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HomeMy WebLinkAboutRBPR-07-2015-21896.TIFOwner THIS IS NOT A PERMIT Case # RBPR-07-2015-21896 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONNIENTAL SERVICES Residential Building Plan Review - Manufactured Home IMPROVEMENT - AUTH CONST - NEW WELL PHILLIP LEONARD, 2475 RIDGE E RD; SALISBURY NC 28144 NAME TO APPEAR ON PERMIT Phillip Leonard SITE ADDRESS: 9496 GOLDEN EAGLE RD, VALE NC 28168 NAME of SUBDIVISION: PROPERTY SIZE: Square Feet Acres DIRECTIONS: Hwy 18 South 20 miles from 140 on rt, end of road PRIMARY CONTACT: Owner GALLONS PER DAY: 360 DESCRIBE WORK: 28 x 54 Doublewide PIN # 265702598053 Lot # Section/Block SEWERTYPE: Septic Tank WATER SUPPLY: Private 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? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF, I singlewide - to be removed EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 14 x 70 NUMBER OF EXISTING BEDROOMS: # OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 28 x 54 # OF NEW BEDROOMS:: 3 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED ALTERNATIVE'. OTHER Other described: INNOVATIVE: CONVENTIONAL, ANY YES APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO 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 lapelin of all property lines and corners and making the site ace sl so that a corn lete site evaluation can be performed. Date: 7/ %/ / Signature ofApplicant or Agent ��_ An Environmental Health Specialist will contact you within 5 44orkine days of application date. If you need further CCi formation or assistance please call 828-466-7291 a♦as**<�:*��>+»....:s...<er.rs*s***+++.......d** r :*1.++1�G.+..:���r:r+s:+++*+....rsx:<::++�+..+e++�w:+::s E9-elmpphcatton 07/07/2015 1623 Page I of ,RA CATANVBA COUNTY Case 4 �z G\ Public Health Department Subdivision Fnvironmental Health Division PIN# PO Bos 389, 100-A Southwest Blvd, Newton. NC 28658 Ig 2 su NAME ON PERMIT: (PHILLIP LEONARD), 2475 RIDGE E RD, SALISBURY NC 28144 Site Address: Property Size: Directions: ( Phillip Leonard) 9496 GOLDEN EAGLE RD, VALE NC 28168 Square Peet Acres Hwy 18 South 20 miles from 140 on rt, end of road FEENAME Authorization to Construct Fee (New/Expansion) Fee Improvement Permit Fee Well Permit & Inspection Fee TOTALFEES RBPR-07-2015-21896 265702598053 DATE FEE AMOUNT 07/07/2015 $150.00 07/07/2015 $150.00 07/07/2015 $300.00 $600.00 FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9 - ehapplicanon 07/07/2015 16 23 Page 2 of 4 Parcel Report Parcel Report- Catawba County NC Parcel Information: Owner Information: Parcel ID: 265702598053 Owner: LEONARD PHILLIP OSKER Parcel Address: 9496 GOLDEN EAGLE RD Owner2: City: VALE, 28168 Address: 2475 E RIDGE RD LRK(REID):9699 Address2: Deed Book/Page: 2789/1224 City: SALISBURY Subdivision: State/Zip: NC 28144-1277 Lots/Block: / School Information: Last Sale: $10,000 on 2006-10-24 District: COUNTY Plat Book/Page:School Elementary School: BANOAK Legal: 9496 GOLDEN EAGLE RD Middle School: JACOBS FORK Calculated Acreage: 1.640 Ace10 High School: FRED T FOARD Tax Map: B 03003 School Map Township: BANDYS State Road #: 18 Tax[Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: COOKSVILLE Zoningl: R-40 Building(s) Value: $0 Zoningl: Land Value: $11,000 Zoning3: Assessed Total Value: $11,000 Zoning Overlay: WP -O Year Built/Remodeled: / Small Area: PLATEAU Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2008-02-20 Building Permits for this parcel. Firm Panel #: 3710264600L Building Details 2010 Census Block: 1018 WaterShed: WS -III Protected Area 2010 Census Tract: 011802 Voter Precinct: P2 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report Page I of I 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 anses 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. 3bO's ro r,(�Pr�l �3a0 http:Hgis.catawbacount),ne.gov/nomap/parcel_report.php?key=265702598053&typ=P 7/7/2015 a THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT °: :•r,��;,,, Application for Environmental Services Page 1 i Improvement Permit Authorization to Const�ct ❑' Septic Repair El Septic Malfunction ❑ Septic Expansion ❑ New Well Permit M'Replaccment Well ❑ Well Abandonment ❑ Well Repair ❑ ' Existing System Inspection (Pre -Approval Required) ❑ Application is for New Construction ❑ Existing Facility ❑ Property Address C'�i�l /, %<<� , f :1.