The URL can be used to link to this page

Home My WebLink AboutRBPR-07-2014-19400.TIFA Environmental Health - Division of Public Health CATAWBA PQ Raw 399 ---West olvd. piewo6n) piepok 600040& Mr&ig (828) 465-8270 —Fax (828) 465-8276 w\,\1�v.cata wt)acMin tNinc. Lo0em, i wii iiieii tal heal th/ North C€�roiin AUTHORIZATION OF REFUND Date: Case Applicant: Refund Amount: Refund Reason: Authorizing Signature: Received By Staff: Date: "CAR A—ed,zed rt—t 8/1/2014 RBPR-07-2014-19400 Dennis Hinkle $400.00 Abandonment and expansion not now needed due to Changes made on application Lcadin,iz the Wa.), to a Healthier (701111771111ilj)" 90 ,t.3.',+..'k Catawba County; R 6' tK: arolin_ w ®asburs`emel�t Vouc6ier {Vendor No. Make Payment To: Dennis Hinkle 1448 Cauble Dairy Rd Hickory, NC 28602 ATTACHMENT {Prepared by Julia English { Description (Expansion and abandonment no longer required due to changes in application I I Date 08/01/14 Voucher No(s). {{ Amount 400.00 Sub -Total $ 400.00 Food Tax { Sales Tax Total I $ 400.00 For Accounting }C— d r Ij'I S>Z$=r:r K a FVC z.E :S+S ,;{.� 'es«�, it I,', : Fund Cost Center Obj°ect ys :; ¢Project, ,Fal Amount , :I ' .k Use 110 580200 663000 I I � I Total The undersigned hereby certifies that the goods or services specified above have been received or performed. Payment has not been previously authorized and this expenditure is a proper charge to the appropriation indicated. The above charge is certified to you for payment. (SIGNATURE - APPROPRIATE OFFICIAL) PAYOR: Hinkle, Dennis IMMINUMNIMI TRANSACTION NUMBER PAYMENT DATE PAYMENT TYPE CATAWBA COUNTY |O&\SOUTHWEST BLVD NEWTON, NORTH CAROLINA 2860 PHONE: 828.465.8399 TRC -3 61087-01-08-2014 0&N|/2O|4 DV Friday, August 1, 2014 INVOICE NUMBER FEE NAME FEE AMOUNT 07'14-308442 Authorization tnConstruct Fee ($300.00) _-�. ^- TOTAL PAYMENTS: ($400.00) P,BpR,07_2014_19400 CASE TYPE: Residential Building Plan Review WORK CLASS: Manufactured Home SITE ADDRESS: |697HIGH MEADOW LN, NEWTON NC286j8 Applicant DENNIS 8|NKLB.|448C&D8LEDAIRY RD, HICKORY NC2X602 B:828464702OC:8283205637 **NOPB0PLES0FTACCOUNT ASSIGNED Owner CHARLES RUDISILL, 3447 HUIE ST, NEWTON NC 28658-8301 ** sy receipt omn|omw ox`m Page |m| SBA 1842 sm IV, i Qvi /-�y � to Applicant Owner THIS IS NOT A PERMIT Case # RBPR-07-2014-19400 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Manufactured Home IMPROVEMENT DENNIS HINKLE, 1448 CAUBLE DAIRY RD, HICKORY NC 28602 13:8284647020 C:8283205637 CHARLES RUDISILL, 3447 HUIE ST, NEWTON NC 28658-8301 NAME TO APPEAR ON PERMIT Dennis Hinkle SITE ADDRESS: 1697 HIGH MEADOW LN, NEWTON NC 28658 NAME of SUBDIVISION: CHARLES C RUDISILL JQl D PIN # 371007592990 Lot # 4 Section/Block PROPERTY SIZE: Square Feet Acres 0.46 DIRECTIONS: Hwy 10 - Robingson Rd app 2 1/2 mil to Huie Str Left on High Meadow Ln PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Community Well DESCRIBE WORK: 8/1/2014 revised app to IP only. no expansion or well abandonment needed. Fees for those refuned. 7/9/14 revised to 2 br 14 x 60 will not abandon well unless necessary per Dennis Hinkle Change out SW Mobile Home (Previous MOH removed a few years ago - OK to place SW with Shingle roof and vinyl siding per Zoning) - Original well to be abandoned and home to be connected with community well. 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? Yes Are there any easements or right-of-ways on this property? APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Mobile Home 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:: 14 x 60 # OF NEW BEDROOMS:: 2 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: FI - ehapplicatfim 08/01/20t4 08:50 Page I of SBA CATAWBA COUNTY Case # RBPR-07-2014-19400 C a Public Health Department Subdivision i~ �,• � CHARLES C RUDISILL Environmental Health Division PIN# 371007592990 r� PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Ig SM NAME ON PERMIT: (DENNIS HINKLE), 1448 CAUBLE DAIRY RD, HICKORY NC 28602 ( Dennis Hinkle) Site Address: 1697 HIGH MEADOW LN, NEWTON NC 28658 Property Size: Square Feet Acres 0.46 Directions: Hwy 10 - Robingson Rd app 2 1/2 mil to Huie Str Left on High Meadow Ln Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified conditions. