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Home My WebLink AboutEHPR-05-2023-44261.tif .�� G THIS IS NOTA PERMIT Case# EFIPR-05-2023-44261 Q giQ ? CA'I'AWI3A COUNTY 1-IEAI.;IT1 DEPARTMENT 40 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES /842 '" Environmental Health Plan Review- OSWP IMPROVEMENT Applicant SI-IKELZEN GJEN,6001 I IWY 711 E,NEBO NC 28761 • Q82852771I0 Owner MACK COOK,5770 WISLEY ST, HICKORY NC 28601 I I:8282566711 I-IOME:828256671 I Paid By CAROLYN BOLDEN,3944 JOHNSON BRIDGE RD, HICKORY NC 28602 C:8283023092 NAME TO APPEAR ON PERMIT Shkelzen Gjen SITE ADDRESS: 4322 CHURCH DR,HICKORY NC 28602 PIN# 370011667867 NAME of SI113DIVISION: HOWARD AND CLOYD PROPST PROP Lot# 25-36 Section/Block A PROPERTY SIZE: Square Feet 72,309.60 Acres 1.66 DIRECTIONS: Zion Church Rd,left Church Dr on left PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP only for purchase of property 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? No 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: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 28 x 40 #OF NEW BEDROOMS:: 3 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: oLnppliomnn 05/05/2023 1.1:26 Page I of 3 -Pig ; CATAWBA COUNTY Case11 EHPR-05-2023-44261 estiPublic Health Department Subdivision HOWARD AND CLOYD PROPS] Environmental Health Division " ®e Y PIM 370011667867 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 !y. w NAME ON PERMIT: (SI-IKELZEN GJEN),6001 HWY 70 F,NEBO NC 28761 (Shkelzen Gjen) Site Address: 4322 CHURCH DR,HICKORY NC 28602 Property Size: Square Feet 72,309.60 Acres 1.66 Directions: Zion Church Rd,left Church Dr 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 Appl leant or Agent If you need further information or assistance please call 828-465-8270 AREAI t4****************************************************t*****t***5***t**t************************************ FEENAME DATE FEE AMOUNT Improvement Permit Fee 05/05/2023 $150.00 TOTAL FEES $150.00 • 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) rleippM1rm=,i, 05/o5/203 I4:26 rage 2 of 3 r 11 &rt1.11geaitcOJL nn5 N.. a Catawba county V 6W public health /' A�) Application for Environmental Health Services (`i(,/_ I t'On(ti/ei ( (Digit THIS IS NOT APERMIT 1 �dCG , : x� ;sus*;,{3 r � ,.;,.1°,` ...,s:A TIultlunns for vr1"�a • Nc}v Go'ii's'truupon x '_ _ Ezlstrn Facth .ring',., ."msr .,:.:_e ' Improvement Permit ❑Authorization to Construct New Septic ❑Septic Repair/Malfunction ❑Septic Relocation 0 Septic Expansion ❑Existing System Inspection or Reconnection ❑New Well 0 Replacement�Well ❑WelAbandonment r0 Well Repair 'Property Address g3)a C1�tm-r- Iran 1-;cKor QC Art(0Q,Q Vex-ceSV) 'xi DIt1(, 8)W) Acres Subdivision r 7 Driving Directions to Property 7 ito M 4 ate► -��I€ - a l\ y„-t`.,h pJ_t_et? %Describe work .Applicant Name ---r - Applicant Addres / l o y Phone `� I _ Email y� Owner Name 7y/! ., &ir,j Owner Address Phone � � A Email Contractor Name Contractor Address Phone Email Name to Appear on Permit? El Owner Applicant [El Contractor \Who will he the Primary Contact? ElOwner U Applicant ❑Contractor °,Tropes d CwGoas *,,t��,,htl rrton Rislilenndl.'; :`,�� . .'N �...� r�ty'a � f� t.3 ., ,tii;�, .,. ,,. .�'. ; t 'E` ,u',.,;rt' Primary Residence New Residence ❑ Addition to Residence #of New Bedrooms*t • if of Occupants Project Description Structure Dimensions,also specify dimensions of decks&porches _ ,ra 41(n MO_�(p( (Choose One) ❑Basement rp Crawl Space ❑ Slab If Basement,WillThere Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Walt>2' ❑ Yes 0 No Accessory Dwelling #of New Bedrooms*t #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 0 No Accessory Structurc(s)Describe Structure(s)Dimensions _ Plumbing ❑Yes ❑No Describe Plumbing Needed (Choose One) 0 Basement 0 Crawl Space ❑ Slob if Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' ❑ Yes ❑ No Muhl-Family Residence #of Apartments.-_- ,#Bedrooms per Apartment*t Total#Bedrooms in Structure*t #of Occupants Structure Dimensions (Choose One) 0 Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' ❑ Yes ❑ No -m f�; �, r ig n4fc : a 'W 11 ❑ p F /Jt.ep . .tr m...tAL ,�i,i. , :,`.� , -r _ . 9t�i ttl a.i 1 k +iviL., ytt 1f' br a`, riti ,,, � Cp,stpu t on/�bTu'}71opn�egt ran ;? . Proposed Well Type .R 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 U 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 Slruclw•es rtii Site /,/. }�'p - 1' Describe �Q- - Sttveture Dimensions #of Bedrooms * !! #of Occupants Basement ❑Yes ❑ No Basement Plumbing ❑Yes ❑ No Existing Watci•Supply ❑ Individual Well ❑Shared Well—Number of Connections / 0 Community Well ❑ County/City/Township Water Line /V Is a public water supply available? ** ❑ Yes No 4 Coiumercial _:❑Proposed New Construction_. ❑Existing/Change of Use ❑Repair • . .. Food Service Specify Type #Seats Dining Area(Sq.Ft.) n / #Employees per Shift #of Shifts // V n' Church #of Seats Daycare❑Yes ❑No #of Children ft of Employees per Shift if of Shifts Commercial Kitchen ❑ Yes ❑No Residential Kitchen ❑Yes ❑No Daycare It of Children if of Employees per Shift l/I +,1 oftifts Business/Other Specify Type Y_i q Sti lure Dimensions Retail Floor Space it of Employees per Shill i V nf Shifts Other Information l 11 Calculated Design Flow, Commercial 'r (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 No Does the site contain any jurisdictional wetlands? 