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HomeMy WebLinkAboutEHPR-08-2022-41898.tif $ �G THIS IS NOTA PERMIT Case# EIIPR-08-2022-41898 11 CATAWBA COUNTY HEALTH DEPARTMENT O PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES \842 SM Environmental Health Plan Review-Septic Malfunction AUTH CONST- SEPTIC MALFUNCTION Applicant GARY BLAIR,5950 WOODHALL,HICKORY NC 28602 C:8282946316 PZBLA►R@YA11OO.COM NAME TO APPEAR ON PERMIT Gary Blair SITE ADDRESS: 5950 WOODIIALL,HICKORY NC 28602 PIN# 269905089900 NAME of SUBDIVISION: DEERFIELD SUBD of# 80 1 Section/Block PROPERTY SIZE: Square Feet 45,302.40 Acres 1.04 DIRECTIONS: Hwy 127 S,right Deerfield Ln,right Fawn Trail, left Shirebourn,right Brandywine,left Woodhall on left PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Tank only top broken 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: 90 x 50 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION BASEMENT? Yes 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: 08/08/2022 14:54 I'agc I orb e • CATAW'BA COUNTY Case# EHPR-08-2022-41898 Public Health Department 'f' 2 Subdivision DEERFIELD SUED Environmental Health Division PIN# 269905089900 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 8 w NAME ON PERMIT: (GARY BLAIR),5950 WOODHALL,HICKORY NC 28602 (Gary Blair) Site Address: 5950 WOODhIALL,HICKORY NC 28602 Property Size: Square Feet 45,302.40 Acres 1.04 Directions: Hwy 127 S,right Deerfield Ln,right Fawn Trail, left Shireboum,right Brandywine,left Woodhall on left 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�j of the owner. 6,( Date: ( ( b etiignature of Applicant or Agent If you need further information or assistance pleas all 828-465-8270 AREA1 ###f######ffi#t###4i#i#fitf#f4if#f#f4ff4f######ff4#f###4##############f########f####i#########4############f FEENAME DATE FEE AMOUNT Authorization to Construct(Repair)Fee 08/08/2022 $150.00 TOTAL FEES S150.00 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) _li:�q,lii:nI 08/08/2022 14:54 Page 2 of6 catawba county pci})lic health Application for Environmental Health Services THIS IS NOT A PERMIT Application is for: ❑New Construction ❑Existing Facility ❑Improvement Permit1'Authorization to Construct ['New Septic Septic Repair/Malfunction ❑Septic Relocation ❑Septic Expansion ❑Existing System Insp do or Reconnection ❑New Well Replacement Well ❑Well Abandonment El Well Repair Property Address Sgs-0 ( j 6 0 Acres /, (}Lf Subdivision e e r '�� of Lot# Driving Directions to Property Describe work cep tc `Tqt v1 IC rep(a c C lYve ►n± Applicant Name G a P (a. <(- Applicant Address p LI 0 o d ka Phone -c - 4,3 1 (0 Email p Zb (a I r a h p c C o Owner Name 64 a r g k f' by Owner Address set co G 0 h Phone - 31 Email I Contractor Name Lo OS e e Vt dr e�� t r Contractor Address Phone a( - L(( 3 j( Email Name to Appear on Permit? ❑Owner ❑Applicant ❑Contractor Who will be the Primary Contact? ❑Owner ❑Applicant ❑Contractor Proposed New Construction-Residential Primary Residence ❑ New Residence 4ddition to Residence #of New Bedrooms*t #of Occupants Project Description V (q c_ o'T 701✓L Structure Dimensions,also specify dimensions of decks&porches (Choose One) ❑Basement 0 Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement El Yes ❑ No Retaining Wall>2' 0 Yes 0 No Accessory Dwelling #of New Bedrooms *t #of Occupants Structure Dimensions (Choose One) ❑Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' 0 Yes ❑ No Accessory Structure(s)Describe Structure(s)Dimensions Plumbing ❑Yes ❑No Describe Plumbing Needed (Choose One) El Basement ❑Crawl Space 0 Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' 0 Yes ❑ No Multi-Family Residence #of Apartments #Bedrooms per Apartment*t 'Total#Bedrooms in Structure*t #of Occupants Structure Dimensions (Choose One) ❑Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes 0 No Retaining Wall>2' 0 Yes ❑ No Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well 0 Community Well Abandonment Type ❑ Drilled ❑ Bored 0 Dug ❑ Unknown Well Repair Requested ❑Yes ❑No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank?