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HomeMy WebLinkAboutEHPR-09-2023-45528.tif (64 THIS IS NOT A PERMIT Case# EHPR-09-2023-45528 CATAWBA COUNTY HEALTH DEPARTMENT till IPLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1$ 2 sa Environmental Health Plan Review-Septic Malfunction AUTH CONST- SEPTIC MALFUNCTION Owner GLORIA DEVANE, 1616 ROLLING LN,I IICKORY NC 28602 H:828-294-1415 HOME:828-294-1415 GLORYGLORYGLORY92 a GMAIL.COM NAME TO APPEAR ON PERMIT Gloria Devane SITE ADDRESS: 1616 ROLLING LN,HICKORY NC 28602 PIN# 370005198345 NAME of SUBDIVISION: FOREST RIDGE Lot# 3 Section/Block D PROPERTY SIZE: Square Feet 16,988.40 Acres 0.39 DIRECTIONS: Bethel Church Rd,Wallace Dairy Rd, right Forest Ridge Dr,right Magnum Rd,left Rolling Ln on right PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Community Well DESCRIBE WORK: tank only collapsing 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: 55 x 57 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 1 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: YES Other described: ehapplicatiou 09/20/2023 12:46 Page I of 6 0CATAWBA COUNTY Case# EHPR-09-2023-45528 Public Health Department Subdivision FOREST RIDGE Environmental Health Division PIN# 370005198345 PO Box 389,100-A Southwest Blvd,Newton,NC 28658 NAME ON PERMIT: (GLORIA DEVANE), 1616 ROLLING LN,HICKORY NC 28602 (Gloria Devane) Site Address: 1616 ROLLING LN,HICKORY NC 28602 Property Size: Square Feet 16,988.40 Acres 0.39 Directions: Bethel Church Rd,Wallace Dairy Rd,right Forest Ridge Dr,right Magnum Rd,left Rolling Ln on right 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 /23 the property or legal agent of the owner. /aJ` Date: // Signature of Applicant or Agent L1. z �f If you need further information or assistance please call 828-465-8270 AREA1 FEENAME DATE FEE AMOUNT Authorization to Construct(Repair)Fee 09/20/2023 $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) ehapplication 09/20/2023 12:46 Page 2 of 6 . Catawba county public health Application for Environmental Health Services THIS IS NOT A PERMIT Application is for: ❑ New Construction El Existing Facility ■ Improvement Permit uthorization to Construct ew Septic Septic Repair/Malfunction ❑ Septic Relocation ❑ Septic Expansion ❑Existing System Inspection or Reconnection ❑New Well ❑Replacement Well ❑ Well Abandonment Cl Well Repair Property Address /(a I C" % e 1I;r? )'7' • Acres Subdivis' n'! ,by S grdeeP� J Lot# Driving Directions to P erty e4he I Chili gh. 1,1416 Ilea Pam/ FA, 4 P PeSt`gi Dr, ri`s�' ray itti !et t Abil ,5 taut, r;sus I /describe work by r Applicant Name &1 Applicant Address ///(o gip/Jr ha L�.rca Phone T 7 �,.q't /5 1 Email (.i)o 13)or- G�1Dr[,�9Z 9► ta.-4 l Owner Name J _J Owner Address ,Sr-mp Phone Email Contractor Name Contractor Address Phone Email Name to Appear on Permit? ❑ Owner El Applicant ❑ Contractor Who will be the Primary Contact? ❑Owner El 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 El Yes ❑ No Retaining Wall>2' ❑ Yes ❑ 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 El No Accessory Structure(s)Describe Structure(s)Dimensions Plumbing 0 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' ❑ Yes ❑ No Multi-Family Residence #of Apartments #Bedrooms per Apartment*t Total#Bedrooms in Structure*t #of Occupants Structure Dimensions (Choose One) El Basement ❑ 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 El Semi-Public Well ❑ Community Well Abandonment Type El Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested El Yes El No Describe Will Certified Wel]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 • hng Structures on Site Describe Structure Dimensions #of Bedrooms* .3 #of Occupants I Basement 0 Yes /No Basement Plumbing ❑Yes jdNo Existing Water Supply 0 Individual Well 0 Shared Well—Number of Connections Community Well ❑County/City/Township Water Line Is a public water supply available?