construct (Repair) Fee Adjustable $300.00 Total Fees Due: $300.00 PAYMENTS PAYER: KIM HIRST Date Pay Type Check Number Amount Paid Change 06/03/2011 Check 122 $300.00 $0.00 Total Paid: $300.00 Total Due: $0.00 plan receirt 06/03/2011 15:09