The URL can be used to link to this page

Home My WebLink AboutEHPR-2-11-9276 (2).TIF �$ ,C� THIS IS NOT A PERMIT Case # EHPR - - 11 - 9276 d CATAWBA COUNTY HEALTH DEPARTMENT c) " 0 ''C Plan Review Application for Environmental Services 1841 sM Environmental Health Plan Review - OSWP ABANDONMENT NAME TO APPEAR ON PERMIT NEILL GRADING & CONSTRUCTION SITE ADDRESS: BLUE STAR RD, HICKORY, NC Pin#: 360901167925 NAME of SUBDIVISION: Lot # Section/Block/Phase PROPERTY SIZE: Square Feet Acres 45.319 DIRECTIONS: HWY 127 S LEFT HUFFMAN FARM RD, RIGHT PITTTOWN RD, RIGHT ON BLUE STAR, AT END OF ROAD APPLICANT OWNER CONTRACTOR NEILL GRADING & CONSTRUCTION WOODLAND VILLAGE LLC PO BOX 3916 PO BOX 729 HICKORY NC 28603- HICKORY NC 28603- (828)324 -1327 (828)322 -7169 PRIMARY CONTACT: Applicant APPLICATION FOR: Existing Structure DIM EXISTING STRUCTURE: EXISTING FACILITY TYPE: House NUMBER OF EXISTING BEDROOMS: SEWER TYPE: Septic Tank NUMBER OF EXISTING OCCUPANTS: EXISTING WATER SUPPLY IN USE: Private Well CALCULATED DESIGN FLOW: Public water is **NOT** available for this property. PUBLIC WATER TYPE AVAILABLE: DESCRIBE WORK: WELL ABANDONMENT DESCRIPTION OF ABANDONED HOUSE EXISTING STRUCTURES ON SITE (IF ANY) PROPOSED FUTURE ADDITIONS N/A OR IMPROVEMENTS: PROPERTY EASEMENTS: YES PROPOSED CONSTRUCTION APPLICATION FOR WELL CONSTRUCTION /ABANDONMENT /REPAIR PROPOSED WELL TYPE: ABANDONMENT TYPE: Dug WELL REPAI REQUESTED? I understand that this is a formal application for a well permit, Improvement permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is transferable and may be eligible for a non - expiring date, but may be revoked if this information, site plans or intended use changes for the proposed facility. A Well Permit and Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or struct re location should conform to applicable setbacks. Date: 1 1 1 Signature of Applicant or Agent K An Environmental Health Specialist will contact you wit ' 2 working days of application date. If you need further information or assistance please call 828 - 466 -7291 AREA2 Minimum Setbacks: Front: Side: Rear: Side St: Max Height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eill Grading 2002 :M+ COUNTY IS NOT A PERMIT (f�T, fi R CATAWBA CONTY DEALTH DEPARTMENT (< "II Application for Environmental Services Page 1 K.. ti Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonmeut E ' Well Repair ❑ Existing System Inspection (Pre- Approval Required) ❑ Application is for New Construction ❑ Existing Facility ❑ Property Address EMI) or f31ut=. STAR Ror NO Subdivision p (-eti,/ ' - , - ° DS Lot# Acres Section/Bloch/Phase Driving Directions to Property ) -IVN.P ■( 127 5 To I••11)nrirotN Farm 24_ Le F"T o FE • j 1 . r.To u F 4 arras ! t. T o r, rt rs w T r r T» p Blue n STAQ. // � 1 g ! p� ¢ ( ry /� LIJ Q P P ? IG� U.G �I., 6 A r0 (d 1 �f" fl ✓ ll 3 11 to e� 6 0 i+A . Beni fi�l 4.l Ir e✓ Cl.. NAME TO APPEAR ON PERMIT? ❑ Owner C❑ Applicant Contractor O Applicant Contact Information U Name . m Address - 1.. Phone Cell Phone • Owner Contact Information Name VJoc4(arcl ViIICIC,G LLG � z Address PO iNDK 129 HickoQ`( NC.. 2g4,03 O Phone 8215- 322. '7 1 639 Cell Phone F Contractor Contact Information W Name 1••kei ll 671(11d,r• • - ■ GnnST• Co. lase _ V) Address � • =• - I t .. r • 28603 x Phone $ �.g . 3z4. Cell Phone 62 , E . . 244 - 42 , G2. , Z WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant Contractor z Description of Existing Structures on Site O N A it of Bedrooms *-F Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes ❑ No cZ Planned Future Additions or Improvements (Building Permit NOT requested at this time) CC Describe A Proposed Future Structure Dimensions It of Bedrooms *f if applicable • Arc there easements or right - - ways recorded on this property Qf Yes ❑ No Describe 1s a public water supply available on or adjacent to the above property * ❑ Yes [jNo Check type available ❑ Community Well ❑ Semi - Public Well ❑ County /City/Township Water Line Existing water supply in use ❑ Individual Well ❑ Community well ❑ Semi- Public Well • u A ❑ County /City/Township Water Line ❑ I WOULD LIKE TO SCHEDULE A COMBL'(ED FLAGGING AND SOIL EVALUATION (SEE COMBINED EVALUATION PROCEDUES) 3a -'415 1415 - 5t2Na 02:0 15:08 FAX 828 321 9632 Neill Grading 003 THIS IS NOT A PERMIT .