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HomeMy WebLinkAboutEHPR-08-2022-42127.tif A T111S IS NOTA PERMIT Case# EIIPR-08-2022-42127 d i CATAWBA COUNTY HEALTH DEPARTMENT ° PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Environmental Health Plan Review-Septic Sept c Malfunction AUTH CONST- SEPTIC MALFUNCTION Applicant MICHAEL POE,6389 WILLOWBOTTOM RD,HICKORY NC 28602 C:828-446-0766 MLPOE.1977crGMAIL.COM NAME TO APPEAR ON PERMIT Michael Poe SITE ADDRESS: 6389 WILLOWBO'l'TOM RD,HICKORY NC 28602 PIN # 268902875653 NAME of SUBDIVISION: DEERFIELD 4 Lot# 73 Section/Block PROPERTY SIZE: Square Feet 41,817.60 Acres 0.96 DIRECTIONS: S NC 127,right Deerfield,left Fawn Tr,right Shireborn, right Willowbottom Rd, .8 mile on left PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: tank is under sidewalk, sidewalk is sinking due to cracks in tank 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: 76 x 53 NUMBER OF EXISTING BEDROOMS: 4 #OF OCCUPANTS: 4 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: 08/31/2022 08:53 Pagc 1 of6 _`3 CATAWBA COUNTY Case 1 EIIPR-08-2022-42127 F ' Public Health Department r. (" 7. Subdivision DEERFIELD 4 Q -1 Environmental Health Division 'C PIN# 268902875653 I'O Box 389, 100-A Southwest Blvd,Newton,NC 28658 NAME ON PERMIT: (MICHAEL POE),6389 WILLOWBO ITOM RD,HICKORY NC 28602 (Michael Poe) Site Address: 6389 WILLOWBOTTOM RD,HICKORY NC 28602 Property Size: Square Feet 41,817.60 Acres 0.96 Directions: S NC 127,right Deerfield,left Fawn Tr,right Shireborn,right Willowbottom Rd,.8 mile 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 of the owner. Date: Signature of Applicant or Agent If you need further information or assistance please call 828-465-8270 AREA1 FEENAME DATE FEE AMOUNT Authorization to Construct(Repair) Fee 08/31/2022 $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) •i..;,h.:a. 08/31/2022 08:53 Page 2 of 6 catawba county f1 ii, Application for Environmental Health Services (� THIS IS NOT A PERMIT l el )7 4j5b Application is for: El New Construction Existing Facility ❑Improvement Permit ❑Authorization to Construct ❑New Septic IKSeptic Repair/Malfunction ❑Septic Relocation ❑Septic Expansion El Existing System Inspection or Reconnection ❑New Well ❑ Replacement Well CI Well Abandonment ❑Well Repair Property Address lv;36'y L(J)J/Djha#/ci fci f�iCkoyu VC 2RLZ Acres 0.9(p Subdivision eer--iiv 1 Pis t! T.LZ Lot# 7S-' Driving Directions to Property /t/C I Z7 •- LCer•t-;eld L i. L/ o„ /wrn Try,1 h)91-27 oh S6 )ccY'1,73 g i��+ r•.� IA :lbw -I'O r Ed horise is 20. m; 0,1 /eiL'z� / Describe work Cm (/?e c r ici et e�,1�•0-4 1-u ik We 1 '4/ uic y /S f ivafCi`), dzie �D ()ti('111 jr") 7C/h �i Applicant Name ittat1u,e1 L. P ( ���', Applicant Address c9 j�`9 t()i I)c,�.�iht I/�3r-, ?'it �.i /�i y/ vc, 2i �e_ Phone (8Ze�) 4'/i, 07to6 I Email yr,� C', /977e,:- ;/.Co w Owner Name 5 a mw Owner Address Phone Email Contractor Name 'TB 6 Contractor Address Phone Email Name to Appear on Permit? ❑Owner ElApplicant Et Contractor I&tSe' 'i4 1.2e st,/d oj, `//I/zz; Who will be the Primary Contact? ❑Owner El Applicant Contractor(humeo/o,, fx-4rw,, r2/ae Utv 'ti,P c /1 Proposed New Construction-Residential Primary Residence ❑ New Residence ❑ Addition to Residence #of New Bedrooms*t #of Occupants Project Description 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 ❑Yes ❑ No Retaining Wall>2' ❑ 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' ❑ Yes ❑ No Accessory Structure(s)Describe Structure(s)Dimensions Plumbing El Yes ❑ No Describe Plumbing Needed (Choose One) ❑Basement ❑Crawl Space ❑ Slab If Basement,Will'[Isere Be Water Using Fixtures In Basement 0 Yes ❑ No Retaining Wall>2' ❑ 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 ❑ No Retaining Wall>2' ❑ Yes 0 No Well Construction/Abandonment/Repair Proposed Well Type El Individual Well ❑Semi-Public Well ❑Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ 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 ���53 Describe , f Structure Dimensions #of Bedrooms* ` t #of Occupants q Basement ❑Yes CO No Basement Plumbing ❑Yes No Existing Water Supply 34 Individual Well ❑Shared Well—Number of Connections El Community Well ❑County/City/Township Water Line Is a public water supply available?** ❑ Yes ❑No ynif Commercial El Proposed New Construction ❑Existing/Change of Us Repair Food Service Specify Type #Seats Dining Area(Sq.Ft.) #Employees per Shift #of Shifts Church #of Seats Daycare❑Yes ❑No #of Children #of Employees per Shift #of Shifts Commercial Kitchen ❑Yes ❑No Residential Kitchen ❑Yes ❑No Daycare#of Children #of Employees per Shift #of Shifts Business/Other Specify Type Structure Dimensions Retail Floor Space #of Employeesl per Shiift� / /� #tof Shifts • / J� Other Information Lh ix y'pprviiitf ►'E 6rt04 d Uc... -(-y vi4 L,alkeey /S S�h,1lrq doe.4i dQrn Q 4 Calculated Design Flow,Commercial t (This value will be determined by EH staff) 11 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 tirNo Does the site contain any jurisdictional wetlands? ❑Yes No Does the site contain any existing wastewater systems? ❑Yes fit No Is any wastewater going to be generated on the site other than domestic sewage? ❑Yes 14 No Is the site subject to approval by any other public agency? ❑Yes Q9 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 o .o�,� eference) ❑ Accepted 0 Alternative 1i s a- CP:: CIInnovative 0 Other 0 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 SCHEDULE1 Environmental Health soil/site evaluations require digging,angering,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/sprinider 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 the effect ermit 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 1 al agent of ner. Signature of Owner or Legal Agent /404/ Date s')z /zae Printed Name of Owner or Legal Agent Michae I I.... Pte. • • • i , . ,, ...411114r' : . . r .'.• 41J f • • r • tiA • » `7 'FYI' ■ I �•i l 1. • !AG .r ,. .I„ , ,,,, . ....„ „„-....,,,,,, ....,,,...,,,::.:,..,.,..:„, ... ...,, , .,. r; + . aw 1 410111Vik. . Ce- _ -. . 00-° • fr #y , Catawba County Environmental Health .29s "oo 4' N • CO ■ Ifs •657,7 (213 763 30 g 95.00 40 0b 180.00 •6389 �� 00 7S27S (% 9ti ��6 rj 0,, •6407 178.64 Parcel: 268902875653, 6389 WILLOWBOTTOM tin=60ft RD 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 08/31/2022 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 268902875653 Owner: POE MICHAEL L Parcel Address: 6389 WILLOWBOTTOM RD Owner2: POE LIZA N City: HICKORY, 28602 Address: 6389 WILLOWBOTTOM RD LRK(REID): 90730 Address2: Deed Book/Page: 2673/1169 City: HICKORY Subdivision: DEERFIELD 4 State/Zip: NC 28602-9211 Lots/Block: 73/ School Information: Last Sale: $278,000 on 2005-06-29 Plat Book/Page: 29/14 School District: COUNTY Elementary School: MOUNTAIN VIEW Legal: LOT 73 73 PL 29-14 DEERFIELD