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Home My WebLink AboutEHPR-04-2023-44063.tif THIS IS NOT A PERMIT Case# EHPR-04-2023-44063 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Ig 2 sM Environmental Health Plan Review- OSWP ABANDONMENT Applicant WK DICKSON, 1213 W MOREL LEAD ST,CI IARLOTTE NC C:7043345348 SWALTERS a WKDICKSON.COM NAME TO APPEAR ON PERMIT WK Dickson SITE ADDRESS: 3820 HICKORY LINCOLNTON 1IWY,HICKORY NC 28658 PIN # 361801087291 NAME of SUBDIVISION: Lot i Section/Block PROPERTY SIZE: Square Feet 259,182.00 Acres 5.95 DIRECTIONS: W NC 10 Hwy left Hickory Lincolnton Hwy,on left before Old State Rd PRIMARY CONTACT: Applicant SEWER TYPE: GALLONS PER DAY: WATER SUPPLY: DESCRIBE WORK: well abandonment 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? Yes 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? Yes Property Easements Description: see survey APPLICATION FOR: STRUCTURE TYPE: **NO STRUCTURE SELECTED** 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(SQ FT): Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: APPLICATION FOR WELL ABANDONMENT ABANDONMENT TYPE: Bored eLa1q>liratin 04/17/2023 14:23 Page I of7 CATAWBA COUNTY Case# Ef[PR-04-2023 44063 Public Health Department Subdivision rIF Environmental Health Division PIN/I 361801087291 PO Box 389,100-A Southwest Blvd,Newton,NC 28658 w NAME ON PERMIT: WK DICKSON (), 1213 W MOREI IEAD ST,CI IARLOTTE NC WK Dickson ( ) Site Address: 3820 HICKORY LINCOLNTON HWY,HICKORY NC 28658 Property YSize: Square e Feet 259,182.00 Acres 5.95 Directions: W NC 10 Hwy left Hickory Lincolnton Hwy,on left before Old State Rd 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 AREA2 ************************************************************************************************************ FEENAME DATE FEE AMOUNT Well Abandonment Fee 04/17/2023 $100.00 TOTAL FEES S100.00 FEES ARE NON-REFUNDAI3LE 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) chapplivau.ni 04/17/2023 14:23 Page 2 of7 Catawba county public health Application for Environmental Health Services THIS IS NOT A PERMIT Application is for: _ _❑New Construction _ IN Existing Facility ❑Improvement Permit LI Authorization to Construct ['New Septic • ❑Septic Repair/Malfunction LI Septic Relocation ❑Septic Expansion ❑Existing System Inspection or Reconnection ❑New Well El Replacement Well ®Well Abandonment ❑Well Repair Property Address 3820 Hickory Lincolnton Highway Newton NC 28658 Acres 5.85 Subdivision Lot# Driving Directions to Property From US 321 -travel west on NC Hwy 10 to Hickory-Lincolnton Highway- turn south and travel approx 0.36 miles to site located on the east side of mad. Describe work abandonment of existing well Applicant Name WK Dickson & Co., Inc Applicant Address 1213 W Morehead Street Charlotte NC 28208 Phone 704.334.5348 Email swalters@wkdickson.com Owner Name Microsoft Corporation Owner Address 1 Microsoft Way, Redmond WA 98052-8300 Phone Email Contractor Name to be determined Contractor Address Phone Email Name to Appear on Permit? IE Owner ❑Applicant ❑Contractor Who will be the Primary Contact? ❑Owner ®Applicant ❑ Contractor 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 ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes 0 No Retaining Wall>2' ❑ Yes ❑ No Accessory Dwelling #of New Bedrooms *t #of Occupants Structure Dimensions (Choose One) ❑Basement ❑Crawl Space 0 Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes 0 No Retaining Wall>2' ❑ Yes ❑ 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 ❑Yes ❑ No Retaining Wall>2' 0 Yes ❑ No Multi-Family Residence #of Apartments Bedrooms per Apartment*t Total# Bedrooms in Structure*-- #of Occupants Structure Dimensions (Choose One) ❑ Basement 0 Crawl Space ❑ Slab If Basement.Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' ❑ Yes ❑ No Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well emi-Public Well ❑Community Well Abandonment Type r Drilled RSBored ❑ 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 Structure Dimensions #of Bedrooms * _ _ #of Occupants _ Basement ❑ Yes ❑ No Basement Plumbing 0 Yes ❑ No Existing Water Supply ❑X Individual Well ❑ Shared Well--Number of Connections ❑Community Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes El 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 El Yes El No #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 EH 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 0 No Does the site contain any jurisdictional wetlands? l Yes 0 No Does the site contain any existing wastewater systems? ❑Yes RI No Is any wastewater going to be generated on the site other than domestic sewage? ®Yes 0 No Is the site subject to approval by any other public agency? III Yes 0 No Are there any easements or right of ways on this property? Describe see attached ALTA survey 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 ❑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 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 '• _ . .• - •rovided herein is true, complete and correct. Authorized county and state officials are granted right of entry to cone - necessary inspec Sons to determine compliance with applicable laws and rules. I understand that I am solely responsib -/'o• the proper identifica:on and labeling of all property lines and corners and making the site accessible so that a complete site ev:uat'en can be performed. The undersigned is the owner o he pro,- •• or -:al agent of the owner. Signature of Owner or Legal Agent AL/4 Date l 1 i I� Printed Name of Owner or Legal A_ `` N 0 bcr&lf NilCasa T Gpe.Po-Astor► • ka 1 . . . v 4 -t .,c. 1 _, (2, _, w , ,,,, - C="1 1 , W \ x\ r \ I z Do m O '� z W � • com ti ,0I E \ . , cN I • oW°C 4 i EXZ . ,.._ 2L. , ,--- .._,.), Z NV 61- q „, Q1 ...-.7.--- A ,!, „ * \ .„ 'i 1 ,. ,.,, \\ .,... 4-, 1 • , I i. ..,„ \\ ., I g, 4i o 1 : F. w "...i..--,.... a 4 c4 :J -40P4, . - , 1 1 o I i j ism' / � -f 1 i toN.p.. s p - to 401.. ti .,, zi. l...t „..,-..-_-_-- _.„, , \ .., .... , , ___ _--.-- , \ p, a r,---. ..,---,.. ..,---?r- ______________-- I :, 1 I - 017,00.0 pG. i Or- ItS .°5:40,PC;cplek A J "734 ` J / DB P 69 Pa 1 1 / I \\\ Julia English From: Shad Walters <swalters@wkdickson.com> Sent: Wednesday, April 12, 2023 4:15 PM To: Julia English Subject: Hickory-Lincolnton Highway property Well Attachments: Stover - Screenshot 2023-04-12 160630.png Julia Attached is the survey with the well location noted - it appears to be a larger bored well for this property. Noted on the well contractor- question for you - how long is this permit valid for? Let us know if you need any additional information. Thanks Shad W. Walters, PE Senior Consultant WK Dickson & Co., Inc. 1213 W. Morehead Street, Suite 300 Charlotte, NC 28208 Office: 704-334-5348 Direct: 704-227-3455 Cell: 704-430-8537 Email: swalters@wkdickson.com www.wkdickson.com From:Julia English <JENGLISH@catawbacountync.gov> Sent:Wednesday, April 12, 2023 11:56 AM To:Shad Walters<swalters@wkdickson.com> Subject: 1723 N NC 16 Hwy application and receipt Please be aware that a certified well contractor must complete the abandonment work. They must schedule the abandonment with the inspector. Julia English Administrative Assistant II PO Box 389 125 Government Drive, Newton, NC 28658 (828)465-8270 office (828) 465-8276 fax https://www.catawbacountync.gov/county-services/environmental-health/ i CATAWBA COUNTY I00A SOUTIIWEST BLVD �` NEWTON,NORTT E CAROLINA 28658 RECEIPT V AIM 0 PHONE:828.465.8399 Monday,April 17,2023 1842 SM www.catawbacountync.gov PAYOR: WK Dickson WK Dickson PAYMENTS TRANSACTION NUMBER: TRC-62082980-17-04-2023 PAYMENT DATE: 04/17/2023 PAYMENT TYPE: Check 92294 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 04-23-421336 110-580200-663000 Well Abandonment Fee $100.00 TOTAL PAYMENTS: $100.00 EHPR-04-2023-44063 CASE TYPE: Environmental I Iealth Plan Review WORK CLASS: OSWP SITE ADDRESS: 3820 I IICKORY LINCOLNTON I1WY,I IICKORY NC 28658 Applicant WK DICKSON. 1213 W MOREFIEAD ST,CI IARLOTTE NC C:7043345348 SWAIJERS@WKDICKSON.COM **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 04/17/2023 14:22 Page I of I