❑Yes ❑No Environmental Health Catawba County Government Center, 25 Government Drive I PO. Box 389, Newton, NC 28658 Phone: (828) 465-8270 I Fax: (828) 465-8276 I EHAdmin@CatawbaCountyNC.gov Existing Structures on Site Describe Pec.s id e eke Structure Dimensions #of Bedroom * 3 #of Occupants ( Basement [v Yes ❑ No Basement Plumbing ❑Yes t/ No xisting Water Supply ❑Individual Well 0 Shared Well—Number of Connections 0 Community Well ❑County/City/Township Water Line Is a public water supply available? ** 0 Yes ❑No Commercial 0 Proposed New Construction ❑Existing/Change of Use ❑ Repair Food Service Specify Type #Seats Dining Area(Sq.Ft.) #Employees per Shift #of Shifts ---Church #of Seats Daycare 0 Yes 0 No #of Children #of Employees per P Y to Shift #of Shifts Commercial Kitchen ❑Yes ❑No Residential Kitchen 0 Yes ❑No Daycare#of Children #of Employees per Shift #of Shifts Business/Other Specify Type Structure Dimensions Retail Floor Space #of Employees per Shift #of Shifts Other Information Calculated Design Flow,Commercial t (This value will be determined by EH staff) e 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. C}Yes No Does the site contain any jurisdictional wetlands? Nj Yes 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 No Is the site subject to approval by any other public agency? ❑ Yes 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) f 0 Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other Ili( 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. t 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) Environmental Health soil/site evaluations require digging,augering,and/or probing into the ground.Property owner/applicant is responsible for marking all underground utilities,including but not limited to:underground power,cable,telephone,gas,water lines,and irrigation systems/sprinkler systems.Catawba County Environmental Health is not responsible for damage to unmarked utilities. 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. e undersigned is the owner of the pro or legal Iagent of the owner. ,t Signature of Owner or Legal Agent ` + ` , Date ��� �U Printed Name of Owner or Legal Agent (_.? r l,, . 73 I ci i r Catawba County Environmental Health t.. i L 1... N.1 —•—ll—• 84 •1360 a w 90.00 360,86 250.86 (M Li ir 80 C aL____,____ •5950 co IA co 81 `n r a •5946 .--C —,....___ 4,-T. 59.83 r� ---'1\\\ l ti i 67 53.16 7,1 �--�" 263.47 179.94 WOODHALL `b .88 53.16 w •5947 179.94 �' 59.08 /N Parcel: 269905089900, 5950 WOODHALL 1 in=60ft 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 2021 Catawba County NC 08/08/2022 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 269905089900 Owner: BLAIR GARY WAYNE Parcel Address: 5950 WOODHALL Owner2: BLAIR PORTIA Z City: HICKORY, 28602 Address: 5950 WOODHALL LRK(REID): 61172 Address2: Deed Book/Page: 1719/0596 City: HICKORY Subdivision: DEERFIELD SUBD State/Zip: NC 28602-8260 Lots/Block: 80/ Last Sale: $144,000 on 1991-05-01 School Information: Plat Book/Page: 20/232 School District: COUNTY Elementary School: MOUNTAIN VIEW Legal: LOT 80 DEERFIELD PL 20-232 Middle School: JACOBS FORK Calculated Acreage: 1.040 High School: FRED T FOARD Tax Map: 189H 09011 Township: HICKORY School Map State Road #: 2945 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: MOUNTAIN VIEW Zoning1: R-40 Building(s) Value: $203,700 Zoning2: Land Value: $27,000 Zoning3: Assessed Total Value: $230,700 Zoning Overlay: WP-O Year Built/Remodeled: 1988/ Small Area: MOUNTAIN VIEW Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permit Address Search for this parcel. Firm Panel #: 3710269900J If available, Building Permits for this parcel. Septic 2010 Census Block: 1027 links are not permits. 2010 Census Tract: 011801 Septic Final Permits prior to 08/2018, contact Agricultural District: Environmental Health. Building Details WaterShed: WS-III Protected Area Voter Precinct: P24/Voting Map 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. ©2022,Catawba County Government, North Carolina.All rights reserved. Y 1 rj t CATAWBA COUNTY HEALTH DEPARTMENT PERMIT # 03496 COMPLETION PERMIT OWNER OR CONTRACTOR: /9_ Z )17o_ep__6 DATE: ,�- ).