� CATAWBA COUNTY HEALTH DEPARTMENT �' Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms 1 1 - Project Description NiPt Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes ❑ No ❑ Accessory Structure(s) Describe # of New Bedrooms *f if applicable Structure Dimensions of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi -Family Residence # Units I Bedrooms per Unit *t NIA Total # Bedrooms #j' Structure Dimensions ❑ Food Service Specify Type PhA # Seats Floor Space - Entire Food Service Facility (Sq Ft) # Employees per Shift # of Shifts Dining Arca (Sq. Ft) ❑ Business Specific Type of Business Retail Floor Space N(P. # of Employees per Shift # of Shifts ❑ Other Facility Type Specify - (A If Church # of Seats Kitchen ❑ Yes ❑ No Tf Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposcd Well Type ❑ Individual Well ❑ Semi- Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored [r Dug ❑ Unknown • Well Repair Requested ❑ Yes ❑ No Describe Calculated Design Plow, Commercial t Additional information may be required to N/A determine design flow from certain facilities. This value will be determined during consultation with on- site staff. *Any room that will bc 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 he confirmed by rooms identified on housc plans as a bedroom at the time of building permit issuance, this may prevent the need for septic system size increase in thc future. fit' structure is plumbed but no bedrooms, calculated design flow is required. ** If No, a well permit must be issued with the Authorization to Construct. Note: You must obtain Zoning approval prior to locating a homc or structure on this property. Any representation by you of house or structure location should conform to applicable setbacks. CHANGE WORK ORDER REQUIRING REDESIGN AND /OR RETRIP WILI: INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 0. 1 understand that this is a formal application for Environmental Services and authorize Catawba County Environmental Health employes to go un this property for evaluation purposes. 1 certify thc above information to be correct and understand that an Improvement Permit issued as a result of this information is valid for 5 year or may bc non - expiring under certain V specified conditions. Improvement Permits and Well Permits are transferrable, but may he revoked if this information. site plans or intended use changes for the proposed facility, An Authorization to Construct issued by this department is valid for ti (5) five years from thc date issued and k not transferable Signature of Owner or Agents C. C J Q rir Z Printed Nam: of Owner or Agent , tr, e. tnrtt,5rnt Date Feb - 4 • 2,ntl Catawba County, North Carolina N This map product was prepared from the Catawba County, NC, Geographic Information System. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information A contained on this map. Catawba County promotes and recommends the independent verification of any data contained on this map 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 product or the use thereof by any person or entity. Legend Selected Parcel Number: 3609 -01 -16 -7925 1 inch = 250 feet Prepared for: r 402.E 37.28A 7645 ° , z -- 3\ 2 12 4.59A Plat 70 -62 ,01 , ,`� 1545 co / %; +1 ro PG 27. 98 320,40 9.a2 4b L hp ., 45.32A . . 