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Home My WebLink AboutEHPR-04-2018-28985.TIF y1Y A \ THIS IS NOTA PERMIT Case# EHPR-04-2018-28985 Q -+ . CAI'AWBA COUNTY HEALTH DEPARTMENT ❑° r oy f❑� illr.e/Y PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES FI J842 to Environmental Health Plan Review- OSWP po , /rD a A IMPROVEMENT El' ci •0 i • Applicant ADAM SMITH,2424 S CENTER ST.HICKORY NC 28602 C:2522066022 NAME TO APPEAR ON PERMIT Adam Smith SITE ADDRESS: 5541 HUFFMAN FARM RD,I IICKORY NC 28602 PIN # 279018419309 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 2,149,250.40 Acres 49.34 DIRECTIONS: Hwy 127 S,left Huffman Farm Rd,approx 1/mile on right old barn with stone foundation PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP For purchase only SITE INFORMATION Do any of the following apply to the properly 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? No 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: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF stone foundation barn EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 40 x 70 NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 30 x100 #OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: ehappl ioewm 0.1/25/20IS 09:10 Page 1 of4 Q,• CATAWBACOUN'PY Cased EI-IPR-04-2018-28985 ,Q' taallll 1 Public Health Department Subdivision < d6 i Lreironmcnud I lealth Division PINK 279018419309 °'" � PO Box 389, 100-A SowMvest Blvd,Newton,NC 28658 •42 w NAME ON PERMIT: (ADAM SMITH).2424 S CENTER ST,HICKORY NC 28602 (Adam Smith) Site Address: 5541 IIUFFMAN FARM RD.HICKORY NC 28602 Property Size: Square 17„r 2,149,250.40 Acres 49.34 Directions: Hwy 127 S,left Huffman Farm Rd,approx 1/mile on right old barn with stone foundation 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 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 property or legal agent of the owner. Date: Li it�/ I (a Signature of Applicant or Agent - 1/ - 111 If you need further information or assistance please call 28-466-72 AREA2 44##########4#######4##4#4###Rif##4###4#44####4######4####44####4##44#4#4#####4##444#4#44#4##4#4#4##4#4#4### EEENAME DATE FEE AMOUNT 1 Improvement Permit Fee 04/25/2018 $150.00 'MTh I,FEES 5159.110` 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) chapplication 04/25/2018 09.10 Page 2 of4 i ATL / /\ TRIS IS NOT A PERMIT COU Ti "t� 'a CATAWBA COUNTY HEAL'1['.IK DEPARTMENT '�... ... .._•.y'''`am. North Application for Environmental Services Application is for: ‘Fl New Construction J Existing Facility Improvement Permit Authorization to Construct New Septic I Septic Repair/Malfunction Septic Relocation - Septic Expansion Existing System Inspection or Reconnection New Well Replacement Well Well Abandonment Well Repair 55� I I��aA 69A d Property Ad�ess �v Subdivision rxrcd ; n 90 1 H ( 7 3 0 9 Lot# rr Acres 4-q Driving Directions to Property jacks, NC,- ia-1 S t L e�+ p . �}v}�w, f&//A IR a-1 Pro ' Lun -Hnc, r 1ti1 vvzirk vCY old kr ht� bA,n w.It flo,1 , .eti4A4(on �i1Jtwf { s -Ia -t{u, r5SLL.t ceC tkc &cn./ Skatj /cR- s�. didcWAy Applicant Contact Information Name MAnn c`IL Address 2..'