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�$ �G THIS IS NOTA PERMIT Case# EHPR-09-2019-32785
CATAWBA COUNTY HEALTH DEPARTMENT
d ( ) PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES
Nk8_42 sM Environmental Health Plan Review-Septic Malfunction
AUTH_CONST- SEPTIC_MALFUNCTION
o - ) Reu. d
Owner FRANCES BECKOM,2019 FRYE AVE,HICKORY NC 28602
H:8282940533 HOME:8282940533
NAME TO APPEAR ON PERMIT
Frances Beckom
SITE ADDRESS: 2019 FRYE AVE,HICKORY NC 28602 PIN# 279115631350
NAME of SUBDIVISION: OLD DAVE WHISNANT FARM Lot#_ 5 8 Section/Block 6
PROPERTY SIZE: Square Feet 24,393.60 Acres 0.56
DIRECTIONS: 127S,turn right Frye Ave,property on left side,first house after office building
PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank
GALLO PER DAY: 360 WATER SUPPLY: Community Well
SCRIBE WOR : 6/27/22 REVISE TO FULL REPAIR SYSTEM FAILING Revised 10/23/2019-Tank only repair
Original Description-System failing-tank being pumped every few months
SI RMATION
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: 50x42
NUMBER OF EXISTING BEDROOMS: 3 ft OF OCCUPANTS: 1
PROPOSED CONSTRUCTION
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:
ehnipli,:nu ni 06/27/2022 14:56 Page I of6
_31 CATAWBA COUNTY Case# EHPR-09-2019-32785
Q' Public Health Department
�, '1" Subdivision OLD DAVE WHISNANT FARM
< • 'j Environmental Health Division PIN# 279115631350
PO Box 389,100-A Southwest Blvd,Newton,NC 28658
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NAME ON PERMIT: (FRANCES BECKOM),2019 FRYE AVE,HICKORY NC 28602
(Frances Beckom)
Site Address: 2019 FRYE AVE,HICKORY NC 28602
Property Size: Square Feet_ 24,393.60 Acres 0.56
Directions: 127S,turn right Frye Ave,property on left side,first house after office building
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: Signature of Applicant or Agent
If you need further infonnation or assistance please call 828-465-8270
AREA1
FEENAME DATE FEE AMOUNT
Authorization to Construct(Repair)Fee 09/06/2019 $300.00
TOTAL FEES S300.00
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)
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