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HomeMy WebLinkAboutRBPR-07-2015-21952.TIFContractor Owner Paid By THIS IS NOT A PERMIT Case # RBPR-07-2015-21952 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Manufactured Home IMPROVEMENT OAKWOOD HOMES 4712 (ELIOBERTO ALFONSO). 1265 70 HWY W, NEWTON NC 28658 6:(828)217-1862 C:(828)464-26621':828-464-4301 JEFF (WILLIAM) CARSON, 1635 19TH ST SW, HICKORY NC 28602 C:828 -2j8-5118 HEFNER MASONRY (KIMBERLY HEFNER), 5116 MT OLIVE CHURCH RD, MORGANTON NC 2 NAME TO APPEAR ON PERMIT Jeff (William) Carson SITE ADDRESS: 1635 19TH ST SW. HICKORY NC 28602 PIN # 279219615870 NAME of SUBDIVISION: KNOLLWOOD Lot 4 Section/Block PROPERTY SIZE: Square Feet Acres 4.44 DIRECTIONS: Go 70 W towards 21st Dr SE Left onto 19th ST SW Lot on Left PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY : Public Water DESCRIBE WORK: Replace singlewide 16x72 with 4x4 and 6x6 decks 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: STRUCTURE TYPE: FACILITY TYPE: Mobile Home DESCRIPTION OF EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: New Structure PRIMARY RESIDENCE OTHER DESCRIPTION: # OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 16x72 w/ 4x4 deck and 6x6 deck # OF NEW BEDROOMS:: 2 Desired system types (Improvement Permit or Authorization to Construct) ACCEPTED: ALTERNATIVE: OTHER INNOVATIVE Other described: CONVENTIONAL: ANY: E9-ehapplicauon 07/15/2015 15:14 Page 1 of CATAWBA COUNTv Case 9 RBPR-07-2015-21952 ,y Public Health Department Subdivision KNOLLWOOD Environmental I lealth Division PIN# 279219615870 V PO Box 389, 100-A Southwest Blvd, Nekton. NC 28658 t 2 NAME ON PERMIT: ( JEFF (WILLIAM) CARSON), 1635 19TFI ST SW, HICKORY NC 28602 ( Jeff (William) Carson) Site Address: 1635 19TH ST SW. HICKORY NC 28602 Property Size: Square Feet Acres 4.44 Directions: Go 70 W towards 21 at Dr SE Left onto 19th ST SW Lot on Left 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, complete4andcort. Authorized county and state officials are granted right of entry to cond ct necessary inspections to determine compliance with applicable lawI understand that I am solely responsible for the proper identificati I be ng of all property lines and corners and making the site accest a co to site evaluation can be performed Date: Signature of Applicant or Agent An Environmental Health Specialist will contact you withing days of application date. If you need further information or assistance please call 828-466-7291 AREA2 FEENAME Improvement Permit Fee TOTAL FEES DATE FEE AMOUNT 07/15/2015 5150.00 S150.00 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) E9 - chapphcauon 07/15/2015 15:14 Page 2 of 4 `7�� �,�j� THIS IS NOT A PERT � 6Q Cil ` asks - cf� M�+�, MI CATAWBA COUNTY HEALTH DEPARTMENT Application for Enviromnental Services Page I Improvement Permit Authorization to Construct ElSeptic Repair ElSeptic Malfunction El Septic Expansion ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre -Approval Required) ❑ 1 Applicati n is for New Construction [:]Existing Facility Elr Property Address u-21 Y ��f5k-<S-� Subdivision Lot # Acres _� Section/Bl ck/Phase Driving DrectionstoProperty 1 �l� ��W W\1C€� �1`�- ar �� ��Y1 C) 1 �l SW � b� - - NAME TO APPEAR ON PERMIT?Owner F-1Applicant❑ Contractor Applicant Contact Information ' ` Name �,�1\tGrn (Na'Nn Address Phone (-r 4 -112 fv� Cell Phone Owner Contact Information Name Address Phone Cell Phone Contractor Contact Infor tion Name C`a\-LjD�Q Addresstp4,y -1 d W Phone 9 LC - 44-4 I I Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site i2uned moixt home _IS tVmmCd # of Bedrooms *j' 0 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 property question. If the answer to any question is "yes", applicant must attach supporting documentation. ® Yeso Does the site contain any jurisdictional wetlands? es ' 1 -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? es No Is the site subject to approval by any other public agency? 