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Home My WebLink AboutEHPR-3-10-4451 (2).TIF $ THIS IS NOT A PERMIT Case # EHPR-3-10-4451 CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services Environmental Health Plan Review - OSWP 1842 SM EXS_SYSTEM APPLICANT OWNER CONTRACTOR LARRY WILLIAMS RICHARD CARLTON 1018 NW 10TH ST LN 4731 1ST ST HICKORY NC 28601-3579 NC 828-328-8888 828-217-2653 NAME TO APPEAR ON PERMIT LARRY WILLIAMS Pin#: 371515533649 SITE ADDRESS: 4731 NW 1ST ST, Hickory, NC DIRECTIONS: HWY 127 N TURN LEFT ON TO 1 ST ST NW, HOUSE ON LEFT #4731 AND #4763 NAME of SUBDIVISION: HOLLAR HOSIERY MILLS INC Lot # TR 2 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 7.13 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure Bedrooms 6 Basement: Yes Water Using Fixtures in Basement:Yes No. in Family 2 Whirlpool Tub : Gal. Capacity: MULTIPLE FAMILY RESIDENCE: Units 0.00 Total Number of Bedrooms DAYCARE: Number of Children RESTAURANT: Seats Square Feet Dining Area Square Feet Foodstand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees 1st 2nd 3rd OTHER: (Specify) Do you aniticipate any additions to Facility? If so, describe: APPLICATION TO LOCATE SYSTEM AND REPAIR AREA FOR EASEMENT TO BE DRAWN. Has any grading, removal, or addition of soil been done to this property? If so, describe NO Are there easements/right-of-ways recorded on this property? NO Type of Water Supply: Individual Well Community Well Municipal Semi-Public 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 non-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 sho Id conform to applicable setbacks. Date- .7 /1 U Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 rking days of application date. If you need further information or assistance please call 828-466-7291 AREA 2 (FOR OFFICE USE ONLY) Zoning Approval: _Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front FEE NAME DATE AMOUNT Side Existinp- Tank Check Fee 03/22/2010 $80.00 Rear TOTAL FEES $80.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 03/22/10 15:42 03/21:2010 15:07 8'2s3,32732~9 OUtJG t,1ITH ATTY PAGIE 02/03 - - ~n ~unr ss i + uuv vin vU J+ I1 I rl {1 l 1 ,1 PAGE J210~ 446 1 C.A►.T.A.V'V,$A, COUNTY A .$EALTR DEPAR371+E fm ppfieation for Environmental Se ices l?ertmit 0 Anthoriz ition to Construct rV;ICe9 1~TT ExistiAg Tank Check New we a Septic Repair se p", Pernik Sep", N'InO to ApPear on Pernnit Replacentent Well WaJI Abandontnent 2. Permit RequCated $y Y. Address 0 S s 3, Property Owner Y. Y- a8(o0 Business Pho L, Address Home Phone 4. NAmc of subdivision BUSInOSS Phone Property Address? L 7 0 t dome Phone Directions to Pro J r Lor 3 Section/$Iocwphe per; ~~1~0 ~ -A to S. Property Ste: Square Feet Z 6• TYPE OF FACILIT y. HOQGe Acres Date Platted/Rocorded 3 tp .rte Mobile Ho (p ~ t' mO Dimension ofSttuetttre bc' ~ ~ M!JW4 + Ydifi Basement On W~ Whirlpool F b no ter Using Ftxrures in 13a9omenc c no MULTIPLE FAl Callon Capacity 1No. in Famu3, - ~ '~I.`i'RESIDENCES: s DAY CARE: Number of Children Total Number of Bedrooms USTAURANT: Seats Square Feet Dining Area _Square Feet Food wend TYPE OF ]BUSINESS: Number of Employees let anzd Floor Spacc3rd OTHER. (5PECi y) 7. Do you anticipate any Additions to Fac9llty? Xes If so, describe: 8. Hrt3 any gjading, removal, or addition of soil been done to this property? Yee N If so, describe: Srr;-I l3h?11~ 9. Are there casements/right-o ways recorded on this property? No ' 10. IS a public water supply available on or adjacent to the above prope e % o Cltcok type that is available: [ ]Community well [ ]Semi-public wej County/Ctryrrawnship water lino **I£No, a Well Permit must be issued with the Septic Formit " 11. Well Type Applying Far: [ ] Individual well [ ] Community well [ ] Semi-Public well I understand that this it at formal application fbr a well pormir, Improvement Permit or Authorization to Construct a ground absorption eawaas disposal systcm to serve the abovo