Loading...
HomeMy WebLinkAboutEHPR-04-2018-28969.TIF • -Syc,A • THIS IS NOTA PERMIT Case# EHPR-04-2018-28969 .-Ma'4 • CATAWBA COUNTY HEALTH DEPARTMENT 0� rro fQi -\1141.0-;t PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES to.o + tiknn t,f$ 2 su Environmental Health Plan Review-Septic Malfunction a r. IMPROVEMENT- AUTH_CONST- EXPANSION Elit�O 4 3�1k SfritAi (Of fairdPc(1 'li„� S4lua .. Applicant JAIME SAI,VA,, C:8282388556 Owner FRANCISCA A BLANCO,. C:8285789689 NAME TO APPEAR ON PERMIT Franc sca A Blanco SITE ADDRESS: 5276 OLDE SCHOOL DR,HICKORY'C 28602 PIN# 279120715109 NAME of SUBDIVISION: OLDE SCHOOL SUB lot'4 31 Section/131ock PIt01'ERT'V SIZE: Square Feet 21,344 40 Acres 0.49 DIRECTIONS: Hwy 127 S,left Bethel Church Rd,left Olde School Dr,property on left before curve PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 840 WATER SUPPLY: Community Well DESCRIBE WORK: System failing-Complaint EH-04-2018-7273-previous repair permit for 5 BR's-7 BR's existing, Residential Care Facility. SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is"YES",then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? No Are there any easements or right-of-ways on this property? No APPLICATION FOR: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Other OTHER DESCRIPTION: Residential Care DESCRIPTION OF residential care EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 69x58 NUMBER OF EXISTING BEDROOMS: 5 #OF OCCUPANTS: 7 PROPOSED CONSTRUCTION #OF NEW BEDROOMS:: 2 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES: SEATING CAPACITY: TOTAL FLOOR SPACE(SQ FT): Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: ehoppticauon 04/23/2018 15:10 Page I of4 • • �jyA • THIS IS NOTA PERMIT Case# EHPR-04-2018-28969 4� u CATAWBA COUNTY HEALTH DEPARTMENT 0° a� f❑' r�.. ti.t.� a:e? U !�� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES } 3i 1842/ Environmental Health Plan Review- Septic Malfunction rr rt it4 Z. � r IMPROVEMENT AUTH_CONST EXPANSION M' r.. % Applicant JAIME SALVA.. C:8282388556 Owner FRANCISA BLANCO,. C:8285789689 NAME TO APPEAR ON PERMIT 1� ��71 Francisa Blanco t' I Gnc15Cct cc p�j 7 Jc+in'fCSANF SITE ADDRESS: 5276 OLDS SCI-100L DR.HICKORY NC 28602 PIN # 279120715109 NAME of SUBDIVISION: OLDE SCHOOL SUB I of# 31 Section/Block PROPERTY SIZE: Square Feet 21,344.40 Acres 0.49 DIRECTIONS: Hwy 127 S,left Bethel Church Rd, left Olde School Dr,property on left before curve PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 840 WATER SUPPLY: Community Well DESCRIBE WORK: System failing-Complaint EH-04-2018-7273-previous repair permit for 5 BR's-7 BR's existing, Residential Care Facility. SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is"YES",then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? No Are there any easements or right-of-ways on this properly? No APPLICATION FOR: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Other OTHER DESCRIPTION: Residential Care DESCRIPTION OF residential care EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 69x58 NUMBER OF EXISTING BEDROOMS: 5 #OF OCCUPANTS: 7 PROPOSED CONSTRUCTION #OF NEW BEDROOMS:: 2 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES: SEATING CAPACITY: TOTAL FLOOR SPACE(SQ FT): Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: chapplicaiio0 04/23/2018 14:34 Page 1 oro y,A CATAWBA COUNTY Case 4 EHPR-04-2018-28969 .� fr.1 Public Health Department Subdivision OLDE SCHOOL SUB 4 .a 7 y Environmental Heahh Division PINk 279120715109 '•N Y "1r PO Box 389. 