** 0 Yes 0 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 ❑No #of Children #of Employees per Shift #of Shifts Commercial Kitchen ❑Yes ❑No Residential Kitchen ❑ Yes 0 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) e 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. 0 Yes 12No Does the site contain any jurisdictional wetlands? Yes 0 No Does the site contain any existing wastewater systems? `❑Yes RJ'To Is any wastewater going to be generated on the site other than domestic sewage? Yes o Is the site subject to approval by any other public agency?\\ID ❑Yes , l'lo Are there any easements or right of ways on this property? Describe f 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 SeAny *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,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 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 Agent Date Printed Name of Owner or Legal Agent Catawba County Environmental Health •1632 •4875 n J 4:3)ipopr is,. ?4B (121 N.;., )04_.;� ,:411. 4.35 �r? o KZ- 1616 \-0. Bea ,n . .,'p to� �'z, 7 : ',/- 7 v 's •1608 0.0c31 cil l2 Parcel: 370005198345, 1616 ROLLING LN 1in=50ft 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 2023 Catawba County NC 09/20/2023 I 9/20/23, 12:34 PM Parcel Report Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 370005198345 Owner: DEVANE GLORIA INEZ Parcel Address: 1616 ROLLING LN Owner2: City: HICKORY, 28602 Address: 1616 ROLLING LN LRK(REID): 47399 Address2: Deed Book/Page: 2097/0480 City: HICKORY Subdivision: FOREST RIDGE State/Zip: NC 28602-9470 Lots/Block: 3/ D Last Valid Sale: $97,000 on 1998-07-01 School Information: School District: COUNTY Plat Book/Page: 19/183 Elementary School: MOUNTAIN VIEW Legal: LOT 3 3D PL19-183 FOR RIDG PL 19-183 Middle School: JACOBS FORK Calculated Acreage: .390 Tax Map: 126H 08003 High School: FRED T FOARD Township: HICKORY School Map State Road #: 2573 TaxNalue Information: Tax Rates Zoning Information: City Tax District:All in County Zoning District: COUNTY County Fire District: MOUNTAIN VIEW Zoningl: R-20 Building(s) Value: $224,500 Zoning2: Land Value: $15,600 Zoning3: Assessed Total Value: $240,100 Zoning Overlay: Year Built/Remodeled: 1985/ 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 links 2010 Census Block: 2031 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 this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall riot 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. ©2023, Catawba County Government, North Carolina.All rights reserved. gis.catawbacountync.gov/nomap/parcel_report.php?key=3700051983458,type=u 1/1 1 • CATAWBA COUNTY HEALTH DEPARTMENT NEWTON, NORTH CAROLINA l 7 COMPLETION PERMIT FOR SEPTIC TANKS PERMIT NJ° 0 0'8:8:5 DATE : Y'�S— OWNER ADDRESS BUILDING CONTRACTOR c5 SUBDIVISION Folty---4,9 LOCATION j - 02 . /7 ,4/ d"'" 7/ LOT # LOT SIZE BLOCK OR SECTION HOUSE p MOBILE HOME ( ) BUSINESS ( ) OTHER ( ) FHA-VA LOAN ( ) SEPTIC TANK: (SIZE /00C GALS) WATER SUPPLY : NO. BEDROOMS NO FIXTURES a INDIVIDUAL PUBLIC GARBAGE DISPOSAL UNIT:YES (- NO ()Q IF WELL, TYPE : BORED DRILLED DUG AUTO WASHING MACHINE : YES 0.