HomeMy WebLinkAboutEHPR-10-2022-42556.TIF $A THIS IS NOTA PERMIT Case# EHPR-I0-2022-42556
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CATAWBA COUNTY HEALTH DEPARTMENT
� , PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES
\g 2 sra Environmental Health Plan Review-OSWP
NEW WEL - EXS SYSTEM
Applicant HISPANIC WOMEN FARMERS INC,8389 COOKSVILLE RD,VALE NC 28168
C:28264416416
NAME TO APPEAR ON PERMIT
Hispanic Women Farmers Inc
SITE ADDRESS: 2869 9TH AVE SE,HICKORY NC 28602 PIN# 372214433090
NAME of SUBDIVISION: Lot# Section/Block
PROPERTY SIZE: Square Feet 57,499.20 Acres 1.32
DIRECTIONS: 21st St Dr SE right 9th ave SE,2nd from end of street on left
PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank
GALLONS PER DAY: 360 WATER SUPPLY: Private Well
rwoRK: ) 11/16/22 shared well on 2879 will not be used for 2869 9th Ave SE. Revised to add new well for 2869 for
migrant housing unit.
Existing system inspection for migrant housing
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: Mobile Home OTHER DESCRIPTION:
DESCRIPTION OF single wide
EXISTING STRUCTURES
ON SITE(IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 6
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:
PLICATION FOR WELL CONSTRUCTION
OPOSED WELL TYPE Individual WellCI-
REPLACE WELL?: NO
cicqmLuu 11/16/2022 11:01 Page 1 of 3
CATAWBA COUNTY Case irEHPR ]0-2022-42556
' ti 11). Public Health Department Subdivision
Environmental Health Division PIN/1 372214433090
PO Box 389, 100-A Southwest Blvd,Newton,NC 28658
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NAME ON PERMIT: HISPANIC WOMEN FARMERS INC ( ),8389 COOKSVILLE RD,VALE NC 28168
Hispanic Women Farmers Inc
Site Address: 2869 9TH AVE SE,HICKORY NC 28602
Property Size: Square Feet 57,499.20 Acres 1.32
Directions: 21st St Dr SE right 9th ave SE,2nd from end of street 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 ofr the property or legal agent of the owner. rr,,
Date: // l b -_ VN'2 2_ Signature of Applicant or Agent � V \-‘-'\-J-v l_
If you need further information or assistance please call 828-465-8270
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FEENAME DATE FEE AMOUNT
Well Permit&Inspection Fee 11/16/2022 $300.00
TOTAL FEES $300.00
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)
el.applivauk,n 11/16/2022 10:58 Page 2 of3
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Parcel: 372214433090, 2869 9TH AVE SE lin=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 mapheport 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.
Copvriaht 2021 Catawba County NC
Y'A CATAWBA COUNTY
100A SOUTHWEST BLVD
NEWTON,NORTH CAROLINA 28658 RECEIPT
U( PHONE:828.465.8399
Wednesday,November 16,2022
18 4 5M www.catawbacountync.gov
PAYOR:
Calderon,Florencio
PAYMENTS
TRANSACTION NUMBER: TRC-51301904-16-1 I-2022
PAYMENT DATE: 11/16/2022
PAYMENT TYPE: Credit Card
297560875
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
11-22-414838 I10-580200-663000 Well Permit&Inspection Fee $300.00
TOTAL PAYMENTS: $300.00
EHPR-10-2022-42556
CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP
SITE ADDRESS: 2869 9T11 AVE SE,HICKORY NC 28602
Applicant HISPANIC WOMEN FARMERS INC,8389 COOKSVILLE RD,VALE NC 28168
C:28264416416
Paid By FLORENCIO CALDERON,9175 COOKSVILLE RD,VALE NC 28168
C:8284045054
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 11/16/2022 11:04 Page 1 of 1