described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I comity ►he above information to be sorest and understand that an Improvement Permit issued as a result of this information is valid for 5 yem or may be nan-expiring under cermin specified conditions. Improvement Permita and Well Ptrnin are transferable, but may ba revoked if this information, site plans or inlel)dod use ehangos for the proposed facility. An Authorization to Construct Lsoued by this department is valid for (5) flvn, years from The date issued and i9 not transferable. Note: You mutt obtain ironing Approval prior to locating a home o' Ftrueture on this; proper'ry. Any reprmontmion by you of house or structure location should conform to applicable setbacks. **1F A PERMIT AS O BE REDESIGN5D AND/OR RETRIPS MADE TO THE ERTY. THER S ONAL CHARGE." 11117 I Q Signature of Owner or Agent Date E AVW Pa 40, C®,rnv9 arc's, srlc slay . ets4'- d r- 0" F-D¢ sQ /30 1 -4..1b TOTAL P-02 CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3715-15-53-3649 Name: CARLTON RICHARD ALAN Name2: Address: 420 N CENTER ST UNIT M Address2: City: HICKORY State: NC Zip: 28601-5046 Account: 159746523 Calc Acreage: 7.13 Tax Map: 202H 01003 LRK: 62710 Deed Book: 2775 Deed Page: 0010 Subdivision Name: HOLLAR HOSIERY MILLS INC Subdivision Block: Lots: TR 2 Plat Book: 67 Plat Page: 175 Building Number: 4731 Street Name: 1ST ST NW Site Zip: 28601 Township: HICKORY Fire Code: HICKORY RURAL City Code: COUNTY State Road: 1351 Total Bldgs Value: $2,101,000 Land Value: $407,800 Total Value: $2,508,800 Year Built: 1999 Year Remodeled: Last Sale Date: 5/1/1990 Last Sale Amount: $540,000 Neighborhood: 3 Watershed: WS-IV Critical Area Watershed Split: NO Voter Precinct: P39 E911 District: HICKORY Zoning: R-3 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: Zoning District: HICKORY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: HICKORY Elementary School: JENKINS Middle School: NORTHVIEW High School: HICKORY School Split: NO P&Z Case Number: Census Tract 2010: 010500 Census Block 2010: 1005 Small Area Plan: Agricultural District: Printed: Monday, March 22, 2010 10:59 AM Catawba County, North Carolina N This map product was prepared from the Catawba County, NC, Geographic Information System. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map. Catawba County promotes and recommends the independent verification of any data contained on this map product by the user. The County of Catawba, its employees, agents and personnel disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential which arises or may arise from this map product or the use thereof by any person or entity. Legend Selected Parcel Number: 3715-15-53-3649 1 inch = 120 feet Prepared for: TR 3 P4888 ~Q, 3.87A n~ 48~ 3U a cti 6- b^ 7.13A 11 3649 SO~iJ J TR 2 Plat 67-17P b 7 rs.ss a CJ\ v ry ~ 1 cc:s v S'~ ~tL 70 a 12 93 tS.SO r' 82.98 N 1p&.?9 5516 1,3 7 111.60 TR 1 Plat 67-175 7227. y 1.97A Sg J 6 0 0294 ~r v J~U0 V~o Za2.~.3 N 50 I 6198 1.12A ' 3105 3s.se THIS IS NOT A LEGAL DOCUMENT Monday, March 22, 2010 11:07 AM CRY R 4 Catawba County, North Carolina N This map product was prepared from the Catawba County, NC, Geographic Information System. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map. Catawba County promotes and recommends the independent verification of airy data contained on this map product by the user. The County of Catawba, its employees, agents and personnel disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential which arises or may arise from this map product or the use thereof by any person or entity. Legend Selected Parcel Number: 3715-15-53-3649 1 inch = 150 feet Prepared for: ps ~b2' \ 5.63 as, os 1B ~ 1° •S~ ry116h 'yjC/j~ 1.46A 7118 x" Q~ 5127 'os , 'a h of 3 1ya r~,c1 99 Plat 46-62/ Tract 8 ^~ry0 Plat 67-175 ~iQ ! O\5~ ~'4- 8082 TR 3 Plat 46-62 G~ 'O p y~ ~1.1A Tract A d~ .a7A 7912 9901 3 0 4888SOa'i p O/ /J` 1 48~3Q n M 01 1 o° Al o^ 7.13A \G 3649 s°~o (~`~11 7R 2 ^b p. 1y. ^o-' e ?s, v^ ~Plat 67-176 <C\ 4p 8572 v 438 V 62 m V N ~ 8414 s,, ~,,o a o0 1293 2S ZS s ~9Sp Slq~ 217 s3 ~ 7 ~ 82.98 t0g29 55.16 30.73 0~. 