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. 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 p operty lines and corners and making the site acce� a so that a comp bite valu n can be performed. Date: ^ f Signature of Applicant or Agent O An Environmental Health Specialist will contact you within 2 working day/of application date. If you need further information or assistance please call 828-466-7291 AREA2 MINIMUM SETBACKS FRONT: 30 SIDE: 15 REAR: 30 MAX HEIGHT: .FEENAME DATE.' FEE•AMOUNT Improvement Permit Fee 07/02/2014 $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) 1-'9 - ehmphlication 08/01/2014 08:50 Page 2 of4 r THIS IS NOT A PERMIT Case # RBPR-07-2014-19400 CATAWBA COUNTY HEALTH DEPARTMENT M. . , A111 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES f Residential Building Plan Review - Manufactured Home IMPROVEMENT - AUTH_CONST - EXPANSION - K�Jt�e� ABANDONMENT Applicant DENNLS HINKLE, 1448 CAUBLE DAIRY RD, HICKORY NC 28602 B:8284647020 :8283205637 Owner CH UDISILL, 3447 HUIE ST, NEWTON NC 28658-8301 NAME TO APPEAR ON PERMIT Dennis Hinkle D SITE ADDRESS: 1697 HIGH MEADOW LN, NEWTON NC 28658 PIN # 371007592990 NAME of SUBDIVISION: CHARLES C RUDISILL Lot # 4 Section/Block PROPERTY SIZE: Square Feet Acres 0.46 DIRECTIONS: Hwy 10 - Robingson Rd app 2 1/2 mil to Huie Str Left on High Meadow Ln PRIMARY CONTACT: Api2licant SEWER TYPE: Septic Tank 240 GALLONS PER DAY: WATER SUPPLY: Community Well DESCRIBE WORK: 7/9/14 revised to 2 br 14 x 60 will not abandon well unless necessary per Dennis Hinkle Change out SW Mobile Home (Previous MOH removed a few years ago - OK to place SW with Shingle roof and vinyl siding per Zoning) - Original well to be abandoned and home to be connected with community well. 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? Yes Are there any easements or right-of-ways on this property? APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Mobile Home 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:: 14 x 60 # OF NEW BEDROOMS:?. . Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: APPLICATION FOR WELL ABANDONMENT ABANDONMENT TYPE: Bored F9 - ehapplication 07/09/2014 15:52 Page ] of 8 IgA C CATAWBA COUNTY Case # ` 'RBPR-07-2014-19400 �Y y Public Health Department Subdivision CHARLES C RUDISILL d Environmental Health Division PIN# 371007592990 PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 1842 5M NAME ON PERMIT: (DENNIS HINKLE), 1448 CAUBLE DAIRY RD, HICKORY NC 28602 ( Dennis Hinkle) Site Address: 1697 HIGH MEADOW LN, NEWTON NC 28658 Property Size: Square Feet Acres 0.46 Directions: Hwy 10 - Robingson Rd app 2 1/2 mil to Huie Str Left on High Meadow Ln Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified conditions. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. 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 identificatio and labeling of all roperty lines and corners and making the site acce��' le- —so that a comp t� % e eva uati can be performed. Date: V � Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 working da s �gappltcation date. If you need further information or assistance please call 828-466-7291 AREA2 MINIMUM SETBACKS FRONT: 30 SIDE: 15 REAR: 30 MAX HEIGHT: FEENAME Authorization to Construct Fee (New/Expansion) Fee Well Abandonment Fee Improvement Permit Fee TOTAL FEES DATE_ FEE AMOUNT 07/02/2014 $300.00 07/02/2014 $100.00 07/02/2014 $150.00 $550.00 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) F9 - chapplication 07/09/2014 15:52 Page 2 of 8 Applicant THIS &8NOT A PERMIT Case# R8PB-07-2014-19400 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Manufactured Home IMPRO VEMENT~A UT� �r� ~ '--_ CONS EXPA ABANDONMENT DENN(8H[NKL8 |448CAU6LBDAIRY RD, HICKORY NC 28602 C:8283205637 Owner CHARLES RDD|8|L[`]447HU}ESlNEWTON NC 28658-8301 NAME TOAPPEAR <JNPERMIT Dennis Hinkle SITE ADDRESS: i697HIGH MEADOW LN, NEWTON NC28658 NAME of SUBDIVISION: CHARLES C RUDISILL PIN # 371007592990 Lot 4 PROPERTY SIZE: Square Feet Acres 0.48 DIRECTIONS: Hwy 10 RniingsonRdapp 21/2mil {o HuiaS\rLeft onHigh Meadow Ln PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Community Well DESCRIBE WORK: Change out SW Mobile Home (Previous MOH removed g few years ago - OK to place SVVwith Shingle roof and vinyl siding per Zoning) - Original well to be abandoned and home to be connected with community well. SITE INFORMATION Duany ofthe following apply 0othe property for which this application ioapplied? 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 \athe site subject Vmapproval byany other public agency? Yeo Are there any easements orhght'mf-wayoonthis property? APPLICATION FOR: STRUCTURE TYPE: FACILITY TYPE: Mobile Home DESCRIPTION OF EXISTING STRUCTURES QNSITE (IF ANY) / DIM EXISTING STRUCTURE: NUMBER OFEXISTING BEDROOMS: New Structure PRIMARY RESIDENCE OTHER DESCRIPTION: #OFOCCUPANTS: 1 PROPOSED CONSTRUCTION NEW STRUCTURE [UK8:: 16x77 #OFNEW BEORODMS:: 4 Desired system types (Improvement Permit o/Authorization hmConotruoU: ACCEPTED: ALTERNATIVE: u/nEm: INNOVATIVE: Other described: CONVENTIONAL: APPLICATION FOR WELL ABANDONMENT ABANDONMENT TYPE: Bored n9'*map»icatioo 07m2o014 wxo Page '"r8 CArAWBA COUNTY Cuse# RBPR'07-2014-19400 Public Health Department Subdivision CHARLES C RUD|S(LL 8n,ihmmenxd Health 0,�o�vo . P|N# 371007592090 pVBox 389.|V0'ASouthwest Blvd, Newton, NC 28658 NAME ON PERMIT: ([}BNNlBH|NKLC)` !448C&UBLRDAIRY RD, HICKORY NC28602 ( Dennis Hinkle) Site Address: \6078\GllMEADOW LN, NEWTON NC28658 Property Size: Square Feet Acres 040 Directions: Hwy 10 RobingaonRdapp 21/2mil to HuiwShLeft onHigh Meadow Ln Improvement Permits issued as a mouK of this information are valid for years o, may be non -expiring under certain specified conditions. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable; improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. } 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 forme proper m m rl-lulauenngnf n roperty|| d corners and making the site ounbopehvnned. Date: al t Signature of Applicant or Agent�/�k. An Environmental Health Specialist will contact you g days , -,,.i'_ '-__ If you need further information or assistance please call 828'466-7291 AREA2******************************************************************************************^***************** MINIMUM SETBACKS FRONT: 30 SIDE: 15 REAR: 30 MAX HEIGHT: FEENAN4E Authorization hoConstruct Fee (New/Expansion) Ree Well Abandonment Fee Improvement Permit Fee TOTAL FEES DATE FEE AMOUNT 07/02/2014 $300.00 07/02/2014 $100.00 07/02/ 2014 $150.00 SYSTEM REDESIGN AND/OR FlETR1PWILL INCUR ANADDITIONAL CHARGE (SEE FEE SCHEDULE) 29'ehoynUxuiov 07m2/2014 wxu Page 2o/o 7BAT141S IS NOT A PERMIT qLr�u TtAW.--- CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page I Improvement Permit[ uthorization to Construct Septic Repair ElSeptic Malfun�c '°n ❑ Septic Expansion ] New Well Permit ❑ Replacement Well ❑ Well Abandonment 66 Well Repair ❑ Existing System Inspection (Pre -Approval Required) ❑ Application is for New Construction ❑ Existing Facility ❑ Property Address 16j / ( /T /� � , o ��/Ysubdivision / /C Ccs % v�J �; C , Lot # Acres Section/Block/Phase Driving Directions to Property �7 W l �� " /� d �l �t'f U,t/ � ;z NAME TO APPEAR ON PERMIT? ❑ Owner Ll-pplicant ❑ Contractor Applicant Contact Information h Name Address If Phone r Owner Contact Information Name C 1 ,f' L L Address Phone Contractor Contact Information Name Address Phone Cell Phone _,�O j Cell Phone I Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner 2'Applicant ❑ Contractor Description of Existing Structures on Site „ . l�1/ e G L �l v (J s ......... W..• ,•„ „ . •,. _.