-I2,4 S Lc lc- SF. 4,0A-ory Nc, Phone Cell Phone 252--- Loc re o 2 z Owner Contact Information Name Address Phone Cell Phone Contractor Contact Information Name License # Address Phone Cell Phone Name to Appear on Permit? [ Owner 's. Applicant ❑ Contractor Who will be the Primary Contact? ❑ Owner Applicant ❑ Contractor Existing Structures on Site? Yes No If yes. describe �n r #of Bedrooms * NM # of Occupants N/A Structure Dimensions q Q X —1 0 Basement n Yes 17 No Basement Plumbing ❑ Yes' No Existing Water Supply? Individual Well I Community Well ❑ County/City/Township Water Line Is a public water supply available? *"' •Yes •. No Well Construction/Abandonment/Repair Proposed Well Type I I Individual Well ❑ semi-Public Well Community Well Abandonment Type J Drilled n Bored Ei Dug n Unknown Well Repair Requested I I Yes No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank? EI Yes 0 No yr/\W\B A THIS IS NOT A PERMIT cfl . coin r CATAW I.A COUNTY HEALTH DEPARTMENT ,„„c„-,-;;;--,;,.„ Application for Environmental Services Proposed New Construction - Residential Primary Residence...1V New Residence Addition to Residence #of New Bedrooms j 3 Project Description 541cLC, btd, I+ °v/S-V wi tve..5.L Structure Dimersions 3 0 x 100 3000 s S{. #of Occupants 2_ Basement 1 1 Yes -W No Basement P umbing ❑ Yes ]] No Accessory Structure(4) Describe Structure Dimensions Plumbing n Yes n No Describe Plumbing Needed Accessory Dwelling n Yes ❑No #of New Bedrooms *1 # 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 If of Employees per Shift #of Shifts If Church# of Seats Commercial Kitchen n Yes n No 1f Daycare,# of Children (Multi-Family Residence,#of Apartments #Bedrooms per Apartment"t Total# Bedrooms *it. 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 ❑ No Does the site contain any jurisdictional wetlands? ❑ Yes N.g No Does the site contain any existing wastewater systems? • ❑ Yes % No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes NRI No Is the site subject to approval by any other public agency? ❑ Yes b No 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) 0 Accepted ❑ Alternative ❑ Conventional El Innovative ❑ Other Ng Any *Any room that will be imended 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. RETRIP TO TME PROPERTY AND/OR SYSTEM REDESIGN WILL INCUR AN ADDITIONAL CHARGE(SEE FEE SC ED ULE) Completed applications are valid for a period of2 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 -rf. -d. The undersigned is the owner of the propert.' or le!, •g It oft • owner. SignatureofOwner orLegal Agent _ ' `� Date UIL4� 1� Printed Name of Owner or Legal Agent Catawba County Environmental Health 3 • 6. 26% Tizi4s' *� 'Q' `� <�At {( bib Sk\Z in .HUf.FMAN F \\:: , \ (, 13/4 qinP rip ')Iii, %Mr ell\"•06%are v s 8J r. •V�►� .e gA5 j \itik,. At 1111111 .Coorrell,11111k. f. 1 )ri Jr rike S t Ss 0 ° iL limma•••••••04 it a rim OA -11r...joilblEs.rmit _iot ) .11, . .:, 0 7 ti 9u I 4 ‘. 1 :. . 11\.; ' re r ,. 0:„...:, a / t tfi 4)0 11111111111\41%I\6 WIS.11Thill66111.111hIll Iliks.'* NNW _ . . i ,,.$ 3 !I bil 0 I 4 ##FiVi1/24:11S j f)i 96 0, glir I 11111 Parcel: 279018419309, HUFFMAN FARM RD lin=300ft HICKORY, 28602 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. Copyright 2014 Catawba County NC 04/25/2018 leasa:rinal CATAWBA COUNTY IOOA SOU'T'H WEST BLVD NEWTON.NORTI I CAROLINA 28658 RECEIPT PHONE:828.465.8399 Wednesday,April 25,2018 \842 Sld www.calaobacount nc.gov PAYOR: Smith,Adam PAYMENTS TRANSACTION NUMBER: 'IRC-3479921-25-04-2018 PAYMENT DATE: 04/25/2018 PAYMENT TYPE: Credit Card 203098341 INVOICE NUMBER FEE NAME FEE AMOUNT 04-18-352189 Improvement Permit Fee $150.00 TOTAL PAYMENTS: 5150.00 EHPR-04-2018-28985 CASE TYPE: Environmental health Plan Review WORK CLASS: OS WP SITE ADDRESS: Applicant ADAM SMITE,2424 S CENTER SI'.HICKORY NC 28602 C:2522066022 **NO PEOPLESOPI'ACCOUNT ASSIGNED** receipt 0.1/25/2018 09:08 Pagc I of I