-5 -e� ADDRESS: PHONE: LOCATION: S_-e_rt i•-3, , SUBDIVISION: -e}- ,:e /c,/ LOT:' kd SECTI.ON OR BLOCK.: LOT SIZE: House ( Mobile Home ( ) Business ( ) Other ( ) Flow Rate: gpd Bedrooms : Bathrooms : '� Special Fixture.s : Other:: - Yes ( jA-N.o (- )Fixture in basement-Yes ( ) No (L L - Garbage Disposal Unit: Yes ( ) No (()----- Water Supply: Private (Z...)-----Public. ( ) TANK SIZE; 7l9 o G gallons Distance from septic tank or nearest source of NITRIFICATION FIELD: pollution: 5 3 Number of lines: 2 FINAL APPROVAL OF THIS SEPTIC. TANK SYSTEM SHALL .IN Length and width of lines NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM' WILL (a) Bed System FUNCTION. SATISFACTORILY FOR ANY GIVEN PERIOD OF (b) Trench System 36" x / TIME. or Trench Sys. 30" x DATE INSTALLED: - ?-5.- , Total Sq. Ft;. ''7 4 Depth of Stone/ INSTALLED BY: n k. REMARKS: SANITARIAN: SITE AND spit C TANK LAYOUT ---T r_ _ . !. . ... .! 19 � • f • / I I11 ( , l / 1 ► ' n 0` r 1 � r / E f ` F-EALT1i. DEPARTMENT COPY • .. . . • ,.. ` , ----- rrRMtr NO..02473 PERMIT FEE: ti �� [J PEft` IT VOID_ AFTER 36 MONTH'S • . CATAWBA COUNTY HEALTH DERARTMENT IMPROVEMENT PERMIT • OWNER OR. CONTRACTOR: 1 DATE.: '/.��J� --� ADDRESS: A _ t� 9 7 /�lt' - •- �i4 PHO•E.: 3/. 1 LOCATION�I 2-7 S�2�y ,�� �- 4" _4 ( dz r.- :, ��r+ /Z -" i�.�, •>6 (w 0 Jh r):. ' SUBD ISION: • *i7- rf.1 ti LOT # rd SECTION OR BLOCK: LOT..SIZE: r!?ifi- Noti ied to-.• - eck with Zoning Yes ( i3-No ( ) Zoning Approval !l /P 61 .House ( . ' Mobile Homey( ) Business ( ) Other C. -): - . ow Rate.: • gpd Bedrooms:�_ Bathr ms: a-- Special Fixtures.: Other: Basement - Yes •( No ( ) Fixtures in. Basement - Yes ( No ( ) Pump Sys)emYes( ) No ( ) Garbage Disposal Unit Yes ( ) No ( (-----"' Water, Supply:: Private ( 'Public '( ) • TANK SIZE: f CP er 65 gallons Cowmen.ts/Special' Instructions: NITRIFICATION FIELD: Number of Lines Length. and width of Lines System must be. installed as shown. Any • (a) 'Bed System changes will be •made. only with prior Health (b) 'Trench System •36" X i - h _ Department approval. If unforeseen •prohles or Tr-n h System 30" Xt arise during installation., contractor must otalo are Fon�ag P�t_Qs_� T ne f .��QIIe . f 2- cal- ealth Department. _ • .� \�// I •CE TI IEWED AND AGREE TO PRO I ON N TM RM•IT. • Owner/Agent S.an.' ran Final •approval of th"isrseptic 'tank system shall in no y be - 'k - as a guarantee that the -.—system.will •funct•ion s(atisfactor-ilay. ,for-'any -given-peri d.:of:.ti ._._ _ SITE AND SEP IC. TANK PLAN.• elArit ( oX A .. .1, - 4 ... ..,4,:e. ; . . . , ,14 . 1 , • 1 � 1 . % . . - � _ .- ,— 1. • (Health Department CopyI" Site' Factor: Soil Group Soil Textu - Class. A lic-atio a ' 4.,�S�ldpe and d Landscape Position S - PS - U • Soil Drainage S - PS - U Sandy Clay Soil Depth S - PS - U III Fine Silt Loam 0.6-0.. Restrictive Horizon ' S - PS - U Loams Clay Loam Available Space • S - PS .- U Silty Clay • Other S - PS - U • (Specify) — Sandy Clay 'Soil Characteristics: S - PS - U IVa Clays Silty Clay 0.4-0.2 Repair• Area Required:., Yes ( ) No ( ) Clay r' *Bed systems are allowed only in soil Groin III, �4'A • CATAWBA COUNTY 111 100A SOUTHWEST BLVD 0 NEWTO I,IOORT828.4AR 8LINA 28658 RECEIPT 7399 Monday,August 8,2022 /8 4 2 SM www.catawbacountync.gov PAYOR: Blair,Gary PAYMENTS TRANSACTION NUMBER: TRC-4493228 1-08-08-2022 PAYMENT DATE: 08/08/2022 PAYMENT TYPE: Credit Card 293517021 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 08-22-410191 110-580200-663000 Authorization to Construct(Repair) $150.00 Fee TOTAL PAYMENTS: $150.00 EH PR-08-2022-41898 CASE TYPE: Environmental I lealth Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 5950 WOODHALL,I IICKORY NC 28602 Applicant GARY BLAIR,5950 WOOD]IALL,I IICKORY NC 28602 C:8282946316 PZBLAIR@YAI-IOO.COM **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 08/08/2022 14:53 Page 1 of 1