-. << Subdivision Lot # Acres :) Section/Block/Phase Driving Directions to Property 9,_t/1Y NAME TO APPEAR ON PERMIT? ©`Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name H.�:(1,� t.t.,.t Address 'Phoi7q�4' __76Z -f b6 Cell Phone „ 1 yS iS4 Owner Contact Information Name Address Phone Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? EJ -Owner ❑ Applicant ❑ Contractor 'Desciiption of Existing'Structures on Site iln t PIMIUe(t # of Bedrooms *j Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures Yes ® No The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the propertyin question. If the answer to any question is "yes", applicant must attach supporting documentation. ® Yes 15' o Does the site contain any jurisdictional wetlands? )'Yes ®-Ko— Does the site contain any existing wastewater systems? lJ Yes 04o Is any wastewater going to be generated on the site other than domestic sewage? ® Yes M—No Is the site subject to approval by any other public agency? ® Yes U -No Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well ❑ Community Well ❑ Semi -Public Well ❑ County/City/Township Water Line is a public water supply available? ** ❑ Yes MNo 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) ❑ Accepted 0 Alternative rConventional ❑ Innovative 0 Other YAny CATAJVJ JBA THIS IS NOT A PERMIT COUNTY -V-�? CATAWBA COUNTY HEALTHDEPARTMENT K„� o Application for Environmental Services Proposed Facility Type ❑ Primary Residence ❑ New Residencce� ❑ Addition to Residence # of New Bedrooms *j Project Description 5 . s) > 1 a l tAA nc- ,a”, / ulluQ.e Structure Dimensionsa� X � f 1 # of Occupants, a— Basement ❑ Yes �o Basement Fixtures ®Yes �)rNo ❑ Accessory Structure(s) Describe # of New Bedrooms *-1 if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed' ❑ Multi -Family Residence # Units #Bedrooms per Unit*j Total # Bedrooms * i Structure Dimensions Page 2 3 ❑ 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 "Rbtail 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 0 Individual Well ❑ Setni-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ' ❑ Unknown Well Repair Requested ❑ Yes ❑ No Describe Calculated Design Flow, Commercial f Additional information may be required to determine design flow from certain facilities. , This value will be determinedmmduring 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 NVILL INCUR AN AD DITIONAL,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 do determine compliance,with'applicable laws and rules. 1 understand that I atn 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 l� r�� / Date Printed Name of Owner or Agent Catawba County Environmental Health EAGLE RD r N Parcel: 265702598053, 9496 GOLDEN EAGLE RD VALE, 28168 1 in=80ft 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 07/07/2015 Parcel Report Parcel Report- Catawba County IVC Parcel Information: Owner Information: Parcel ID: 265702598053 Owner: LEONARD PHILLIP OSKER Parcel Address: 9496 GOLDEN EAGLE RD Owner2: City: VALE, 28168 Address: 2475 E RIDGE RD LRK(REID): 9699 Address2: Deed Book/Page: 2789/1224 City: SALISBURY Subdivision: State/Zip: NC 28144-1277 Lots/Block: / Zoning3: Assessed Total Value: $11,000 School Information: Last Sale: $10,000 on 2006-10-24 Small Area: PLATEAU Current Tax Bill School District: COUNTY Plat Book/Page: Zoning Agency Phone Numbers Legal: 9496 GOLDEN EAGLE RD Elementary School: BANOAK Middle School: JACOBS FORK C Calculated Acreage: 1.640 High School: FRED T FOARD Tax Map: 010 B 03003 School Map Township: BANDYS State Road #: 18 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: COOKSVILLE Zoning1: R-40 Building(s) Value: $0 Zoning2: Land Value: $11,000 Zoning3: Assessed Total Value: $11,000 Zoning Overlay: WP -O Year Built/Remodeled: / Small Area: PLATEAU Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2008-02-20 Building Permits for this parcel. Firm Panel #: 3710264600L Building Details 2010 Census Block: 1018 WaterShed: WS -III Protected Area 2010 Census Tract: 011802 Voter Precinct: P2 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report 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. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=265702598053&typ=P 7/21/2015