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HomeMy WebLinkAboutRBPR-07-2015-21887.TIF1842 SM Owner THIS IS NOT A PERMIT Case # RBPR-07-2015-21887 CATAWBA COUNTY HEALTH DEPARTMENT [E]�kY •J0 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Building New ti IMPROVEMENT - AUTH CONST - NEW WELL ROBERT FERTIG JR, 9077 BURROUGHS CT, SHERRILLS FORD NC 28673 C:7048811288 D NAME TO APPEAR ON PERMIT Robert Fertig Jr SITE ADDRESS: 6334 LONG ISLAND RD, CATAWBANC 28609 PIN # 369901299066 NAME of SUBDIVISION: Lot # Section/Block PROPERTY SIZE: Square Feet Acres 13.52 DIRECTIONS: From intersection of Long Island Rd & sherrrills Ford Rd/turn onto Long Island Rd/property is 200 yards on the left. Go down neighbor's driveway on the right of property to get to area where home will be built PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 720 WATER SUPPLY: Private Well DESCRIBE WORK: New 3 bedroom home w/basement and bonus room **Septic to be sized for 6 bedrooms 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? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF None EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: # OF OCCUPANTS: 4 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 110 x 80 # OF NEW BEDROOMS:: 3 BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED? Yes Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO E9 - chapplication 07/06/2015 16:59 Page 1 of 4 IgA CATAWBA COUNTY case # RBPR-07-2015-21887 Public Health Department Subdivision Environmental Health Division per# 369901299066 PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 1842 SM NAME ON PERMIT: ( ROBERT FERTIG JR), 9077 BURROUGHS CT, SHERRILLS FORD NC 28673 ( Robert Fertig Jr) Site Address: 6334 LONG ISLAND RD, CATAWBA NC 28609 Property Size: Square Feet Acres 13.52 Directions: From intersection of Long Island Rd & sherrrills Ford Rd/turn onto Long Island Rd/property is 200 yards on the left. Go down neighbor's driveway on the right of property to get to area where home will be built 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 an JabeJing of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. Date: /,�/� Signature of Applicant or Agent An Environmental Health Specialist will contact you within 5 working days of application date. If you need further information or assistance please call 828-466-7291 AREA1 FEENAME Authorization to Construct Fee (New/Expansion) Fee Improvement Permit Fee Well Permit & Inspection Fee TOTAL FEES DATE FEE AMOUNT 07/06/2015 $500.00 07/06/2015 $150.00 07/06/2015 $300.00 $950.00 FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORD ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9 - chapplication 07/06/2015 16:59 Page 2 of LATA A L� THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT North Carolina Application for Environmental Services Page I Improvement Permit ®❑ Authorization to Construct ❑® Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit 0 Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre -Approval Required) ❑ Application is for New Construction 0 Existing Facility ❑ Property Address 6334 Long Island Road Subdivision N/A Lot # NSA Acres 13.52 Section/Block/Phase Driving Directions to Property From Intersection of Long Island Road and Sherrills Ford Road, Turn onto Long Island Road, Property is 200 yards up on the left. It is best to go down neighbors drive way on the Right of the property to get to area where home will be built and septic and well locations. NAME TO APPEAR ON PERMIT? 0 Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name Bobby Fertig Address6334 Long Island Road, Catawba, NC Phone Owner Contact Information Name Bobby Fertig Address 6334 Long Island Road, Catawba, NC Phone Contractor Contact Information Name Address Phone Cell Phone 704.881.1288 I Cell Phone I Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑® Owner ❑ Applicant ❑ Contractor Description of Existing S ructures on Site None, was all wooded # of Bedrooms *4 Structure Dimensions of Occupants --4' Basement ❑® Yes ❑ No Basement Fixtures 0 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. ® Yes KD No Does the site contain any jurisdictional wetlands? ® Yes 0 No Does the site contain any existing wastewater systems? ® Yes El No Is any wastewater going to be generated on the site other than domestic sewage? Wes 10 No Is the site subject to approval by any other