0 Yes �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 ❑ 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 ❑ Alternative 0 Conventional ❑ Innovative 0 Other 0 Any `AT r xmA THIS IS NOT A PERMIT iausri CATAWBA COUNTY HEALTH DEPARTMENT '-,�,,•_,,,o� Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *t tqle Project Description fes `� l p� --�Qckt Structure Dimensions Occupants r% Basement ❑ Yes o Basement Fixtures ® Yes o ❑ Accessory Structure(s) bescribe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi -Family Residence It Units #Bedrooms per Unit*t 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/Abandonme'nt/Rep air Proposed Well Type ❑ Individual Well ❑ Semi -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 lia ldung permit issuance. This may prevent [be need for septic system size increase in the future. T 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 comers and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent 4kA4 Date I Printed Name of Owner or Agent C� NVA �1� Catawba County Environmental Health Parcel: 279219615870, 1635 19TH ST SW lin=100ft HICKORY, 28602 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 shaft not be held liable tar 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 07/15/2015 Parcel Report Parcel Report- Catawba County NC Parcel Information: Parcel ID: 279219615870 Parcel Address: 1635 19TH ST SW City: HICKORY, 28602 LRK(REID): 48589 Deed Book/Page: 1403/0017 Subdivision: KNOLLWOOD Lots/Block: 4/ Last Sale: $15,648 on 1985-06-01 Plat Book/Page: 17/14 Legal: LOT 4 PL 25-67 PL 17-14 Calculated Acreage: 4.440 Tax Map: 134H 02023F Township: HICKORY State Road #: 1197 TaxNalue Information: Tax Rates(pdf) City Tax District: All in County County Fire District: LONG VIEW RURAL Building(s) Value: $500 Land Value: $38,200 Assessed Total Value: $38,700 Year Built/Remodeled: / Current Tax Bill Miscellaneous: Building Permits for this parcel. Building Details WaterShed: Voter Precinct: P19 Parcel Report Data Descriptions List all Owners Deed History Report Owner Information: Owner: CARSON JEFF (WILLIAM) Owner2: Address: 1635 19TH ST SW Address2: City: HICKORY State/Zip: NC 28602-4847 School Information: School District: HICKORY Elementary School: SOUTHWEST Middle School: GRANDVIEW High School: HICKORY School Map Zoning Information: Zoning District: HICKORY Zoningl: R-1 Zoning2: Zoning3: Zoning Overlay: Small Area: Split Zoning Districts: / Zoning Agency Phone Numbers Firm Panel Date: 2007-09-05 Firm Panel #: 3710279200J 2010 Census Block: 1113 2010 Census Tract: 011101 Agricultural District: Assessment Report Page 1 of 1 This map/report product was prepared from the Catawba County, NC Geospabal 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. DA 11° T r �c►t �fbacur l �� LA nt� a� ��`` ct`�Fr�` �� �C a r3 y p 5Pd http://gis.catawbacountync.gov/nomap/parcel_report.php?key=279219615870&typ=P 7/15/2015 C CATAWBA COUNTY HEALTH DEPARTMENT PERMIT # 03363 COMPLETION PERMIT OWNER OR CONTRACTOR: (��s'o'-, DATE: 6/go/�� ADDRESS: �T� �� � (� �1- ,�p �-�S PHONE: 3?,d 22S/ LOCATION: / © V17C .k/ Ah 1� ii d 1--40k A4 As 5- y Fe d Ai. -S scb, —,PC -f,5- s5'�...,(i /� Azw/ rA,,-.