•..,..... # of Bedrooms *T Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures Q Yes No 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. * Y 1'�,No Does the site contain any jurisdictional wetlands? ' Y es 0 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 o Is the site subject to approval by any other public agency? Yes o y,son, thisproperty? ribe ®istin water supply in use there any tWell right oaCommuni s Well erre Public Well' De g pP Y ❑ tY ❑ S..••• •- ❑ County/City/Township Water LineIs a public water supply available? ** ElYes ElNo 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) 0 Accepted 0 Alternative 0 Conventional 11 Innovative 0 Other 0 Any CATAWBA THIS IS NOT A PERMIT COUNTY ---.-"-,-CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type c� ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *t / Project Description "o, ,. Structure Dimensions # of Occupants Basement ❑ Yes 'P No Basement Fixtures Yes WNo ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed Lit lMulti-Family Residence # Units #Bedrooms per Unit* Total # Bedrooms *t 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 Church # of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Se -Public Well ❑ Community Well Abandonment Type ❑ Drilled Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ No Describe Calculated Design Flow, Commercial t 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. f If structure is plumbed but no bedrooms, calculated design flow is required. ** If No, a well permit must be issued with the Authorization to Construct. SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) Improvement Permits issued as a result of this information are valid for 5 years or maybe non -expiring under certain specified conditions. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. 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 comers and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent �.�-�K� Date "1�� Printed Name of Owner or Agent 163.44 M1~`1709 ti 2092 C aJ cyi 164.01_...-:- 1697 9 %7�.. 26 - 14\0 j,J 1685 CD O O 2788 2.45 `X- o ppO DW Saved:6/41/201�i-- lO Time: 1:36:04 PM Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geospatial Information System. N Catawba County has made substantial efforts to ensure the accuracy of location and labeling information 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. Selected Parcel Number: 3710-07-59-2990 1 inch = 50 feet Prepared for: 163.44 M1~`1709 ti 2092 C aJ cyi 164.01_...-:- 1697 9 %7�.. 26 - 14\0 j,J 1685 CD O O 2788 2.45 `X- o ppO DW Saved:6/41/201�i-- lO Time: 1:36:04 PM CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3710-07-59-2990 Name: RUDISILL CHARLES C Name2: Address:. ` 3447 HUIE ST Address2: City: NEWTON State: NC Zip: 28658-8301 Account: Calc Acreage: 0.47 Tax Map: 131H 01035 LRK: 47880 Deed Book: 2027 Deed Page: 1519 Subdivision Name: CHARLES C RUDISILL Subdivision Block: Lots: 4 Plat Book: 39 Plat Page: 185 Building Number: 1697 Street Name: HIGH MEADOW LN Site Zip: 28658 Township: HICKORY Fire Dist: HICKORY RURAL City/Tax: State Road: Total Bldgs Value: Land Value: $8,300 Total Value: $8,300 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 87 Watershed: Watershed Split: NO Voter Precinct: P35 E911 District: COUNTY Zoning: R-20 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: BLACKBURN Middle School: JACOBS FORK High School: FRED T FOARD School Split: NO P&Z Case Number: RZ2012-05 Census Tract 2010: 011102 Census Block 2010: 2081 Small Area Plan: MOUNTAIN VIEW Agricultural District: Printed: Wednesday, July 02, 2014 01:36 PM f�D Pei NL h f e� pa n S') v, $�Sb 4100 Catawba County, North Carolina I This map product was prepared from the Catawba County, NC, Geospatial Information System. N Catawba County has made substantial efforts to ensure the accuracy of location and labeling information 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. pelf bener5 V; Selected Parcel