100-A Southwest Blvd,Newton,NC 28658 r; .ti w NAME ON PERMIT: (FRANCISA BLANCO).. ( Francisa Blanco) Site Address: 5276 DUDE SCHOOL DR. HICKORY NC 28602 Property Size: Square Feet 21,344.40 Acres 0.49 • Directions: Hwy 127 S,left Bethel Church Rd, left Olde School Dr,property on left before curve Completed applications are valid for a period of 2 years.Improvement Permits are valid:with complete site plan=60 months(5 years);with complete plat =without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid.An Authorization to Construct issued for septic repair is valid for 60 months(5 years).Permits may be revoked if the information on this applicaliorIsite plan changes or if the intended use for the proposed facility changes. Permits may be revoked if site conditions are altered such that they effect permit conditions or installation requirements I have read this application and certify that the information provided herein is true,complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. The undersigned is the owner of the property or legal agent of the owner. Date: L( I 7,3 / Signature of Applicant or Agent (ANAO 3 (t/t f If you need further infommlion or assistance please call 828-466-7291 AREA2 **********.**********44*********4**************4*****MS****4***********4**4*4******Mt*****************St* __ _ sir-_�._.^—._—.r--•--- ^^„ _ _—.'� FEENA\IE `. x 1_DATE IEE ANOIIN'fl Authorization to Construct Fee(New/Expansion) 04/23/2018 $500.00 Fee Improvement Permit Fee 04/23/2018 $150.00 r „ I O t s! I I?F.S • "' swim I J FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) elwpplication 0.1/232018 14:31 Page 2 oft ( I crinvis'? THIS 1S NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services / Application is for: New Construction V Existing TNaciliiy Improvement PermitAutho'ization to Construct I New Septic V Septic Repair/Malfunction Septic Relocation Septic Expansion U Existing System Inspection or Reconnection New Well I Replacement Well Well Abandonment Well Repair Property Address S 7(p O 1j psaciatd 1r Subdivision C n4- 11_1_( l,o'('( ' NL /�1// 0 1Lot# / Acres �{-{' t{ 7aC� - n p Driving Directions to Property 740 CQ 5 J f oI -eXP1 /�� d Ko (-1 ov y_2v/ so crl C ] 0 1�J l7 cv em?4- / `7 s� <00 kJ �n v SeP r- y /a 14 /c; i; -r =t.R,R/'� fr r -o 0 LrFt q0 4of 'e /c /. Pr d�7� eta JP , cZ tom' � F 'gnA '( ne ef{ oh o-?dx cLool dr be //vufr' Oil (e&' Ap lieant Contact Information Name AMES Address Phone Cell Phone*g) -�3 K3 c6 Owner Contact Information Name —Tiaittc,sra R(ck CO Address Phone Cell Phoni i g Sok_ %-e7 Contractor Contact Information Name License# Address Phone Cell Phone Name to Appear on Permit? Owner ❑ Applicant LJ Contractor Who will be the Primary Contact? [Owner El Applicant H Contractor Existing Structures on Site? v Yes ❑ No if yes, describe # of Bedrooms * #of Occupants 2 Structure Dimensions Gyq Basement ❑ Yes P'No Basement Plumbing ❑ Yes 2"No Existing Water Supply?pl Individual Well ✓� Community Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes H No Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well H Community Well Abandonment Type Drilled Bored H Dug [1 Unknown Well Repair Requested I Yes J I No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well Bead to Pressure Tank? LI Yes ❑No F j�tti�,�,i / ) MI / THIS IS NOT A PERT • ouxr, Y i CATAWBA COUNTY WEALTH DEPARTMENT North ,tr_ Application for Environmental Services Proposed New Construction - Residential Primary Residence _ New Residence I I Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement ❑ Yes No Basement Plumbing n Yes f 7 No Accessory Structure(s) Describe Structure Dimensions Plumbing Yes Fl No Describe Plumbing Needed Accessory Dwelling U Yes LI No # of New Bedrooms *j # of Occupants Proposed New Construction - Commercial Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq. Ft.) #Employees per Shift #of Shifts Dining Area (Sq. Ft.) Business/Other Specify Type Structure Dimensions .Retail Floor Space # of Employees per Shift # of Shifts If Church# of Seats Commercial Kitchen n Yes No if Daycare,#of Children If Multi-Family Residence,# of Apartments #Bedrooms per Apartment*j Total #Bedrooms *-1. Other Information Calculated Design Flow, Commercial j (This value will be determined by EH staff) The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in question. If the answer to any question is "yes", applicant must attach supporting documentation. ❑ Yes BeiNo Does the site contain any jurisdictional wetlands? NlYes 