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HomeMy WebLinkAboutEHPR-04-2018-29008.TIF THIS IS NOTA PERMIT Case# EHPR-04-2018-29008 2 H CAJAWBA COUNTY HEALTH DEPARTMENT E° La-4va nfr Y cr.� : ara ��� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES reit Ig A 2 SM Environmental Health Plan Review- Septic Malfunction Mh�l. AUTH CONST- SEPTIC MALFUNCTION "jri Applicant MARY CRANI'ORD,2418 28TH ST NE, HICKORY NC 28601 11:8288389420 PIOME:8288389420 NAME TO APPEAR ON PERMIT Mary Cranford SITE ADDRESS: 2418 28Th ST NE.HICKORY NC 28601 PIN # 372306493398 NANIE of SUBDIVISION: Lot ACRES PL 9-50 34 Lot if Section/Block PROPERTY SIZE: Square Feet 18,730.80 Acres 0.43 DIRECTIONS: Springs Rd,left 28th St NE,2nd on right past 24th Av NE PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: WPCOG repair See GAN-Dy-)D15-))35 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: House OTHER DESCRIPTION: DESCRIPTION OF residence EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 58 x47 NUMBER OF EXISTING BEDROOMS: 3 It OF OCCUPANTS: 3 PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: chnppllavion 04/262018 12:57 Pagel of7 ae • CATH WBA COUNTY Case# EHPR-04-2018-29008 Public Health Department Subdivision CLEARVIEW ACRES PL 9-50 < Baa ; Environmental Health Division ' PINK 372306493398 ao 11.• PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 NAME ON PERMIT: (MARY CRANFORD).2418 28TH ST NE.HICKORY NC 28601 ( Mary Cranford) Site Address: 2418 28111 ST NE. HICKORY NC 28601 Property Size: Square Feet 18,730.80 Acres 0.43 Directions: Springs Rd,left 28th St NE,2nd on right past 24th Av NE 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: IF ;71.G— 201 g Signature of Applicant or Agent`s v \ I_ I f you need further information or assistance please call 8.11,466-7291 AREA2 SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) elup1lieation 04/26/2018 12:58 Page 2 of 7 Ci- `,'�\U A THIS IS NOT A PERMIT -L ll CATAWBA CIUNT� IIEPARTIVIENT coup 1r - HEALTH ) � No„„Ci:p�� <, Application For Environmental Services Application is for: New Construction Existing Facility n Improvement Permit I I Authorization to Construct New Septic 1-peptic Repair/Malfunction Septic Relocation Septic Expansion Existing System Inspection or Reconnection New Well Replacement Well Well Abandonment I I Well Repair Property Address//[ zg S-i_ Air Subdivision Lot# Acres Driving d Directions to Property fr°'il[ J �p , �j)%� Applicant Contact Information Name Address a,f/ I u S-I- �aq� ADZ � Sk , /UC• i�' ��e7 Phone / o Z y§ _ &g 5O`��/ I d e) / G�11 R13ene— Owner Contact Information Name //4(bvy (7 C o>h Address a f II 8 7S S4 ,u hr'k-� , AJd 2- o Phone Cell Phone 92 g _Egg -9 'Lala Contractor Contact Infornmation Name License# Address Phone Cell Phone Name to Appear on Permit? Owner Applicant ❑ Contractor Who will be the Primary Contact? ❑ Owner ❑ Applicant Contractor Existing Structures on Site? VIres n No If yes; describe # ofBedrooms * 3 of Occupants 3 Structure Dimensions 5U. 1-'7 Basement ❑ Yes R-i-Sto Basement Plumbing ❑ Yesro Existing Water Supply? ❑ Individual Well ❑ Community Well County/City/Township \Vater Line Is a public water supply available? ** Yes ❑ No Well Construction/Abandonment/Repair Proposed Well Type n individual Well n Semi-Public Well n Community Well Abandonment Type ❑ Drilled 'Bored n Dug n Unknown Well Repair Requested n Yes No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank? Yes 0 No TUtAIA I-IIS IS NOT A PERMIT • COUNTY CATAW t A COUNTY HEALTH DEPARTMENT Application for Environmental Services Proposed New Construction - Residential Primary Residence _ New Residence Addition to Residence #of New Bedrooms *t Project Description Structure Diinensions # of Occupants Basement Lf Yes U No Basement Plumbing I I Yes PI No Accessory Structure(s) Describe Structure Dimensions Plumbing ❑ Yes No Describe Plumbing Needed Accessory Dwelling LJ Yes ❑ No # of New Bedrooms tt # of Occupants Proposed New Construction - Commercial Food Service Specify Type # Seats Floor Space-Entire Food Service Facility(Sq. FL) #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 I No If Daycare,#of Children If Multi-Family Residence,#, of Apartments #Bedrooms per Apartment*j Total #Bedrooms *t Other,information Calculated Design Flow, Commercial t (This value will be determined by Ell 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. ❑ y'es IV No Does the site contain any jurisdictional wetlands? res ❑ o Does the site contain any existing wastewater systems? ❑ Yes e;) Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes Is the site subject to approval by any other public agency? ❑ Yes o 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) O Accepted ❑ Alternative ❑ Conventional ❑ Innovative 0 Other 1;1/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. 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 THE PROPERTY AND/OR SYSTEM REDESIGN WILL INCUR AN ADDITIONAL CHARGE(SEE FEE SCHEDULE) 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 arc 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,?mpg rty or legal agent of theowner. Signature of Owner or Legal Agen Q �� Date 171.-2, g Printed Name of Owner or Legal Agent_�{ C CCS A_ A 72c1 Catawba County Environmental Health i i _.. _ 114 Ai , O N - - 1III!!IIlIt / I / C--; 144.8 I 79g4 I l ..- 7.. O -- I n "Pr i pCC _ I N N / /' h>2 - - I I / N \ , f O .-- --- Eif �Vl / N /it 150 24TH A v 7 I 100 t\ Parcel: 372306493398, 2418 28TH ST NE 1 in=50ft HICKORY, 28601 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 04/26/2018 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 372306493398 Owner: CRANFORD MARY C Parcel Address: 2418 28TH ST NE Owner2: City: HICKORY, 28601 Address: 2418 28TH ST NE LRK(REID): 53690 Address2: Deed Book/Page: 3288/1028 City: HICKORY Subdivision: CLEARVIEW ACRES PL 9-50 State/Zip: NC 28601-7995 Lots/Block: 3 4/J Last Sale: $101,000 on 2015-05-05 School Information: School District: COUNTY Plat Book/Page: 9/50 Legal: LOT 3 & 4 PLAT 9-50 Elementary School: CLYDE CAMPBELL Middle School: ARNDT Calculated Acreage: .430 Tax Map: 155H 05002 High School: ST STEPHENS Township: HICKORY School Map State Road #: 1495 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: HICKORY County Fire District: ST STEPHENS Zoning1: R-2 Building(s) Value: $85,800 Zoning2: Land Value: $13,400 Zoning3: Assessed Total Value: $99,200 Zoning Overlay: Year Built/Remodeled: 1965/1990 Small Area: Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710372300J Building Details 2010 Census Block: 1014 WaterShed: 2010 Census Tract: 010303 Voter Precinct: P30 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 riot 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. ©2018, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=372306493398&typ=P 4/26/2018