0 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 EsNo 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) rA ❑Accepted 0 Alternative Conventional ❑Innovative ❑ Other 0 My *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'1'O THE PROPERTY AND/OR SYSTEM REDESIGN WILL INCUR AN ADDITIONAL CHARGE(SEE FEE SCHEDULE) 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/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 l 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 Agent OCV a\ Date <rj ',S- c2 4,73 Printed Name of Owner or Legal Agent 6 _i iv,), Catawba County Environmental Health l l voel 23,1°y goo p0� Ike brA, 0 \-1y0 rbcP JQ G* • G • 1 j r� fJ P 1rep Parcel: 370011667867, HICKORY, 28602 1in=6oft This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts to ensuro the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and rocommends 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 2023 Catawba County NC 04/28/2023 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 370011667867 Owner: COOK MACK EDISON Parcel Address: 4322 CHURCH DR Owner2: COOK PEGGIE P City: HICKORY, 28602 Address: 5770 WESLEY ST LRK(REID): 47961 Address2: Deed Book/Page: 1667/0393 City: HICKORY Subdivision: HOWARD AND CLOYD PROPST State/Zip: NC 28601-7051 PROP School Information: Lots/Block: 25-36/ A Last Valid Sale: School District: COUNTY Elementary School: BLACKBURN Plat Book/Page: 7/61 Middle School: JACOBS FORK Legal: LOT 25-36 CHURCH DRIVE PL 7-61 High School: FRED T FOARD Calculated Acreage: 1.660 School Map Tax Map: 131H 04004 Township: HICKORY State Road #: TaxNalue Information: Tax Rates Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: MOUNTAIN VIEW Zoning1: R-20 Building(s) Value: $0 Zoning2: Land Value: $14,900 Zoning3: Assessed Total Value: $14,900 Zoning Overlay: ED-O Year Built/Remodeled: / Small Area: MOUNTAIN VIEW Tax Revaluation 2023: Info, COMPER Split Zoning Districts: / Online Appeals Zoning Agency Phone Numbers Valid Sales (COMPER) for this parcel Contact Tax Dept. at 828-465-8436 Current Tax Bill Miscellaneous: Firm Panel Date: 2007-09-05 Building Permit Address Search for this parcel. Firm Panel #: 3710370000J If available, Building Permits for this parcel. Septic 2010 Census Block: 2073 links are not permits. 2010 Census Tract: 011102 Septic Final Permits prior to 08/2018, contact Agricultural District: Environmental Health. Building Details WaterShed: Voter Precinct: P23/ 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 Julia English From: Katherine Smith Sent: Wednesday, May 3, 2023 11:10 AM To: Julia English Subject: Re: Church Dr address needed please The new address will be: 4322 Church Dr. Thank you, Katherine Smith E-911 Addressing Coordinator Catawba County Government Center 25 Government Drive, Newton NC, 28658 Office 828.465.8147 On May 3, 2023, at 11:04 AM,Julia English <JENGLISH@catawbacountync.gov>wrote: Parcel ID: 37001 1 667867 LRK/REID: 47961 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/ We want to hear from you. Please take a minute to take our customer service survey. English Queremos escuchar de usted. Tomese un minuto para realizar nuestra encuesta de servicio al cliente. Espanol <image001.,Ipg> Confidentiality Statement:The information contained in electronic transmissions is confidential and may he subject to protection under the law, including the Health Insurance Portability and Accountability Act(HIPAA).An electronic transmission is intended for the sole use of the individual or entity to whom it is addressed. If you are not the intended recipient,you arc hereby notified that any use,distribution or copying of • the message is strictly prohibited.If you received a message in error,please contact the sender immediately by replying to the e-mail and delete the material from any computer. 1 �A CATAWI3A COUNTY 4 nii rt 100A soUTNWEST t3LVD NEWTON.NOR7TI CAROLINA 28658 RECEIPT PHONE:828.465.8399 i 2 S Friday,May 5,2023 84M Kwww.eatavh,conntync,gov PAYOR: Bolden,Carolyn PAYMENTS TRANSACTION NUMBER: 'I'RC-6339090 1-05-05-2023 PAYMENT DATE: 05/05/2023 PAYMENT TYPE: Credit Card 304888423 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 05-23-422171 il0-s8Uzoa663000 Improvement Permit Fee $150.00 TOTAL PAYMENTS: S 150.00 Ili 1'12-0 5-202 3-442 6 1 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWI' SITE ADDRESS: 4322 CHURCH DR,HICKORY NC 28602 Applicant SIIKELZEN GJ EN.6001 HWY 70 IL NEI3o NC 28761 C:8285277110 Owner MACK COOK.5770 WESLEY Sh.HICKORY NC 28601 I-1:8282566711 I'aid By CAIROLYN BOLDEN,3944 JO1-INSON BRIDGE RD, HICKORY NC 28602 C:8283023092 ** NO I'ECI'LESOPTAC'UUNT ASSIGNED** receipt 05/05/2023 1.1:25 Page I ofI