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Home My WebLink AboutEHPR-3-10-4472 (2).TIF A C THIS IS NOT A PERMIT Case # EHPR-3-10-4472 C a CATAWBA COUNTY HEALTH DEPARTMENT V C;: C Plan Review Application for Environmental Services Ig ~}2 Ski Environmental Health Plan Review - Septic Malfunction SEPTIC MALFUNCTION APPLICANT OWNER CONTRACTOR GERALD KILLIAN GERALD KILLIAN 1805 NE KOOL PARK RD 1805 NE KOOL PARK RD HICKORY NC 28601 HICKORY NC 28601 828-256-3958 828-256-3958 NAME TO APPEAR ON PERMIT GERALD KILLIAN Pin#: 372409060549 SITE ADDRESS: 1805 NE KOOL PARK RD, Hickory, NC DIRECTIONS: SPRINGS RD - TURN LEFT ONTO KOOL PARK RD - JUST OVER 2 MILES BRICK RANDH HOUSE WITH DETACHED GARAGE NAME of SUBDIVISION: Lot # Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.75 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure 28 X 50 Bedrooms 3 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: NO 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 X 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 should conform to applicable setbacks. Date: Signature of Applicant or Age t 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 (FOR OFFICE USE ONLY) Zoning Approval: Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front FEE NAME DATE AMOUNT Side Authorization to Construct (Repair) Fee 03/22/2010 $300.00 Rear TOTAL FEES $300.00 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 15:51 THIS IS NOT A PERMIT A*bS*- CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit ❑ Authorization to Construct ❑ Septic Repair V Septic Expansion ❑ Existing Tank Check ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ 1. Name to Appear on Permit etZgZJ rn. f /~i ( 2, V, y - M L~/'/ 2. Permit Requested By ® ere /1 Business Phone R6-6 Address Igo ~ goo/ 6A ek L=, 4oye A] C 2P6c Home Phone 1~ S'( -?5,5-7 3. Property Owner &'efe 1W. e%/ Business Phone ,.2S-6 97`1,1 Address J e x'o~L 6d Home Phone a S7a 3113-8 4. Name of Subdivision Lot # Section/Block/Phase Property Address 6 S Directions to Property: - - J'lj _A 4- 5. Property Size: Square Feet r Acres 75" Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home Dimension of Structure o? 9 X ~U Bedrooms* 3 *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 system size increase in the future. Basement: CEO~/no Water Using Fixtures in Basement: Ono No. in Family Whirlpool Tub yese Gallon Capacity MULTIPLE FAMILY RESIDENCES: Units Total Number of Bedrooms DAY CARE: Number of Children RESTAURANT: Seats Square feet Dining Area -Square Feet Food stand/Meat Market Floor Space TYPE OF BUSINESS: ,/1///9' Number of Employees 1st 2nd 3rd OTHER: (Specify) 7. Do you anticipate any additions to Facility? Yes 149) If so, describe: 8. Has any grading, removal, or addition of soil been done to this property? Yes / If so, describe: 9. Are there easements/right-of-ways recorded on this property? Yes /ffi? 10. Is a public water supply available on or adjacent to the above property? e Y No Check type that is available: [ ] Community well [ ] Semi-public wel [County/City/Township water line **If No, a Well Permit must be issued with the Septic Permit.** 11. Well Type Applying For: [ ] Individual well [ ] Community well [ ] Semi-Public well 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 valid for 5 years or may be non-expiring under certain specified conditions. Improvement Permits and Well Permits are transferable, but may be revoked if this information, site plans or intended use changes for the proposed facility. An 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. **IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TOT E PROPERTY, THERE IS AN ADDITIONAL CHARGE." Date 0 Signature of Owner or Agent Z~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 ony 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: 3724-09-06-0549 1 inch = 60 feet Prepared for: 1 ~2go1 1 t 6.75 " os 2 235 ~ 0. 1000k mss, N-~ , s ' 054' co M °co 1575 8533f A\ (146) - ~ ti~ol 8488\ 61 JL (g) - _ 9430 245 23 THIS IS NOT A LEGAL DOCUMENT 1 Mon, March 22, 2010 03:35 PM "CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3724-09-06-0549 Name: KILLIAN GERALD M Name2: KILLIAN JANET S Address: 1805 KOOL PARK RD NE Address2: City: HICKORY State: NC Zip: 28601-9223 Account: 38235500 Calc Acreage: 0.75 Tax Map: 226H 02005 LRK: 65369 Deed Book: 1292 Deed Page: 0037 Subdivision Name: Subdivision Block: Lots: Plat Book: Plat Page: Building Number: 1805 Street Name: KOOL PARK RD NE Site Zip: 28601 Township: HICKORY Fire Code: ST. STEPHENS City Code: COUNTY State Road: 1400 Total Bldgs Value: $152,500 Land Value: $18,300 Total Value: $170,800 Year Built: 1995 Year Remodeled: Last Sale Date: 5/1/1982 Last Sale Amount: $34,000 Neighborhood: 58 Watershed: Watershed Split: Voter Precinct: P29 E911 District: HICKORY Zoning: R-3 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: Zoning District: HICKORY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: CLYDE CAMPBELL Middle School: ARNDT High School: ST STEPHENS School Split: NO P&Z Case Number: Census Tract 2010: 010302 Census Block 2010: 3000 Small Area Plan: Agricultural District: Printed: Mon, March 22, 2010 03:35 PM CATAWBA COUNTY, NC 100-A South West Blvd PLAN RECEIPT Newton, NC 28658- V (828)465-8399 Monday, March 22, 2010 1$ 4'L sM www.catawbacountync.gov Plan Case: EHPR-3-10-4472 Invoice Number: INV-3-10-260661 Environmental Health Plan Review Invoice Date: 03/22/2010 Site Address: 1805 NE KOOL PARK RD, Hickory, NC APPLICANT OWNER GERALD KILLIAN GERALD KILLIAN 1805 NE KOOL PARK RD 1805 NE KOOL PARK RD HICKORY NC 28601 HICKORY NC 28601 828-256-3958 828-256-3958 Fee Name Fee Amount Authorization to Construct (Repair) Fee Adjustable $300.00 Total Fees Due: $300.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 03/22/2010 Check 5292 $300.00 $0.00 Total Paid: $300.00 Payer: GERALD KILLIAN, JR. Total Due: $0.00 plan receipt ; tldOtZ~cd(1-hRt3h-'16?e-Kaai-h 4dc~en 176bh; .rpt 03/22/2010 15:50