<1. NO ( ) DISTANCE FROM SEPTIC TANK OR NEAREST NITRIFICATION FIELD: /0 1 0 SQ .FT . POLLUTION: FT. 1) NUMBER OF LINES _.5 SEPTIC TAN 2) LENGTH AND WIDTH OF LINES /6 K. 7 Z PERMIT FEE G� a) BED SYSTEM (},-) CERTIFICATE OF COMP TION BY : b) TRENCH SYSTEM ( ) .� __ 3) DEPTH OF STONE IN LINES / _ REMARKS : ADEQUATE FALL (GRADE) ON: I) BUILDING (HOUSE) SEWER LINE : I YES 2) NITRIFICATION LINES : DATE -INSTALLED: 7 f SA� YES (x NO ( ) SEPTIC TANK LAYOUT � �� H 6",-ci� U 0 ,- �./ r fr+ H H O 0 '-1 ,--1 HEALTH DEPARTMENT COPY ` CATAWBA COUNTY HEALTH DEPARTMENT 96-Fa. Telephone 28)465- 70 TDD (828)465-8200 WL5#d�-44�ot� � IP AC R Prmt. 0 Opr Prmt. Sys Type ./j-Well Prmt. Replacement Well Well-, Prmt. OwnerrA ent -2C-.^-Q�! Phone_�j �`—J k.� Address B�F, Subdivision T � Sec ' n/Block/Ph se ot# Lot Size Directions f� eyr - ! ;A bLt s Property Address /r Facility: House �c Business Multi-family Other Pin Number37Q- •- ..� �� Other Zoning Approval# #Bedrooms .� #Seats #Employees Application Rate GPD Flow Hot Tub or Spa yes/no Special Fixtures Basement yes/no 100% Repair Area yes/no Basement Plumbing yes/no Water Supply- Private Well Public emi-Public *************************************************************************************************************************** Type of System: Trench Bed Pump Pump/Panel Panel LPP Other Septic Tank Size j4e,, p Tank Size Nitrification Field. Total Square Feet ( a() Depth of Stone i Bed Size ,l L()(5-0 Trench Width Total Length of All Trenches Number of Trenches Trench Length / /_ l/ / / Feet on Center Maximum Trench Depth Distance of Nearest Well dd x *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* *********************************************************************************************************** * *********** Topo .-`" % Slope Texture • Structure Clay Min. 1-41:j).- `' Soil Wetness Soil Depth c Restric Hoz at A r4j1P) (f)ir Available space no •1, Overall Class S U Comments _ .. - . `a� � -- - 1 ` t I ...\-.\i' . .. ow, c „ ty�1 1 i Filter Required \ )11Riser required when tank is more than 6 inches deep. **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility An Authorization to Construct is valid for(5) five years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. The siting of the well by the Health Department staff is to provide protection from known possible sources of contamination. No volume of water is guarant ed at any ate by the Health Department. Permit --- --Date Q l EHS82.....,..,..(2,_ //�' Laa z, 1 -xs:_ Owner/ en ,A Septic Tank Installed By "` - / ea.o.yti,,,..2 Date 5---/0--•0/ EHS Well Installed By Well Grout Approval Date Well ead Approval Date Date Sample Collected Date of Results Results EHS White Office Blue-Building Inspection Operation Permit Yellof':•Owner/Agent Green-Building Inspection Authorization to Construct • . 1'1$A • CATAWBA COUNTY 100A SOUTHWEST BLVD l • NEWTON,P NO T828.465 8399H A 28658 RECEIPT Kla13- 4 / *^JWednesday,September 20,2023 8 /� SM www.catawbacountync.gov PAYOR: Devane,Gloria PAYMENTS TRANSACTION NUMBER: TRC-73596041-20-09-2023 PAYMENT DATE: 09/20/2023 PAYMENT TYPE: Credit Card 310962737 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 09-23-428361 110-580200-663000 Authorization to Construct(Repair) $150.00 Fee TOTAL PAYMENTS: $150.00 EHPR-09-2023-45528 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 1616 ROLLING LN,HICKORY NC 28602 Owner GLORIA DEVANE, 1616 ROLLING LN,HICKORY NC 28602 H:828-294-1415 GLORYGLORYGLORY92@GMAIL.COM **NO PEOPLESOFT ACCOUNT ASSIGNED** 1 receipt 09/20/2023 12:46 Page 1 of 1