Number: 3710-07-59-2990 1 inch = 200 feet !,� j I [Obc �,ed S `o« Prepared for: 1�� a �F7Ftj,Lf r53 191766' m 1 8� 0069cP 8 .6034 69 7 46 a5 ad I •42 a a0 38{ ',36 3 55_ �(152� ) 2 1 i j 2 62/ ') 2a] W 56 00 100 02 6713 5n 9 101 ' ] I/ 1 I 63 J Moo 57 I Plat -130 2 8 �7 So 39 04 �) -P6 /1 �30 591 81 7932 8 62 1 t 092 m & "- .11/ 125 w 61 so 00 15056 i Pler j13= 53 13 3\ 44 1113) I WA, RD 25 18923, 16 "5 — o� 5 5 25 f-� Plat -53 I < d1A + V 1 221 1 ' 879 21 1 97 I5 �' 9d 3 192 1 1 190 189 188 B 86 85 1 83 182 I01tI 80 78I -7 9 ° /-0 D6 \ 22 �4 8 46 124 gf/ -^ \ 60 170 D6 5 5 QJ/ 2 A4 030o R1 0 ) H'AE SR 1240 NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES VARIANCE APPLICATION FOR 2C.0100 WELL CONSTRUCTION STANDARDS: PRIVATE DRINKING WATER WELLS UNDER 15A NCAC 02C.0300 WATER SUPPLY WELLS UNDER 15A NCAC 02C.0107 All tivater supply ivells not considered "Private Drinking Water IVells" and including irrigation, industrial, and commercial wells. WELLS OTHER THAN WATER SUPPLY UNDER 15A NCAC 02C.0108 Including monitoring and recovery ivells. Print clearly or type information. Illegible submittals will be returned as incomplete. DATE: ,l UL' Y ;'I— / 20_/�( PERMIT NO.: (to be completed by DWQ/DPH) A. WELL OWNER — For single family residences list the property owner(s). For all others, list name of the business, organization, or government agency and person delegated signature authority: 47 Mailing Address: J '7 7 /+ City: /l% PC// / Gam/ State: /Zip Codei?ounty: C�%✓¢L!/�� Day Tele No.: S% 7 Cell No.: EMAIL Address: Fax No.: B. PHYSICAL LOCATION OF WELL SITE (1) Parcel Identification Number (PIN) of well site: County: (2) Physical Address (if different than mailing address): 11-AAe r City: 1 f16�/ X41 G State: NC Zip Code C. WELL DRILLER INFORMATION (if known) '' Well Drilling Contractor's Name: NC Well Drilling Contractor Certification No.: Company Name: Contact Person: City: State: Zip Code: County: Day Tele No.: Cell No.: EMAIL Address: Fax No.: Form GW -22V Page 1 Revised February 2013 D. REASON FOR VARIANCE REQUEST — Include type of well(s) to be constructed; rule for which the variance is being requested; description of how the alternate construction will not endanger human health and welfare and the environment; and reason why construction and/or operation in accordance with the standards is not technically feasible and/or provides equal or better protection of the groundwater. E. ATTACHMENTS — Provide the following information as attachments to this application: (1) A map showing general location of the property (including road names, NC State Route Number, distances, any key landmarks, etc.) sufficient for finding the well location. (2) Detailed site map with scale showing location of proposed well relevant to septic system(s), building foundations, property lines, water bodies, potential sources of contamination, other wells, etc. (3) Submit a copy of the local well permit application and site evaluation map (if applicable). (4) Any other information relevant to the variance request such as a well construction diagram showing proposed well liner or atypical construction materials/methods. F. OTHER MINIMUM CONSTRUCTION REQUIREMENTS For water supply wells, approval of a variance will require that additional construction requirements beyond those specified in 15A NCAC 02C .0107 be met. Minimum additional construction requirements for Coastal Plain and Piedmont and Mountain region wells are referenced on Attachments A and B on pages 4 and 5 of this application. Approval of a variance will not be considered in cases where the specified minimum additional construction requirements cannot be met. G. SIGNATURES v Signature of Person Responsible for Well Construction (typically the well driller) Print or Type Full Name of Person Responsible for Well Construction (typically the well driller) Signature of County Environmental Health Specialist Print or Type Full Name of County Environmental