PL 29-14 Middle School: JACOBS FORK Calculated Acreage: .960 Tax Map: 002AB 01073 High School: FRED T FOARD Township: BANDYS School Map State Road #: 2725 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: MOUNTAIN VIEW Zoningl: R-40 Building(s) Value: $263,400 Zoning2: Land Value: $25,700 Zoning3: Assessed Total Value: $289,100 Zoning Overlay: WP-O Year Built/Remodeled: 1994/ 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 #: 3710268900J If available, Building Permits for this parcel. Septic 2010 Census Block: 1024 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. **,*Op. Permit and/or Cert. Op. Required (Must be completed prior to final) 7 2 L 1 C A T A W H A C O U N T Y HEALTH DEPARTMENT - (704) 465-8270 Lot Eval. ' Improve. Permit C Repair Permit Cert. of,Comp. Permit Oper. Permit II - Owner/Agent ent it I IR T L Phone $= g y c/ Address p Ceckit--e- i Qr Subdivision - Section/Block/Phas 77 - Lot# 7 S Lot Size D ctions: L20"2 .f AVO r01 /Lr . te--, L'r t/.0 (0 381 /GCDx.)841/7 [ /7-ei Facility: House , 7 Mobile Home Business . Other: Tax-Map # Q4 - / - '7 Multi-family_ Other . Zoning Approval # 4K0-.13 le a Bedrooms Seats Employees . Application Rate ., GPD Flow YJO Hot Tub or pa es1P Special Fixtures . 100% Repair Area yes/no REPAIR NOTICE: Basement yes Basement Plumbing yes/no . REPAIRS MUST BE WITHIN 30 DAYS OR Water Suppl : Private )( Public DAYS FROM DATE OF PERMIT. Type of System: Trench A7 JBed Pump Pump/Panel Panel LPP Other Tank Size: Septic Tank MOO l',4./ Pump Tank Nitrification Field: Total Square Feet /249D Depth of Stone /Z Bed Size Trench Width c.A0 To gth,a I � of All Trenches 10Q Number of Trenches__d 7' , Individual Trench Lengt /1'_ Feet on Center 9 Maximum Trench Dep�—th 29- Distance of Nearest Well J Lot Evaluation: Approved/no (Void After 24 months) Topo S(rl0 % Slope Sketch of lot Evaluation Site - System Design - Final Texture INSTALL Structur 77 i WHEN WET in 7 et 1 Dep R stric. Hoz. at " sO t Available space yes/no l_ C ' Overall Class S PS U l a-e 7 Comments: 12 7 __ 13-rit'rer")°44t- II:- Septic Tank Contractors .25.0 MUST contact the Sanitarian BEFORE I (016(o - O changing permit. **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN THROUGH THE ISSUANCE OF THIS PERMIT** Permit Date � //-j`�� (Improvement •ermit voi`T to 60 months) Owner/Agent '/ ,y '1. I �/ an' arian �I/, ,L,/f/„4 - Aar Installed By .�,� jidil�/ . / .;r' ;._to Sanitarian (Note any changes/i format n red or by sketch on ._ck) IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE IS AN ADDITIONAL 426 CHARGE. ' - White-Office Blue-Bldg Imp,Comp. Yellow-Owner/Agent Green-Bldg.Imp.LP. 4'A • CATAWBA COUNTY 100A SOUTHWEST BLVD � NEWTON,NORTH CAROLINA 28658 RECEIPT V71 ►i PHONE:828.465.8399 !4W Wednesday,August 31, 2022 \1\8 4'2 sM www.catawbacountync.gov PAYOR: Poe,Michael PAYMENTS TRANSACTION NUMBER: TRC-4632 183 1-3 1-08-2022 PAYMENT DATE: 08/31/2022 PAYMENT TYPE: Credit Card 294469977 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 08-22-411331 110-580200-663000 Authorization to Construct(Repair) $150.00 Fee TOTAL PAYMENTS: S150.00 EHPR-08-2022-42127 — — CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malrunction SITE ADDRESS: 6389 WILLOWBOTTOM RD,HICKORY NC 28602 Applicant MICHAEL POE,6389 WILLOWBOTTOM RD,HICKORY NC 28602 C:828-446-0766 MLPOE.1977 r@Q GMAIL.COM **NO PEOPLESOFT ACCOUNT ASSIGNED** • receipt 08/31/2022 08:39 Page 1 of 1