7925 4.53A f 2952 w t r / / Plat 70-62 / / o' Q / M oo 33 / , $ q g01 t / Kg. 4� pl o ot 3.62A 6269 s, A � sr,, L1 .6? f\ „Plat6s rS uy 9Q ," THIS IS NOT A LEGAL DOCUMENT Tuesday, February 08, 2011 11:28 AM 30A XC ., 02> \ \ _ .. j 1 :2�02 ° CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3609 -01 -16 -7925 Name: WOODLAND VILLAGE LLC Name2: Address: PO BOX 729 Address2: City: HICKORY State: NC Zip: 28603 -0729 Account: 159767719 Calc Acreage: 45.32 Tax Map: 172H 01021 LRK: 58594 Deed Book: 3055 Deed Page: 1125 Subdivision Name: Subdivision Block: Lots: Plat Book: 70 Plat Page: 62 Building Number: Street Name: BLUE STAR RD Site Zip: 28602 Township: HICKORY Fire Code: MOUNTAIN VIEW City Code: COUNTY State Road: 1134 Total Bldgs Value: Land Value: $116,100 Total Value: $116,100 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 81 Watershed: WS -III Protected Area Watershed Split: NO Voter Precinct: P23 E911 District: COUNTY Zoning: R -40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: DWMH-0,WP-0,FPM-0 Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: MOUNTAIN VIEW Middle School: JACOBS FORK High School: FRED T FOARD School Split: NO P &Z Case Number: Census Tract 2010: 011801 Census Block 2010: 3008 Small Area Plan: MOUNTAIN VIEW Agricultural District: Printed: Tuesday, February 08, 2011 11:29 AM 02/04/11 15:08 FAN: 828 324 9632 Neill Grading 2001 A K s a, ° uoe NEILL GRADING & CONSTRUCTION CO., INC i,tl^ ••'' 3050 First Ave. Ct. S.E., P.O. Box 3916 • Hickory, North Carolina 28603 J (828) 324 -6774 • Fax (828) 324 -9632 Fax Transmittal To: Cc,- ra,,.,bn, coo TJ Company: cc- WooOL.c. v,�ta9e ��c Fax #: 4cS - 627(o Pages: 5 including cover Date: a- 4 • ►i From: -Jain jasvr Re: _21.6l abanba■mern' Comments: If you do not receive all pages, please notify Shipping: 3050 First Ave Ct. SE, Hickory NC 28602 Telephone: (828) 324 -6774 Fax number: (828) 324 -9632 faxrcw &$7$:%$&2817< &DVH (+35 % 3XEOLF+HDOWK'HSDUWPHQW 6XEGLYLVLRQ (QYLURQPHQWDO+HDOWK'LYLVLRQ3ODQ5HYLHZ % /RW 32%R[$6RXWKZHVW%OYG1HZWRQ1& % %%%% 3,1 ! 1(,//*5$',1* &216758&7,2132%2;+,&.25<1& $SSOLFDQW2ZQHU % %/8(67$55'+,&.25<1& 6LWH$GGUHVV % 6) 3URSHUW\6L]H $&5(6 ( +:<6/()7+8))0$1)$505'5,*+73,7772:15'5,*+721%/8(67$5$7(1'2)52$' 'LUHFWLRQV % 15A NCAC 02C .0113 ABANDONMENT OF WELLS (a) Any well which has been temporarily abandoned, shall be abandoned in accordance with one of the following procedures: (1) Upon temporary removal from service or prior to being put into service, the well shall be sealed with a water-tight cap or seal compatible with casing and installed so that it cannot be removed easily by hand. (2) The well shall be maintained whereby it is not a source or channel of contamination during temporary abandonment. (3) Every temporarily abandoned well shall be protected with a casing. (b) Any well which has been abandoned permanently shall be abandoned in accordance with the following procedures: (1) Procedures for permanent abandonment of wells, other than bored and hand dug wells: (A) All casing and screen materials may be removed prior to initiation of abandonment procedures if such removal will not cause or contribute to contamination of the groundwaters. Any casing not grouted in accordance with 15A NCAC 2C .0107(e) of this Section shall be removed or properly grouted. (B) The entire depth of the well shall be sounded before it is sealed to ensure freedom from obstructions that may interfere with sealing operations. (C) Using a hypochlorite solution (such as HTH), disinfect the well in accordance with 15A NCAC 2C .0111. Do not use a common commercial household liquid bleach, as this is too weak a solution to ensure proper disinfection. (D) In the case of gravel-packed wells in which the casing and screens have not been removed, neat-cement, or bentonite grout shall be injected into the well completely filling it from the bottom of the casing to the top. (E) Wells, other than "bored" wells, constructed in unconsolidated formations shall be completely filled with cement grout, or bentonite grout by introducing it