HomeMy WebLinkAboutEHPR-04-2022-40592.TIF 71S- • THIS IS NOT A PERMIT Case# EHPR-04-2022-40592
-7:0(1"11I61
CATAWBA COUNTY HEALTH DEPARTMENT
mrit(� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES
/8 2 ski Environmental Health Plan Review-OSWP
ABANDONMENT
(if) 4,a) RRosd
Applicant J MICHAEL HOLCOMB, PO BOX 519,CORNF,LIUS NC 28031
B:9803952634
Owner SETI l WOLFORD,,
C:7046615324
Paid By MIYAH FORD, 11309 OLD STATESVILLE RD,I IUNhERSVILLE NC 28078
MIYAHFrYAIIOO.COM
NAME TO APPEAR ON PERMIT
J Michael Holcomb
SITE ADDRESS: 1092 MANOR ST,CONOVER NC 28613 PIN# 375014339963
NAME of SUBDIVISION: Lot tl 29-32 Section/Block A
PROPERTY SIZE: Square Feet 17,424.00 Acres 0.4
DIRECTIONS: NC 10,turn right onto Manon St,home is on the left
PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank
GALLONS PER DAY: WATER SUPPLY: Private Well
CRI E WORK: 6/2/22 ADDED 2ND WELL TO BE ABANDONED PER MIYAH FORD SEE NEW SITE PLAN Well
Abandonment, home on the property has been demoed
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
EXISTING STRUCTURES
ON SITE(IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS:
PROPOSED CONSTRUCTION
EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES:
SEATING CAPACITY: TOTAL FLOOR SPACE(SO FT):
Desired system types(Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL:
OTHER: INNOVATIVE: ANY:
Other described:
APPLICATION FOR WELL ABANDONMENT
ABANDONMENT TYPE:
eliapplicauom 06/02/2022 11.09 Page 1 of 7
jArallr CATAWBACOUNTY' Casey EIiPR-04-2022-40592
Public I Iealth Department Subdivision
vs, Not\ szi Environmental Health Division PINH 375014339963
PO Box 389.100-A Southwest Blvd,Newton,NC 28658
NAME ON PERMIT: (1 MICIIAEL I301.COM13).PO BOX 519,CORNELIUS NC 28031
(J Michael Holcomb)
Site Address: 1092 MANOR ST,CONOVER NC 28613
Property Size: Square heel 17,424.00 Acres 0.4
Directions: NC 10,turn right onto Manon St.home is on the left
Completed applications are valid for a period of 2 year:.Improvement Permits are valid:with complete site plan a BO 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 applicatioNsite 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 solety
responsible for the proper identification and labeling of all property fines and corners and making the site accessible so that a complete site evaluation
can be performed.
The undersigned is the owner of the properly or legal agent of the owner
Date:__ /2.
IS_ Signature ofApplicant or Agent
If you need further information or assistance pl rise c. 828-465-8270
AREA2
FEENAME PATE FEE:AMOUNT
Well Abandonment Fee 04/04/2022 S 100.00
Well Abandonment Fee 06/02/2022 S 100.00
TOTAL FEES S200.00
FEES ARE NON-REFUNDABLE
ONCE A SITE VISIT IS MADE OR
WORK ON A PLAN REVIEW HAS COMMENCEI)
SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
chappluali,m 06/0212022 11:09 Page 2 of 7
•
in
de
0
o:. 0 ..•., -
ii cr, >-.
...7:. .
g to r.1.1 '- • •
.-1 al
al (....
(r) 4-; ......• .2:,
.... m ELI "u
MS d' 0 (-• cn r„, f:4 i.: C '.. '- *"' "
u • .-• csa rry r-4 .i4 r" fi
n 0 N. — to ribLt. .:..,.. -! a:: !,: -,;. _
to 'I' r:4 (0 .._. ..-- 1-11 .r•• :" . '2-- :':
...•
g t".... rei 0 03 ix GO •
-, in •,_. (=> .-. 7-., ::• Ir. 4.:.
h.s _.,. f i li ki Z if .' 0 Cr) ..`:". a g, '''. :•:: '-: .'",: -' :::f .
'
•••••••1 0..../ I , 0 a) ..._. 1:?..: •-' 0 Fr ...,Y
L..c-) " Z n 2 •E: f., — 11..' t ^.=.. A'
it Cd 0 .....1 <4 c..) tn i: ,.- e.:: •.:1 •.. :::
•
c--, _ . .. _
.4.-..,
•
•
,..-A.
, - -T -
.,---- k..... .z.. .
,----
.,•-•--
,,,...•
;
\
.1 ‘
•
.---I- -- •
-
4- --,,,---,--.--- 1,\ _
'..
---
. ...1+ )
v...........„.........,.
51
ttO
ik
OP%
C� CATAWBA COUNTY
.{, 100A SOUTHWEST BLVD
( NEWTON,NORTH CAROLINA 28658 RECEIPT
PHONE:828.465.8399
Thursday,June 2, 2022
8 4 2 SM www.catawbacountync.gov
PAY OR
Ford,Miyah
PAYMENTS
TRANSACTION NUMBER: TRC-40942597-02-06-2022
PAYMENT DATE: 06/02/2022
PAYMENT TYPE: Credit Card
290746316
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
06-22-407247 110-580200-663000 Well Abandonment Fee S 100.00
TOTAL PAYMENTS: $100.00
EHPR-04-2022-40592
CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP
SITE ADDRESS: 1092 MANOR ST,CONOVER NC 28613
Applicant J MICHAEL HOLCOMB,PO BOX 519,CORNELIUS NC 28031
B:9803952634
Owner SETH WOLFORD,,
C:7046615324
Paid By MIYAH FORD, 11309 OLD STATESVILLE RD,HUNTERSVILLE NC 28078
MIYAHF@YAHOO.COM
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 06/022022 11:07 Page I of I