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HomeMy WebLinkAboutEHPR-12-2022-42917.tif 4A THIS IS NOTA PERMIT Case# EHPR-12-2022-42917 d f i.3 CATAWBA COUNTY HEALTH DEPARTMENT ' ' (/ PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES \84_2 Environmental Health Plan Review-Septic Malfunction P AUTH_CONST- SEPTIC MALFUNCTION Applicant LUCILE BOND,2619 PINOAK DR,HICKORY NC 28602 NAME TO APPEAR ON PERMIT Lucile Bond SITE ADDRESS: 2619 PINOAK DR,HICKORY NC 28602 PIN# 279110455765 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 168,141.60 Acres 3.86 DIRECTIONS: S NC 127 Hwy,right Frye Ave,left Clover St,right Pinoak Dr,house on left PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 600 WATER SUPPLY: Private Well DESCRIBE WORK: Failing drainfield. Replace tank as well. 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: 82 x 43 NUMBER OF EXISTING BEDROOMS: 5 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION BASEMENT? Yes BASEMENT FIXTURES? Yes 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: ehapplication 12/01/2022 10:01 Page I of 6 CATAWBA COUNTY Case# EHPR-1 2-2022-429 1 7 Public Health Department Subdivision ,1-',(..-.)(( tir Environmental Health Division PIN# 279110455765 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 w �. NAME ON PERMIT: (LUCILE BOND),2619 PINOAK DR,HICKORY NC 28602 (Lucile Bond) Site Address: 2619 PINOAK DR,HICKORY NC 28602 Property Size: Square Feet 168,141.60 Acres 3.86 Directions: S NC 127 Hwy,right Frye Ave,left Clover St,right Pinoak Dr,house 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 it 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. �� � sj Date: / — 7 Signature of Applicant or A elc✓ ��`-�`l di • all CC g PP g If you need further information or assistance please call 828-465-8270 AREA1 'FEENAME DATE FEE AMOUNT Authorization to Construct(Repair)Fee 12/01/2022 $450.00 TOTAL FEES S450.00 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) ehapplicanon 12/01/2022 10:01 Page 2 of6 catawba county public health Application for Environmental Health Services THIS IS NOT A PERMIT Application is for: ❑New Construction ❑Existing Facility ❑Improvement Permit ❑ Authorization to Construct ❑New Septic Septic Repair/Malfunction ❑ Septic Relocation ❑ Septic Expansion ❑ Existing System Insp etion or Reconnection ❑New Well ❑ Replacement Well ❑Well Abandonment El Well Repair Property Address .J1,4 q F n p `� 172 N <c-ko C (_ Q o C Acres,I,S1„ Subdivision //�� Lot# Dr'ving Directions to Property ('a r Nis Id7S' LC4 r. (FC ' sat_ & 1s C ■ v - e_ Fo Describe work k e-p(<�, ( Q 1,5 r)C) 6 J p4. rye ,�11z.at b Applicant Name 0C �0 d Applicant Address "'; d ' 4 uoG c��L, Ll r c,kS r L Aicc-0 Phone r .d1 s( a'� ' 4-- E it r'ka c rn Owner Na LuC<<P woe- *()C LLc ) Owner Addressjo cc Phone Jgc.0 g '��� " (3`} Email Lou_ac oc CCe4 3f-n cu ) - CL)rY1 Contractor Name Contractor Address Phone Email Name to Appear on Permit? $1 Owner ®Applicant ❑Contractor Who will be the Primary Contact? yg Owner ❑Applicant ❑Contractor Propose onstruction-Residential Primary Residence El New Residence Addition to Residence #of New Bedrooms*t. #of Occupants 3 Structure Dimensions,a so specify dimensions of decks&porches (Choose One) ]Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement)g]Yes ❑ No Retaining Wall>2' Yes ❑ No Basement? Accessory Dwelling #of New Bedrooms*# II 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 0 No Accessory Structure(s)Describe Structure(s)Dimensions Plumbing ❑Yes ❑No Describe Plumbing Needed (Choose One) ❑Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes 0 No Retaining Wall>2' ❑ Yes 0 No Multi-Family Residence #of Apartments #Bedrooms per Apartment*# Total It Bedrooms in Structure*t #of Occupants Structure Dimensions (Choose One) ❑Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes ❑ No Retaining Wall>2' ❑ Yes ❑ No Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well 0 Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled 0 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 Describe tl_ D U �' k°A Structure Dimensions #of Bedrooms* -5 #of Occupants Basement EYes ❑ No Basement Plumbing X Yes ❑ No Existing Water Supply r ndividual Well ❑ Shared Well—Number of Connections ❑Community Well ❑County/City/Township Water Line a public water supply available?