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Home My WebLink About RBPR-07-2015-21959.TIFContractor THIS IS NOT A PERMIT Case # RBPR-07-2015-21959 ., CATAWBA COUNTY HEALTH DEPARTMENT 0= . Y •J0 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES % ti Residential Building Plan Review - Building New • •ti IMPROVEMENT - AUTH CONST - NEW WELL F1 *MADISON HOME BUILDERS, LLC (W KELVIN ANDERSON), 1721 E BOULEVARD, CHARLOJ 28203 13:7043349339 C:8284648870F:7043740686 SUE@MADISONHOMEBUILDERS.NET Owner DANNY SCHULLER, 140 BUFFALO SHOALS RD, CATAWBA NC 28609 H:703-728-2982 C:980-229-5479 HOME: 703-728-2982 Paid By LISA SCHULLER, , H:7037282982 HOME:7037282982 NAME TO APPEAR ON PERMIT Danny Schuller SITE ADDRESS: 6626 ADAM WRIGHT CIR, CATAWBA NC 28609 PIN # 369902693308 NAME of SUBDIVISION: OAK LEVEL Lot # 18 Section/Block B PROPERTY SIZE: Square Feet Acres 5.62 DIRECTIONS: 16S left Balls Creek Rd/ right W Bandys Crossroads/ right Sherrills Ford Rd/ Left Long Island Rd/ right on Adam Wright Cir/ property on end on left PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: WATER SUPPLY: Private Well DESCRIBE WORK: 1 story dwelling w/ attached garage (no basement) 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 Vacant Lot EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: # OF OCCUPANTS: 4 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 62 x 47 # OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Yes Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO E9 - chapplication 07/16/2015 10:50 Page l of �$A CATAWBA COUNTY Case # RBPR-07-2015-21959 U� Public Health Department Subdivision OAK LEVEL '-1 Environmental Health Division PIN# 369902693308 PO Box 389, 100-A Southwest Blvd, Newton, NC 28658. NAME ON PERMIT: Site Address: 6626 ADAM WRIGHT CIR, CATAWBA NC 28609 Property Size: Square Feet Acres 5.62 P S Directions: 16S left Balls Creek Rd/ right W Bandys Crossroads/ right Sherrills Ford Rd/ Left Long Island Rd/ right on Adam Wright Cir/ property on end 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, 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 and stand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site acce le so that a comp) a ite e e^ §e per`ormed. Date: �I ! 6/ is Signature of Applicant or Agent l lAn Environmental Health Specialist will contact you within 5 king 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 07/16/2015 $150.00 07/16/2015 $150.00 07/16/2015 $300.00 $600.00 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 - chapplication 07/16/2015 10:47 Page 2 of 4 ,CIALTk A THIS IS NOT A PERMIT ;NTti � �.s-.. CA'TAWBA COUNTY HEALTH DEPARTMENT Application for Enviromnental Services Page 1 Improvement Permit V Authorization to Construct Septic Repair ❑ Septic Malfunction ❑ Septic Expansion *New Well PermitL2/Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction 2' Existing Facility ❑ Property Address (42(o Apgrr, WR1601 ('i9Zcc6 Subdivision C197q wl3 A /,J(- 2e609 Lot # Acres ±5-,6-9 D Section/Block/Phase Driving Directions to Property N C 14 S � 6C7 G^J b c(.Z Ozorr- R,00 )e7 ol--% W RANuYS CRoSsf R'l c N t(?jC7 orJ (-NG 1 S (/9N b Roof) kr oN A1,»r. WRiai47 Ci/Z , �AG?ER,rr A7 fth) aN CeF-1 NAME TO APPEAR ON PERMIT? Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name 1� Address 1 Phone I Cell Phone Owner Contact Information Name bigwjY 4 OKA SCI44(tf'J- Address /1161 Qul=F,9t6 S14vatS IZc,i91> f rg119vB A 9`IC Z96cq Phone '7o2 - %Z°' 7-55 Z I Cell Phone q9O- Z29- 5Y 79 Contractor Contact Information Name P )4 U /Sc" i4�,g4 t:� 9c.41 (,D S - )Z 7191`1 PR a C-7 7 Address '-,10 1 !G?/t S 7 u 176 F ` Jr, C-Fav 0R /\4 C Z,5 613 Phone P 2,0- (lb V _a09 76 I Cell Phone , - 7 y y-G q 68 WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant contractor Description of Existing Structures on Site # of Bedrooms *f Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures 0 Yes ® No The Applicant shall notify the local health department upon submittal of thisplication i .. _ of the following apply t a 1 ..:.._ a p f anyy g o the property in question. If the answer to any question is "yes", applicant must attach supporting documentation. ® Yes GKO Does the site contain any jurisdictional wetlands? • Yes �� Does the site contain any existing wastewater systems? •� Yes ;No Is any wastewater going to be generated on the site other than domestic sewage? E Yes 0 No Is the site subject to approval by any other public agency? ® Yes 03<o Are there any easements or right of ways on this property? Describe Existing water --s u., pply in use [✓ Individualy ❑ ...__y Well ❑ _ Well Community 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)c (systems can be ranked in order of your preference) 0 Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other 0 Any ,C '"A THIS IS NOT A PERMIT UJATA G121XTY CATAWBA COUNTY HEALTH DEPARTMENT Application for Enviromnental Services Page 2 Orimary osed Facility Type Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms * f Project Description IV 6 W X rate Structure Dimensions &Z- X Y7 # of OccupVNo It Basement ❑ Yes [��o Basement Fixtures 0 Yes ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi -Family Residence # 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.) ❑ pT e o . Type f Busi Business Secific ness 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 ❑ Semi -Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ No Describe Calculated Design Flow, Commercial j 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. 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 an 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 -16 -1,S - Printed '( 6-1,Printed Name of Owner or Agent Catawba County Environmental Health Parcel: 369902693308, 6626 ADAM WRIGHT 1 in=50ft CIR 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 07/16/2015 Catawba County Environmental Health " �i "I, Parcel: 369902693308, 6626 ADAM WRIGHT 1 in=200ft C I R CATAW BA, 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 07/16/2015 Parcel Report Parcel Report- Catawba County NC Parcel Information: Owner Information: Parcel ID: 369902693308 Owner: SCHULLER DANNY Parcel Address: 6626 ADAM WRIGHT CIR Owner2: City: CATAWBA, 28609 LRK(REID): 18246 Deed Book/Page: 3046/1389 Subdivision: OAK LEVEL Lots/Block: 18/ B Last Sale: $39,900 on 2007-11-08 Plat Book/Page: 13/4 Legal: 18B PL13-4 OAK LEVEL Calculated Acreage: 5.620 Tax Map: 01 7A 02008 Township: CATAWBA State Road #: 2656 Tax/Value Information: Tax Rates(pdf) City Tax District: All in County County Fire District: BANDYS Building(s) Value: $0 Land Value: $35,600 Assessed Total Value: $35,600 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 Address: 1401 BUFFALO SHOALS RD Address2: City: CATAWBA State/Zip: NC 28609-8024 School Information: School District: COUNTY Elementary School: CATAWBA Middle School: MILL CREEK High School: BANDYS School Map Zoning Information: Zoning District: COUNTY Zoningl: R-40 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: 1025 2010 Census Tract: 011503 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. (D 2015, Catawba County Government, North Carolina. All rights reserved. —J�PA' 6 �/Ocj 3 6k S4030 $3Da NOWO)N f300 http://gis.catawbacountync.gov/nomap/parcel_report.php?key=369902693308&typ=P 7/16/2015