Health Specialist Per 15A NCAC 02C.0118 the Secretary of the Division of Water Quality or the Division of Public Health may require submittal of information deemed necessary to make a decision on the variance, may impose conditions as part of the decision, and shall respond in writing to the request within 30 days of receipt of the variance request. A variance applicant who is dissatisfied with the decision of the Director may commence a contested case by filing a petition as described in G.S. 150E-23 within 60 days after receipt of the decision. Form GW -22V Page 2 Revised February 2013 .i �nunw i i lui�u m -i i 'lq� i Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geospatial Information System. N Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map. Catawba County promotes and recommends the independentvIa ification 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 dict, indirect or consequential which arises or may arise from this map product or the use thereof by any person or entity. Selected Parcel Number: 3710-07-59-2940 1 inch = 50 feet 1617 h1 ` j� _ i Ow 6, r Nv-v j �� Prepared for: t 1��(�i _ A 1`he� Weil or ton(& a S {oar 001- lS �{ �Y61►�� CD a `C1�e� will w► oSeA it1 u se Ar �,onnec�;ons, . M som, Aaj I�h 4 o��eY tiu.� Seed AQ veer CONS, UT(ev }t, * as GL d rn z4e( 0" X. T - Ell 154.01 . v,lell 67 E I-- *-+. l- 2990 �tip Y z a 155. 5 2788 CO r1 - CN N C) t6 00 0 0 T- -The, propse� IS O'n o ' �(oper t From. 45 r4 T. c 7 z I Julia English From: Brooks, John Uohn.brooks@dhhs.nc.gov] Sent: Monday, July 28, 2014 1:40 PM To: Julia English Cc: Megen McBride Subject: RE: Variance Request If the information is correct, then no variance will be needed. Our rules only prohibit encroaching upon a private drinking water well. There is nothing to prevent someone from encroaching upon an irrigation or agricultural well. We just need to verify that he is connected to the other well and not this one, then he can proceed with his project without a variance. If you have any questions, feel free to give me a call. Thanks, John From: Julia English fmaiIto: JENGLISH CcDcatawbacountvnc.00vl Sent: Monday, July 28, 2014 7:41 AM To: Brooks, John Subject: FW: Variance Request Please see note below from Megen concerning attached variance request and site plan Julia Julia English Administrative Assistant II Environmental Health Catawba County Public Health 100A Southwest Blvd Newton NC 28658 828-465-8270 828-465-8276 fax Confidentiality Statement: The information contained in electronic transmissions is confidential and may be 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 are 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 From: Megen McBride Sent: Wednesday, July 23, 2014 6:09 AM To: Julia English Subject: please forward well variance request to John Brooks I have attached a site plan for Mr. Hinkle's well variance request. When you send to John Brooks, please forward the following message. 1 John, I have been working with the applicant, Mr. Hinkle, and have looked at the well requesting the variance. It is a bored well. The "floor' of the cinder block well house is concrete and the concrete pad extends up to the edge of the well tile. In the past, I believe we have used this to reasonable assume the well has been grouted. I have made a note on the attached site plan as to owner's stated plans for the well. If approved, the conditions on the variance may be different due to the fact that the well will not be used? Let me know if you need any more information or if I can help. Thanks, Megen Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized State official. Unauthorized disclosure of juvenile, health, legally privileged, or otherwise confidential information, including confidential information relating to an ongoing State procurement effort, is prohibited by law. If you have received this email in error, please notify the sender immediately and delete all records of this email.