0 No Does the site contain any existing wastewater systems? ❑ Yes . o Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes o Is the site subject to approval by any other public agency? ❑ Yeso Are there any easements or right of ways on this property? Describe If applying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) ❑ Accepted ❑ Alternative 0 Conventional ❑ Innovative 0 Other ❑ Any *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 floor plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system expansion in the future. j If structure is plumbed but has no bedrooms,calculated design flow will be determined by EH Staff. ** If No,a well permit must be issued with the Authorization to Construct. RE'l'Rll'TO THE PROPERTY AND/OR SYSTEM t REDESIGN WILL INCUR AN ADDITIONAL CHARGE(SEE FEE SCHEDULE) Completed applications are valid for a period oft years.Improvement Permits are valid:with complete site plan=60 months(5 years); with complete plat=without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid.An Authorization to Construct, issued for septic repair is valid for 60 months(5 years). Permits may be revoked if the information on this application/site plan changes or if the intended use for the proposed facility changes.Permits may be revoked if site conditions are altered such that they effect permit conditions or installation requirements. I have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. The undersigned is the owner of the proper y or legal agent o the owner. or Signature of Owner Legal Agent 'a e I u . QL? Date / 3 Printed Name of Owner or Legal Agent Catawba County Environmental Health O o ., 0 O I N N Tp 0 w fl ui, . O N h • 55.54 162 A9 50{- OR OLOt Parcel: 279120715109, 5276 OLDE SCHOOL DR 1 in=40ft HICKORY, 28602 This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial effods to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report 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/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 04/23/2018 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 279120715109 Owner: SILVA JAIME ANTONIO Parcel Address: 5276 OLDE SCHOOL DR Owner2: BLANCO FRANCISCA A City: HICKORY, 28602 Address: 5276 OLDE SCHOOL DR LRK(REID): 90044 Address2: Deed BooWPage: 3340/0814 City: HICKORY Subdivision: OLDE SCHOOL SUB State/Zip: NC 28602-8283 Lots/Block: 31/ Last Sale: $250,000 on 2016-05-05 School Information: School District: COUNTY Plat Book/Page: 27/193 Legal: LOT 31 PL 27-193 Elementary School: MOUNTAIN VIEW Middle School: JACOBS FORK Calculated Acreage: .490 Tax Map: 132H 04031 High School: FRED T FOARD Township: HICKORY School Map State Road #: 2927 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: MOUNTAIN VIEW Zoningl: R-20 Building(s) Value: $236,700 Zoning2: Land Value: $22,200 Zoning3: Assessed Total Value: $258,900 Zoning Overlay: WP-O Year Built/Remodeled: 1999/ Small Area: MOUNTAIN VIEW Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710279100J Building Details 2010 Census Block: 2026 WaterShed: WS-III Protected Area 2010 Census Tract: 011102 Voter Precinct: P23 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report 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/report product or the use thereof by any person or entity. ©2017, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=279120715109&typ=P 4/23/2018 /))1') / . ...t- 1::/.. CATAWBA COUNTY IfEALTH DEPARTMENT N° 6 2 3 8 Telephur : (828)465-8270 TD . (828)4611204W_, � ,,,1r"1 Imp. Prmt. • Auth. to Const `/ R.I.. Print. _Opr. Print. Sys. Type `..-" int Well Print. Well Rm.. Pr Owner/Agee ' ww _. Phone ,2 ,e7--. �f 9 Address 57 ,349 tJ'-' `/s' . Ai , bil<[ Subdivision Ea d" Section/Block/Phase lit l .,, Lot Size /4•37,„„,...a_ Directions: /�7 S e _ o ;: • / , Facility: HouseZ„..-----kobile Home Business Multi-family . Other: Tax Map or Pin Number a l 20-7/- 3!v P-- Other . Zoning Approval# -2 9-093_5-7 # Bedrooms / # Seats #Employees . Application Rate . /1/- GPD Flow ra Hot Tub or Spa yes/no Special Fixtures Basement ye60 . 