** ❑ Yes 'No Commercial ❑ 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 ❑Yes El No 4 of Children #of Employees per Shift #of Shifts Commercial Kitchen El 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 Employees per Shift #of Shifts Other Information Calculated Design Flow,Commercial t (This value will be determined by ELI staff) 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 El No Does the site contain any jurisdictional wetlands? ❑ Yes ❑No Does the site contain any existing wastewater systems?'mil-1511 n`1 ,. C�l L.... 6y ❑ Yes I:3-No Is any wastewater going to be generated on the site other than domestid sewage? ❑ Yes Ji3 No Is the site subject to approval by any other public agency? ❑ Yes X 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) ❑ Accepted 0 Alternative 0 Conventional 0 Innovative 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 SCHEDULE) Environmental Health soiUsite 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/sprinkler systems. Catawba County Environmental Ilealth 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. The undersigned is the owner of the property or legal agent of the/owner. Signature of Owner or Legal Agentcc_c P „ 119--rt cf Date /-1 " / -ag---- Printed Name of Owner or Legal Agent &Lt C._I I _ J3 c4--1 cf Geospatial Catawba Real Estate Search . , „,, 1t�,+ information Services 1.62A 45 \__ ! 035 DR g.56s Not OGA ------------- 67.53 ;,, 00 rni.5` Z"sue O a:. .6 `sip,;. 3.86A 1. x` \el) ---- • ,. CFI S „,*,,c,N....j ,,k 474 N 1 in=100ft w1E: s Parcel: 279110455765, 2619 PINOAK DR HICKORY, 28602 Owners: BOND MAJOR K, BOND LUCILE A Owner Address: 2619 PINOAK DR Values - Building(s): $216,000, Land: $35,200, Total: $251,200 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 12/01/2022 12/1/22,9:52 AM Parcel Report Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 279110455765 Owner: BOND MAJOR K Parcel Address: 2619 PINOAK DR Owner2: BOND LUCILE A City: HICKORY, 28602 Address: 2619 PINOAK DR LRK(REID): 48238 Address2: Deed Book/Page: 2792/1997 City: HICKORY Subdivision: State/Zip: NC 28602-9447 Lots/Block: / School Information: Last Sale: $225,000 on 2006-11-07 School District: COUNTY Plat Book/Page: Elementary School: MOUNTAIN VIEW Legal: Middle School: JACOBS FORK Calculated Acreage: 3.860 Tax Map: 133H 01025A High School: FRED T FOARD Township: HICKORY School Map State Road #: 1215 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: MOUNTAIN VIEW Zoning1: R-20 Building(s)Value: $216,000 Zoning2: Land Value: $35,200 Zoning3: Assessed Total Value: $251,200 Zoning Overlay: Year Built/Remodeled: 1971/ 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 #: 3710279100J If available, Building Permits for this parcel. Septic 2010 Census Block: 2037 links are not permits. 2010 Census Tract: 011101 Septic Final Permits prior to 08/2018, contact Agricultural District: Environmental Health. Building Details WaterShed: ",)Q4k 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. gis.catawbacountync.gov/nomap/parcel_report.php?key=279110455765&type=u 1/1 .4A CATAWBA COUNTY iT G I OOA SOUTHWEST BLVD 14 III. NEWTON,NORTH CAROLINA 28658 RECEIPT PHONE:828.465.8399 •JThursday,December 1,2022 18 42 sM www.catawbacountync.gov PAYOR: Bond,Lucile PAYMENTS TRANSACTION NUMBER: TRC-52331813-01-12-2022 PAYMENT DATE: 12/01/2022 PAYMENT TYPE: Credit Card i .- 298113707 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 12-22-415388 110-580200-663000 Authorization to Construct(Repair) $450.00 Fee TOTAL PAYMENTS: $450.00 EH PR-12-2022-42917 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 2619 PINOAK DR,HICKORY NC 28602 Applicant LUCILE BOND,2619 PINOAK DR,HICKORY NC 28602 **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 12/01/2022 10:00 Page 1 ot'1