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Home My WebLink AboutEHPR-4-11-10593 (2).TIF , �� p� THIS IS NOT A PERMIT Case # EHPR-4-11-10593 `�" � �� CATAWBA COUNTY HEALTH DEPARTMENT c� ;.,,. ''C Plan Review Application for Environmental Services 1842 sh, Environmental Health Plan Review - Repair REPA/R NAME T APPEA ON PERM IRA WILEY SITE ADDRESS: S 1 S 1 HOPE RD Vale, NC P�n#: 269702852963 NAME of SUBDIVISION: Lot # Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.3 DIRECTIONS: HWY ]0 W, LEFT ON PLATEAU RD, LEFT ON SCRONCE RD, RIGHT ON HOPE RD, PROPERTY ON LEFT, HOUSE # ON MAILBOX APPLICANT OWNER CONTRACTOR IRA WILEY CORR[NE POUNDS HEIRS 5151 HOPE RD 5151 HOPE RD VALE NC 28168- VALE NC 28168 (828)228-2188 PRIMARY CONTACT: Applicant APPLICATION FOR: Existing Structure DIM EXISTING STRUCTURE: 36 X 26 EXISTING FACILITY TYPE: House NUMBER OF EXISTING BEDROOMS: 3 SEWER TYPE: Septic Tank NUMBER OF EXISTING OCCUPANTS: 2 EXISTING WATER SUPPLY IN USE: Private Well CALCULATED DESIGN FLOW: Public water is ""NOT"* available for this property. PUBLIC WATER TYPE AVAILABLE: DESCRIBE WORK: SEPTIC TANK HAS COLLAPSED. APPLICATION FOR REPLACEMENT. DESCRIPTION OF PRIVATE RESIDENCE EXISTING STRUCTURES ON SITE (IF ANY) PROPOSED FUTURE ADDITIONS NO OR IMPROVEMENTS: PROPERTY EASEMENTS: NO PROPOSED CONSTRUCTION APPLICATION FOR WELL CONSTRUCTION/ABANDONMENT/REPAIR PROPOSED WELL TYPE: ABANDONMENT TYPE: 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 empioyees 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 norrexpiring date, but may be revoked if this information, site plans or intended use changes for the proposed facifity. 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 structure location should conform to applicable setbacks. Date:�' ��' f� Signature of Applicant or Agent �'� ��Z An Environmental Health Specialist will contact you within 2 working days of app ication date. If you need further information or assistance please call 828-466-7291 AREA2 ****�********�**************�****�**�***************************�****************��**�**************�****�************ Minimum Setbacks Front: Side: Rear: Side St: Max Height: 04/21 / I I 16:06 � A . CATAWBA COUNTY Case # EHPR-4-1 1-10593 y . Public Health Department Q 2 Subdivision ' _ Environmental Healdi Division - Plan Review "`• :� `�' PO Box 389, 100-A Southwest Blvd, Newton, NC 286�8 Lot# Ig4 s� PIN# 269702852963 Applicant/Owner IRA WILEY, 5151 HOPE RD, VALE NC 28168- Site Address: 5151 HOPE RD, Vale, NC Property Size: SF 0_3 ACRES Directions: HWY 10 W, LEFT ON PLATGAU RD, LEFT ON SCRONCE RD, RIGHT ON HOPE RD, PROPERTY ON LEFT, HOUSE # ON MAILBOX FEE NAME DATE AMOUNT BALANCE DUE Authorization to Construct (Repair) Fee 04/21/201 1 $300.00 $0.00 TOTAL FEES $300.00 $0.00 CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 04/21 / I I 16:06 , ya ti�A THIS IS NOT A PERMIT ¢ �a CATAWBA COUNTY HEALTH DEPARTMENT �� ; Application for Environmental Services Page 1 1 84� sn� Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility ❑ Property Addres� �5�� /-��,�� C�� Subdivision ��d /,� ,�/'� �1 � �_ Lot # Acres SectionBlock/Phase Driving Directions to Property (�.i, D �-� Zcl �� C,�l ��• ' ,� �'_ o c� � rrl u. � 4 � W a NAME TO APPEAR ON PERMIT? ❑ Owner Applicant ❑ Contractor C Applicant Contact Information � V Name - ,�([i �7 m Address j : � � � � Phone �G _. � .— � � O Ce 1 Phon __ -' � ' ___ � j Owner Contact Information � Name z Address � Phone Cell Phone � Contractor Contact Information lij Name � Address � = Phone Cell Phone � Z WHO WILL BE THE PRIMARY CONTACT? Owner �] Applicant ❑ Contractor z Description of Existing Structures on Site Q # of Bedrooms *�' Structure Dimensions �(..P ��(p # of Occupants �_ F� Basement ❑ Yes � No Basement Fixtures ❑ Yes�] No � Planned Future Additions or Improvements (Building Permit NOT requested at this time) CC Describe Q � Proposed Future Structure Dimensions # of Bedrooms *�' if applicable ? Are there easements or right-of-ways recorded on this property ❑ Ye No Describe � Is a public water supply available on or adjacent to the above property ** ❑ Yes No 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 ❑ County/City/Township Water Line ❑ I WOULD LIKE TO SCHEDULE A COMBINED FLAGGING AND SOIL EVALUATION (SE CO MBINED EVALUATION PROCEDUES) �� G THIS IS NOT A PERMIT , , ' `' � CATAWBA COUNTY HEALTH DEPARTMENT 4 �a " Application for Environmental Services Page 2 !84`Z tiM Proposed Facility Type I ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *1' , Pro�ect Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes ❑ No ❑ Accessory Structure(s) Describe # of New Bedrooms *�' if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe P(umbing Needed ❑ Multi-Family Residence # Units #Bedrooms per Unit*�' Total # Bedrooms *�' Structure Dimensions ❑ Food Service Specify Type � # Seats Floor Space -Entire Food Service Facility (Sq Ft) # Employees per Shift # of Shifts Dining Area (Sq. Ft.) ❑ Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Daycare Specify Occupancy , Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown I Well Repair Requested ❑ Yes ❑ No Describe � Calculated Design Flow, Commercial �' Additional information may be required to determine design flow from certain facilities. This value will be determined during consultation with on- site staff. *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 house plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system size increase in the future. TIf 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 home or structure on this property. Any representation by you of house or structure location should conform to applicable setbacks. 0 CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN I� ADDITIONAL CHARGE SEE FEE SCHEDULE �u � ) a I understand that this is a formal application for Environmental Services and authorize Catawba County Environmental C Health employees to go on this property for evaluation purposes. I certify the above information to be correct and understand C that an Improvement Permit issued as a result of this information is valid for 5 years or may be non-expiring under certain O V specified conditions. Improvement Permits and Well Permits are transferrable, but may be revoked if this information, site W plans or intended use changes for the proposed facility. An Authorization to Construct issued by this department is valid for m (5) five years from the date issued and is not transferable � j Signature of Owner or Agent S Printed Name of Owner or Agent �' �, �� -�� Datel'f-��// Catawba County, North Carolina N This map produc! ivas prepnred fi•anr the Caraivba County, NC, Geog��aphic Infonnation System. Catawba Coa�nq� hns made szibstnn�ral e jforrs to ensrn e the accu��acy o f locntron and labeling infonna�ion contained on this map. Catawbn Cotmq+ pro�notes nnd i�econnnends (he rndependent rerifrcntron of any data contnined on thrs map prodi�ct bv the nser. The Comit�� of Catawbq iis employees, agents and personnel disclaim, and shnll »ot be held liuble for any m�d nl1 dnmages, loss or linbility, whether db�ecr, indirecl a� consequential irhich nrises or niay arise jran rhis map prod:ic� or the use �hereof by uny person or entiry. Leg@Ild Selected Parcel Number: 2697-02-85-2963 1 inch = 40 feet Prepared for: �� \ '� i \, /� // � � � � O►�� f �tl,,-•� ♦ �' � .:-�-�°�' � � � �� • � _ '�.- � ;, \�� ]- � �. .�. ,�� .�- � � 1 � �� . ..� ,.,- ,_.� � --a � � � , � _....� �� ? � . W �� r� � �' 3 � i 5 0 � 0 �' _� ,,. .,�--� _... THIS IS NOT A LEGAL DOCUMENT ,/'�, Thursday, April 21, 2011 03:43 PM � /�� 0 � Cp� CATAWBA COUNTY, NC �,� ,� 100-A South West Blvd pLAN RECEIPT Q+ �-] Newton, NC 28658- '�� 828 465-8399 Thursda A ril 21 2011 V � ,�� ''4' ( ) Y, p � � 1g 42 sM www.catawbaco�mtync.gov P�an �ase: EHPR-4-11-10593 �nvoice Number: INV-4-11-274530 Environmental Health Plan Review Invoice Date: 04/21/2011 Site Address: 5151 HOPE RD, Vale, NC APPLICANT OWNER CONTRACTOR IRA WILEY CORRINE POUNDS HEIRS 5151 HOPE RD 5151 HOPE RD VALE NC 28168- VALE NC 28168 (828)228-2188 Fee Name Fee Amount Authorization to Construct (Repair) Fee Adjustable $300.00 Total Fees Due: $300.00 PAYMENTS PAYER: IRA WILEY Date Pay Type Check Number Amount Paid ChangE 04/21/2011 Check 1134 $300.00 $0.00 Total Paid: $300.00 Total Due: $0.00 �,lan r�c�ipt 04/21/2011 16:0