7376 111.60 R6 h 7R 1 Plat 67-175 N 7227 .96 0 0294 ts0 so ° 282.43 83 g4 H n THIS IS NOT A LEGAL DOCUMENT 1.12 9 0~ Monday, March 22, 2010 10:48 AM 4 31, 5 4 OPERATIONS PERMIT FOR TYPE III WASTEWATER SYSTEM PERMIT NUMBER ------5737------ In accordance with the provisions of Article 11 of Chapter 130A, General Statutes of North Carolina as amended, and other applicable Laws and Rules PERMISSION IS HEREBY GRANTED TO --------------Richard Carlton o.perat on of. _a wast.ewatpr_ co;li.ect_ion,,,: tr atment,,_,_and_ disposal system to serve: Pin#3715533649------------- pursuant to 15 A NCAC 18A 1900 et seq and in conformity with the application, improvement permit, and other supporting data subsequently filed and approved by the Catawba County Health Department and considered a part of this permit. Facilities to be served (Address and specific type of facility) A\1st street nw (1)Hydromatic pump shef 50 with alarm in basement (2)-5 lines at 3x103 chamber (3') 1500 gal. Septic tank (~4) 1500 gal. Pump tank (5) preasure manifold ` The owner shall be subject to all applicable provisions of Article 11 of Chapter 130A of the General Statutes and 15A NCAC 18A 1900 .et seq The owner is especially referred to Rules .1935 (31), 1937 (e), .1938 (g), 1945 (a,b), .1950 (a through i), 1961 (a through d), 1965, 1967, and 1968 The owner shall also be subject to the following specified conditions and limitations as they apply - CATAWBA COUNTY HEALTH DEPARTMENT No 5737 Telephone (828) 465-8270 TDD (828) 465-9 Imp Pjmt. Auth. to Const. Rpr Prmt. Opr Prmt. Sys Type Well Prmt.. Well Rpr Print. Owner/Agent iL k. f 1, 7, r i 'T O Phone ~ `a 7 - .Z 97 Address -3-77 h )V Subdivision Section/Block/Phase Loth Lot Size Directions ~.7 r T- ?i 14 v,ge r) N L-r C t1 P ie Facility- House Mobile Home Business Multi-family Other: Tax Map or Pin Number Other Zoning Approval # (!;:!I ry G1= )Ckur!j #J Bedrooms # Seats Employees Application Rate GPD Flow aO Hot Tub or Spa(z5no Special Fixtures Basement no 100% Repair Area es no Basement Plumbing es no Water Supply: Private Well Public Semi-Public Type of System: ren Bed 1'um Pump/Panel Panel LPP Other / cT~ p Nitrification Field. Total Square Feet 60 Depth of Stone Septic Tank Size '5 0&actl Pump Tank Size 1!5' Total Length of All Trenches Number of Trenches Bed Size Trench Width \ Trench Length Ivy/1(3/ Feet on Center G Maximum Trench Depth` Distance of Nearest Well *DO, NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* Topo -4/ % Slope (77~r o -To -L/ 64-7 T Structure exture P -Iei~- I ~ t-A Clay Min. Soil Wetness Lj3t" -p' -7c) re J U-- T r O Soil Depth_ t4 1 Qo Restric Hoz at PTe ry. K'Z CB Available space, e no TO Q Overall Class S U 4- EA S Comments I W'', t r^ 5 DkS 17M L-33 s~ Gi r~-~.w ~T-T~ C D ASTC"I vo I I [ ro m~ r I C CA Y) ~ ~l I Uc ~ press- &4 t p G,- I See **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility An Authorization to Construct is valid for (5) five 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. The siting.of the well by the Health Department staff is to provide protection from k own possible sources of contamination. No volume of water is guarante at any site b th Health Departient. / Permit Date EHS S Owner/Ag t Septic Tank Installed y 'Date77-- ct~/ EHS Well Installed By Well Grout Approval Date Well Head Approval Date Date Sample Collected Date of Results Results EHS White - Office Blue - Building Inspection Operation Permit Yellow - Owner/Agent Green Building Inspection Authorization to Construct ` r r CATAABA COUNTY , ® Public Health Department Environmental Health Division PO Box 389 100-A. South West Boulevard Newton, North Carolina 28658 :(704) 465-8270 FAX (704) 465- 0 0 a,X;03, xl03` T •~4 16,3 J Q ` C) 0 /0 Q ePC, 0 c- Y r O sW IW "Keeping the. Spirit A live Since 1842!" Recycle~Paper 03/1.1/2010 15:07 8283273283 YOUNG SMITH ATT`Y' PAGE 03/03 1 828 465 8276 P.01 COulity of Catawb: State of Norffi Car 0 Envzronmeatal. Health Facsimile Telephone Facsivaile smiU Sheet (828) 465-8276 TDD: (828) 465-8200 -a &4 ,~ON rtq TO., FROM: (2w /I DATE: ?111711 n The number of transmiaed pages is ,x including this cover page. If you dv not recEive all the pages indicated, please call (828) 465-8270 or TDD: (828) 465-8200 and the apj r ate pages wI be retransuitted. 