100% Repair Areno Basement Plumbing yes/no Water Supply: Private Well Public ami-Public ••••••••••••••••******••••••••••*****•••••••••••••••••••••••k*********••••M*****Mak•••••••••****;** *••••••••••****•*****4•••••S Type of System: Trench Bed Pump Pump/Panel Panel LPP Other �"'"'r f7G' /vt 1.4rS Septic Tank Size/dad Pump Tank Size Nitrification Field: Total Square Feet 900 Depth of Stone to g°,94...44- .., Bed Size Trench Width 3 Total Length of All Trenches 3Uti Number of Trenches 1 Trench Length!�J L f r s i /.-3-0/ / / Feet on Center e9 Maximum Trench Dept123 o Distance of Nearest Well *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION'" Topo - ,% Slope Texture dr' t . Structure r 7 l Clay Min. r / /� . r i I Soil Wetnes " }� �ae Soil Depth �_ Restric. Hoz. at ' Available space no b'� � • Overall Class L � 0 a `+ �" Comments: k , `‘ u L( Y Filter Required Riser required when tank is more than 6 inches deep. **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 known possible sources of contamination. No volume of water is guaranteed •t . •site b th• Health Department. . �p ^ _ Permit Date % EHS „ , a / �+ Owner/Agent ��;•�14 A Septic Tank Installed By I ,,L; • - Date f1J EHS - 1 !' . ` , 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 Irnpection Authorization to Construct cp - O'S - GLOZ. CATAWBA COUNTY HEALTH DEPARTMENT s oZVOZ3s L4 Telephone (828)465-731 TDD (828)465-8200 IP X AC �.r Pmt. l� 0 r Ptmt. X Sys Type /j{{ Well Print. Replacement Well Well Rpr Prmt. Ownch/Agent pfdS : 1�1..---- Vatek Phone Address Subdivision Sccti.n/BI. k�hao +.- j� Lot Sizg Uirectiop S- r,/,� ��.'�r%J��i .4 e� .�/ ( mg S Property Address 5 I / )c Facility• House Mobile Home Business Multi-family Other• Pin Number Other \ Zoning Approval# 1/ Bedrooms S1111• Seats If Employees Application Rate GPD Flow f�y� Hot Tub or Spa yes,- ial Fixtures Basement y 0 100% Repair Area yes/no Basement Plumbin• +. Water Suppl, . mate Well Public Semi-Public Type of System. ench Bed./ Pump Pump/Panel Panel I_PP Other Septic Tank Size ( Pump Tank Size Nitrification Field. Total Square Feet (Q0_) Depth of Stone !E '{ iii Bed Size /0 K&_O Trench Width Total Length of All Trenches Number of Trenches / If Trench Length / / / /_/ Feet on Center Maximum Trench Depth 3`v Distance of Nearest Well *DO NOT INSTALL SEPTIC WHEN WET* *- SELL RECORD REQUIRED AT COMPLETION* Topo % Slope Texture Structure • Clay Min. / Soil Wetness " Soil Depth Restric Hoz. at Available space yes/no / �� Overall Class S PS U ,/ V \ Comments _ Azi a 4._____— ---7- loy61° pi/? D t 6 :7_ , , „, Filter Required 6; Riser required when tank is more than 6 inches deep. `�K.l ✓✓✓ **NO GUARANTEE OR WA Y 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 known possible sources of contamination. No volume of water is guaranteed at any site by the Health Department. _ AS Permit Date 03 - /c7-V'2_ HIS �y*,. . A[I A/ -z Owne Vit`. .1 — / Septic Tank I ♦I By u 'it/a , �,�_ , Dat J Z EHS IL.I Lei t *NW Well Installed By Well 1,rout Approval Date Well Het Erov. It ' Date Sample Collected Date of/e lir Results EFTS White-Office Yellow-Owner/Agent Pink-Building Inspection Authorization to Construct • • y1v'A C� CATAWBA COUNTY 17/ r;tYN, G00A SOUTHWEST BLVD n=ratioe !VIOL1 NEWTON.NORTH CAROLINA 28658 RECEIPT PHONE: 828.465.8399 Q w"li svy Monday,April 23,2018 Ig 42 SM www.catawbacountvnc.gov PAYOR: Saha.Jaime PAYMENTS TRANSACTION NUMBER: TRC-3468040-23-04-2018 • PAYMENT DATE: 04/23/2018 PAYMENT TYPE: Credit Card 202994174 INVOICE NUMBER FEE NAME FEE AMOUNT 04-18-352096 Improvement Permit Fee $150.00 04-18-352096 -;,' i " Authorization toLCOnstfuct,Fee_(N`_1 a. $500:00 ew/Expansion) Fee TOTAL PAYMENTS: 5650.00 EHPR-04-2018-28969 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 5276 OLDE SCI TOOL DR. HICKORY NC 28602 Applicant JAIME SAI.VA., C:8282388556 **NO PEOI'LESOFI'ACCOUNT ASSIGNED** Owner FRANCISA BLANCO.. C:8285789689 receipt 0423/2018 1433 Page 1 of 1