public agency? ® Yes 0 No Are there any easements or right of ways on this property? Describe Existing water supply in use Individual WcllEJ Community Well Semi -Public Well ❑ County/City/Township Waler Line Is a public water supply available? ** ❑ Yes 0 No 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 11 Alternative Conventional 0 Innovative 1771 Other )(Any AT,A. THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type FIN]Primary Residence ❑® New Residence ❑ Addition to Residence # of New Bedrooms *t 6/1G��5�t Project Description Single Family Home 3 bedrooms with possibility of 6 down the road,(basement and Bonus room) Structure Dimensions 110x80 # of Occupants 4 'j,kA 't SE C 5' Led Basement Q Yes ❑ No Basement Fixtures Kyes ® No i �jltd Accessory Structure(s) Describe Barn - down the road I;Sf60S I # of New Bedrooms *f if applicable Structure Dimensions 60x100 # of Occupants Accessory Dwelling ❑ Yes 0 No Plumbing ❑ Yes [lM No Describe Plumbing Needed None ❑ Multi -Family Residence # Units #Bedrooms per Unit* i Total # Bedrooms *T Structure Dimensions ❑.Food.,Service ._ Specify ..pecif_TYP..,._e.,..._........,_.,..._...,..........,....,,......o..,_.,....�._, .........._.....,.,..,. # 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 Q Individual Well ❑ Semi -Public Well ❑ Community Well Abandonment Type Drilled El 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. j 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 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 property lines and corners and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent % % Date 7� A% t/ / ” Printed Name of Owner or Agent RA I cw c Parcel Report Parcel Report- Catawba County NC Parcel Information: Parcel ID: 369901299066 Parcel Address: 6334 LONG ISLAND RD City: CATAWBA, 28609 LRK(REID): 20062 Deed Book/Page: 3281/1161 Subdivision: Lots/Block: / Last Sale: $100,000 on 2015-03-19 Plat Book/Page: Legal: Calculated Acreage: 13.520 Tax Map: 019 Y 02035 Township: CATAWBA State Road #: 1833 Tax/Value Information: Tax Rates(pdf) City Tax District: All in County County Fire District: BANDYS Building(s) Value: $0 Land Value: $71,300 Assessed Total Value: $71,300 Year Built/Remodeled: / Current Tax Bill Miscellaneous: Building Permits for this parcel. Building Details Watershed: WS -IV Protected Area Voter Precinct: P21 Parcel Report Data Descriptions List all Owners Deed History Report Owner Information: Owner: FERTIG ROBERT F JR Owner2: FERTIG ERIN Address: 9077 BURROUGHS CT Address2: City: SHERRILLS FORD State/Zip: NC 28673-6502 School Information: School District: COUNTY Elementary School: CATAWBA Middle School: MILL CREEK High School: BANDYS School Map Zoning Information: Zoning District: COUNTY Zoningl: R-20 Zoning2: Zoning3: Zoning Overlay: WP -O Small Area: SHERRILLS FORD Split Zoning Districts: / Zoning Agency Phone Numbers Firm Panel Date: 2007-09-05 Firm Panel #: 3710368800J 2010 Census Block: 2013 2010 Census Tract: 011501 Agricultural District: Assessment Report Page 1 of 1 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. © 2015, Catawba County Government, North Carolina. All rights reserved. ' t ,y �IZ "Do http://gis.catawbacountync.gov/nomap/parcel_report.php?key=369901299066&typ=P 7/6/2015 Jli! Catawba County Environmental Health Parcel: 369901299066, 6334 LONG ISLAND RD 1 in=300ft CATAWBA, 28609 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 2014 Catawba County NC 07/06/2015 RD f�senhower & ihower & l R,tchie D. Esen T,,— Teresa 0 Eisenhower Teesa D Eisenhower \ 0 H 1851, Pg 814 DR 1851, Pg, 814 m O W //2" sol/d Iran Rod Found / L 0.5' tall ` Scoff T Hubbard & Tronslome —1 Drve —^ Scvtl T Hubbard & Ciovel Orr�.e Koren R. Hubbvrd DB 1841, Pg ]03 S23"40'55'�E 1563.97 Total / Karen R. Hubbard _ DB 1841, Py rw Gravel Drrve Tp _ 151557 _ 4340 I.P s. ��{'+ 0 � m W / I2 r Prvpo�sed .1 c GIS N �vled d� /In / 14.17 Acres Total Prooposetl H =e — 0.40 Acres in R/W of Long Island Rd. 13.77 Acres Outside of Long Island Rd.�q`,;ru�-1`�.�% cl _ �1/z' solid N2338'1 381 "W 422.54 _ 50517 =72 58"W 557.84 To 1/2" sand N04-00'58"Wtal Ps" Ps lion Rod FC Iran Rod I I ,� 258'g1 04uTO / 04vWI I 0� N43�14 1/2' spud —� Iron Rod Found „n, 485.15 / 0 4' Tall v I rJ33'27'22� M1 m Jvmes M R,dlehovver & h Str Gnvv \ ilv LDR 3121.RPlenH524 I �a S ved James M Ridlehavver & 'v Lauren M Rrdlehoover D 8 3121, Pg 524 I 'n