03/21/2010 15:07 82832732,89 'VOIJAG SMITH ATT`(1 PAGE 01/03 E"W) - 3- 0 - 445 Young 'U. Smial, Jr. Attorney at Law 225 Fourth Street N.W. Post Office Drawer~1948e 200 Telepbo 82S)327-4101- Hickory, NC 2,9603 FAx: (828) 327-3289 .Facshn>iie Cover Page NAME: FTRM: DATE: FAX NUMBER. F2 7(0 NUMBER OF PAGES: (including cover page) MESSAGE: SENDER: If you have aiX-lems receiving the transmission, please call us right away. The i.nfonna.tion coninined in Ibis facsimile i* attorney-privileged and may be confidential and is intrnd_tl only for the uec of the individual or entigr named above. If Il?e reader of this n+easa}ie is, not tlic intended recipient, plcavc be ndviRed that tiny diN:acminatlolt, dlvtribution or copying of this communictaion is etricLly probibitcd. If [hit communicnlion Lug. been rcceived iv, error. Plcw-e until} Its by telephon and rchi the facsirnilc to u^. at, the shove address, via the U.S. Poslnl. Servlae. Tltank you. r M~ C~~~s h i.~ 4D D c% P S.eP+~ ~ ~~s~ 4-o des ig w-k. s~sl I-gotr J, ease be dew V-POS -Transaction Receipt Page 1 of 1 Transaction Receipt Catawba County, NC Catawba County Permit Center 100 A SW Blvd Newton, NC 28658 828-4658404 03/22/2010 03:37PM Catawba032210153355014Eng 29863264 EHPR-3-10-4451 LARRY WILLIAMS 1 N/A YOUNG M. SMITH JR PO BOX 1948, HICKORY, NC 28603 ************3663 Authorization and Capture Amount: $80.00 Cardmember acknowledges receipt of goods and/or services in the amount of the total shown hereon and agrees to perform the obligations set forth by the cardmember's agreement with the issuer. Signature click here to continue. https://www.velocitypayment. com/admin/catawbacountync/vpos/942/transactions/receipt/?... 3/22/2010 ~$A Cp CATAW13A COUNTY, NC 100-A South West Blvd PLAN RECEIPT Newton, NC 28658- V (828)465-8399 Monday, March 22, 2010 I 84 2 sm www.catawbacountync.gov Plan Case: EHPR-3-10-4451 Invoice Number: INV-3-10-260635 Environmental Health Plan Review Invoice Date: 03/22/2010 Site Address: 4731 NW 1 ST ST, Hickory, NC APPLICANT OWNER LARRY WILLIAMS RICHARD CARLTON 1018 NW 10TH ST LN 4731 1ST ST HICKORY NC 28601-3579 NC 828-328-8888 828-217-2653 Fee Name Fee Amount Existing Tank Check Fee Fixed $80.00 Total Fees Due: $80.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 03/22/2010 Credit Card -1 $80.00 $0.00 Total Paid: $80.00 Payer: young smith Total Due: $0.00 plan receipt ; 90f6da 12-fl 35-4t22-8fc 1-5372a44b94061.rpt 03/22/2010 15:39 $ CATAWBA COUNTY Case # EHPR-3-10-4451 Subdivision Hollar Hosiery Mills Inc F, Public Health Department Section/Bl/Ph/Lot# TR 2 Q ~ Environmental Health Division p~# 371515533649 PO Box 389, 100A Southwest Blvd, Newton NC 28658 18 sw (828) 465-8270 Fax (828) 465-8276 TDD (828) 465-8200 Applicant/Owner Larry Williams Site Address: 4731 1" St NW Hickory Property Size: 7.13 Directions: EXISTING SYSTEM INSPECTION REPORT Site/System Diagram .man k Cl~ (o(ake d (o-i nReld y ~y1,semc~ s~>tild l r\C46 c ~I P°" V m ~ U SL(Ppl y nL P nc)+ Tv~ 4tV, PrbPV_A 't 9r w4K 444 Koi sf, e P ~5 I~ nc.s Jo3'L r S~ S-f !GIP ype of Facility : House Mobile Home -II- #Bedrooms Business Specify Other Specify roposed Additions/Accessory Structure: .pproved Not Approved ❑ Reason vidence of System Malfunction : YES ❑ NO Sysem Type/Description 25% reduction n..0 1;/10 ~0,4 A AUTHORIZED S ATE AGENT APPROVAL DATE NOT FOR LOAN APPROVAL \Do~=M ad SenjW\&m flvWy Daa,m=b Ela MG TAM CHECK. docx