through a pipe extending to the bottom of the well which can be raised as the well is filled. (F) Wells constructed in consolidated rock formations or that penetrate zones of consolidated rock may be filled with cement grout, bentonite grout, sand, gravel or drill cuttings opposite the zones of consolidated rock. The top of the cement grout, bentonite grout, sand, gravel or cutting fill shall terminate at least 10 feet below the top of the consolidated rock or five feet below the bottom of casing. Cement grout or bentonite grout shall be placed beginning 10 feet below the top of the consolidated rock or five feet below the bottom of casing and extend five feet above the top of consolidated rock. The remainder of the well, above the upper zone of consolidated rock, shall be filled with cement grout or bentonite grout up to land surface. For any well in which the depth of casing or the depth of the bedrock is not known or cannot be confirmed, then the entire length of the well shall be filled with cement grout or bentonite grout up to land surface. (G) Temporary wells or monitor wells: (i) less than 20 feet in depth which do not penetrate the water table shall be abandoned by filling the entire well up to land surface with cement grout, dry clay, bentonite grout, or material excavated during drilling of the well and then compacted in place; and (ii) that penetrate the water table shall be abandoned by completely filling with a bentonite or cement - type grout. FRQWLQXHG &$7$:%$&2817< &DVH (+35 % 3XEOLF+HDOWK'HSDUWPHQW 6XEGLYLVLRQ (QYLURQPHQWDO+HDOWK'LYLVLRQ3ODQ5HYLHZ % /RW 32%R[$6RXWKZHVW%OYG1HZWRQ1& % %%%% 3,1 ! 1(,//*5$',1* &216758&7,2132%2;+,&.25<1& $SSOLFDQW2ZQHU % %/8(67$55'+,&.25<1& 6LWH$GGUHVV % 6) 3URSHUW\6L]H $&5(6 ( +:<6/()7+8))0$1)$505'5,*+73,7772:15'5,*+721%/8(67$5$7(1'2)52$' 'LUHFWLRQV % (2) For bored wells or hand dug wells, constructed into unconsolidated material. (A) For wells that do not have standing water in them at any time during the year: (i) Remove all plumbing or piping entering the well, along with any obstructions in the well; (ii) Remove as much of the well casing as possible and then fill the entire well up to land surface with cement grout, concrete grout, bentonite grout, dry clay, or material excavated during drilling of the well and then compacted in place. (B) For wells that do have standing water in them during all or part of the year: (i) Remove all plumbing or piping into the well, along with any obstructions inside the well; and (ii) Remove as much of the well tile casing as possible, but no less than to a depth of three feet below land surface; (iii) Remove all soil or other subsurface material present down to the top of the remaining well casing, and extending to a width of at least 12 inches outside of the well casing on all sides; (iv) Using a hypochlorite solution (such as HTH), disinfect the well in accordance with 15A NCAC 2C .0111 of this Subchapter. Do not use a common commercial household liquid bleach, as this is too weak a solution to ensure proper disinfection; (v) Fill the well up to the top of the remaining casing with cement grout, concrete grout, bentonite grout, dry clay, or material excavated during drilling of the well and then compacted in place; (vi) Pour a one foot thick concrete grout or cement grout plug that fills the entire excavated area above the top of the casing, including the area extending on all sides of the casing out to a width of at least 12 inches on all sides; and (vii) Complete the abandonment process by filling the remainder of the well above the concrete or cement plug with additional concrete grout, cement grout, or soil. (c) Any well which acts as a source or channel of contamination shall be repaired or permanently abandoned within 30 days of receipt of notice from the department. (d) The drilling contractor shall permanently abandon any well in