-, /W7 - /rv4" lC /�4-7 14' I SUBDIVISION: LOT,: SECTION OR BLOCK: LOT SIZE: House ( ) Mobile Home ( L/S Business ( ) Other ( ) Flow Rate: gpd Bedrooms: 3 Bathrooms: �� Special Fixtures: /)j/)*? -F Other: Basement - Yes ( ) No (t4 Fixture in basement -Yes ( ) No (!� ----------------------------------------------------------------------------- ---- Garbage Disposal Unit: Yes () No Water Supply: Private ( ) Public (1�� TANK SIZE:d GO gallons Distance from septic tank or nearest source of NITRIFICATION FIELD: pollution: Number of lines: 3 FINAL APPROVAL OF THIS SEPTIC TANK SYSTEM SHALL IN Length and width of lines NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL (a) Bed System FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF (b) Trench System 36" x 70*' TIME. or Trench Sys. 30" x DATE INSTALLED: 61 3 el eF Total Sq, Ft. Depth of Stone" INSTALLED BY:a, REMARKS: SANITARIAN: A.S bllko SITE AND SEPTIC TANK AYOUT 11 - M <Q Po ' 1990 j 4.1-d1e.d 1 11 0. P3, - tY A4 'moi _5, -� HEALTH F�EPARTMENT COPY O.J., 1t1,Rr A14 02492 PERMIT FEE b r /�� /� ER14I NO. — . � � % G���-��L�•f' ?'_ER`'IiT_ VOID AFTER 36 MOiJTHS: CATAWBA COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT c CQ VS5 V--%7 DATE: S//3/ F f OWNER OR CONTRACTOR: - — ADDRESS:%2�• � 3C7� 7� �G�-� ,�e��- S PHONE: ?C- LO CATION : f 7 L y 41-7 7b,t-,V �fPHT Q d R rt -1-0 f 0 r-Vc/ G-� s U;11 A a, c� i p Vss n, �; - 1 p-�''�- -� 5 �► e �; W o PW s 4 a �*� � ass fj'- I r art' `v.ac�^ d`r'r"F d24K � r'�'i='{ �--c"i'- i�� - �hv Wr- arr•c�; t`fp�..eS a+t �; y ry-ak-e SUBDIVISION: LOT ,,��,,����---- SECTION OR BLOCK: LOT SIZE: Notified to check with Zonin Yes (` No ( ) Zoning Approval # %�hcktl-1 House ( ) Mobile Home ( Business ( ) Other ( ) Flow Rate:13 (j V gpd Fixtures: �%�'�.Q Other - Bedrooms:,3 Bathrooms• Special 41 r Gump System Yes( ) No V Basement - Yes ( ) No Fixtures in Basement - Yes ( ) No -------------------- -------------------------------------------------------------�------- Garbage Disposal Un* Yes ( ) No ( Water Supply: Private ( ) Public TANK SIZE:BQ lJ gallons Comments/Special Instructions: NITRIFICATION IELD: Number of Lines Length and width of Lines System must be installed as shown. Any (a) Bed System changes will be made only with prior Health (b) Trench System _36" X !'l>' � 5 IL � Department approval. If unforeseen problems or Trench System 30" X arise during installation, contractor must . Total Sauare Footage �©0 —22P-I.—Of 2-tggg_% call Health Department. ------------------ VIPON'S� PER I CE TIFY T HAVE REVIEWED AND AGREE TO".nariaV V d Owner/Agent Final approval of this septic tank system shall in no way be taken as a guarantee that the system will function satisfactorily for any given period of time. Mi4X -}►-etc h c�e� �$ -- �1 R LINE Site Factor: Slope and Landscape Position Soil Drainage Soil Depth Restrictive Horizon Available Space Other (Specify) Soil Characteristics: Repair,Area Required: Yes SITE AND SEPTIC TANK PLAN Health Department 5oll S- - U S - P - U S - S = U S - - U S - - U S - PS - U S -�- No �DS� copy 1 Group Soil Texture Class Applie.ation Rate Sandy Clay III Fine Silt Loam 0.6-0.4 Loams_ay Loam? Silty Clay Sandy Clay IVa Clays Silty Clay. 0.4-0.2 Clay J*Bed systems are allowed only in soil Groto III-