which the casing has not been installed or from which the casing has been removed, prior to removing his equipment from the site. (e) The owner shall be responsible for permanent abandonment of a well except that: (1) the well driller is responsible for well abandonment if abandonment is required because the driller improperly locates, constructs, repairs or completes the well; or (2) the person who installs, repairs or removes the well pump is responsible for well abandonment if that abandonment is required because of improper well pump installation, repair or removal. History Note: Authority G.S. 87-87; 87-88; Eff. February 1, 1976; Amended Eff. April 1, 2001; December 1, 1992; September 1, 1984; April 20, 1978. FRQWLQXHG &$7$:%$&2817< &DVH (+35 % 3XEOLF+HDOWK'HSDUWPHQW 6XEGLYLVLRQ (QYLURQPHQWDO+HDOWK'LYLVLRQ3ODQ5HYLHZ % /RW 32%R[$6RXWKZHVW%OYG1HZWRQ1& % %%%% 3,1 ! 1(,//*5$',1* &216758&7,2132%2;+,&.25<1& $SSOLFDQW2ZQHU % %/8(67$55'+,&.25<1& 6LWH$GGUHVV % 6) 3URSHUW\6L]H $&5(6 ( +:<6/()7+8))0$1)$505'5,*+73,7772:15'5,*+721%/8(67$5$7(1'2)52$' 'LUHFWLRQV % 15A NCAC 02C .0114 DATA AND RECORDS REQUIRED (a) Well Cuttings. (1) Samples of formation cuttings shall be collected and furnished to the Division from any well when such samples are requested by the Division prior to completion of the drilling or boring activities. (2) Samples or representatives cuttings shall be obtained for depth intervals of 10 feet or less beginning at the land surface. Representative cuttings shall also be collected at depths of each significant change in formation. (3) Samples of cuttings shall be placed in containers furnished by the Division and such containers shall be filled, sealed and properly labeled with indelible-type markers, showing the well owner, well number if applicable, and depth interval the sample represents. (4) Each set of samples shall be placed in a suitable container(s) showing the location, owner, well number if applicable, driller, depth interval, and date. (5) Samples shall be retained by the driller until delivery instructions are received from the Division or for a period of at least 60 days after the well record form (GW-1), indicating said samples are available, has been received by the Division. (6) The furnishing of samples to any person or agency other than the Division shall not constitute compliance with the department's request and shall not relieve the driller of his obligation to the department. (b) Reports. (1) Any person completing or abandoning any well shall submit to the Division a record of the construction or abandonment. For public water supply wells, a copy of each completion or abandonment record shall also be submitted to the Health Department responsible for the county in which the well is located. The record shall be on forms provided by the Division and shall include certification that construction or abandonment was completed as required by these Rules, the owner's name and address, well location, diameter, depth, yield, and any other information the Division may reasonably require. (2) The certified record of completion or abandonment shall be submitted within a period of thirty days after completion or abandonment. (3) The furnishing of records to any person or agency other than the Division shall not constitute compliance with the reporting requirement and shall not relieve the driller of his obligation to the Department. History Note: Authority G.S. 87-87; 87-88; Eff. February 1, 1976; Amended Eff. April 1, 2001; December 1, 1992; September 1, 1984; April 20, 1978. &$7$:%$&2817< &DVH (+35 % 3XEOLF+HDOWK'HSDUWPHQW 6XEGLYLVLRQ (QYLURQPHQWDO+HDOWK'LYLVLRQ3ODQ5HYLHZ % /RW 32%R[$6RXWKZHVW%OYG1HZWRQ1& % %%%% 3,1 ! 1(,//*5$',1* &216758&7,2132%2;+,&.25<1& $SSOLFDQW2ZQHU % %/8(67$55'+,&.25<1& 6LWH$GGUHVV % 6) 3URSHUW\6L]H $&5(6 ( +:<6/()7+8))0$1)$505'5,*+73,7772:15'5,*+721%/8(67$5$7(1'2)52$' 'LUHFWLRQV %