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HomeMy WebLinkAboutRBPR-07-2015-22015.TIFTHIS IS NOT A PERMIT Case # RBPR-07-2015-22015 CATAWBA COUNTY HEALTH DEPARTMENT • AFEI PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Building New • .� AUTH CONST -NEW WELL h Owner TRACY HARVEY, 6593 ASHFORD NELLIS RD, ASHFORD WV 25009 NAME TO APPEAR ON PERMIT David Jarrell ;T 0 SITE ADDRESS: 4045 HOB LN, TERRELL NC 28682 / 461713124930 NAME of SUBDIVISION: �� Lot # 1 Section/Block PROPERTY SIZE: Square Feet Acres 083 DIRECTIONS: Hwy 150, right on Sherrills Ford Rd lob Ln, 1/2 mile on right PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: 40 x 28 Single family dwelling with 3 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 EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: # OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 40 x 28 # 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: Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO V9 - ehapplication 07/30/2015 13:23 Page 1 of 5 CATAWBA COUNTY Case # Public Health Department .n. Subdivision Environmental Health Division PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 PIN# Ig 2 SM NAME ON PERMIT: ( DAVID JARRELL), 528 ACORN DR, RACINE WI 25165 ( David Jarrell) NAME ON PERMIT: ( TRACY HARVEY), 6593 ASHFORD NELLIS RD, ASHFORD WV 25009 ( Tracy Harvey) Site Address: 4045 HOB LN, TERRELL NC 28682 Property Size: Square Feet Acres 1.083 Directions: Hwy 150, right on Sherrills Ford Rd/Right on Hob Ln, 1/2 mile on right 461713124930 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. 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 ********************************************************************************************************************** y,^FEEIYM 'AE: __... _._,-.w ... , :..,; DATE-: FEE XMOUNT.:� Authorization to Construct Fee (New/Expansion) 07/24/2015 $150.00 Fee Well Permit & Inspection Fee 07/24/2015 $300.00 TOTL AFEES„ i - c$450.00, 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) F,J - ehapplication 07/30/2015 13:23 Page 2 of 5 SBA r 2 1842 sM THIS IS NOT A PERMIT Case # RBPR-07-2015-22015 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Building New AUTH CONST -NEW WELL 0 F� Owner TRACY HARVEY. 6593 ASHFORD NELLIS RD, ASHFORD WV 25009 NAME TO APPEAR ON PERMIT David Jarrell SITE ADDRESS: 4045 HOB LN. TERRELL NC 28682 PIN # 461713124930 NAME of SUBDIVISION: Lot # Section/Block PROPER'1'YSIZE: Square Feet Acres 3.3 DIRECTIONS: Hwy 150, right on Sherrills Ford Rd/Right on Hob Ln, 1/2 mile on right PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: 40 x 28 Single family dwelling with 3 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: STRUCTURE TYPE: FACILITY TYPE: Single Family Residence 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:: 40 x 28 # OF NEW BEDROOMS:: 3 BASEMENT? Yes BASEMENT FIXTURES? Yes Desired system types (Improvement Permit or Authorization to Construct). ACCEPTED. ALTERNATIVE OTHER INNOVATIVE: Other described: PLUMBING REQUIRED? Yes CONVENTIONAL: ANY: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO F9 - ehapphkaumi 117/24/2015 13 50 Page 1 of 5 ` p,A CATAIVBA COUNTV Case 4 `�,11 Public Health Department Subdivision �G 0 J Environmental Health Division OO //"// PO Bos 389, 100-A Southmest RN6S Nev ton. NC 28658 PIN# l VV 4 i/SM NAME ON PERMIT: ( DAVID JARRELL), 528 ACORN DR, RACINE W125165 ( David Jarrell) NAME ON PERMIT: ( TRACY HARVEY), 6593 ASHFORD NELLIS RD, ASHFORD WV 25009 ( Tracy Harvey) Site Address: 4045 HOB LN, TERRELL NC 28682 Property Size: Square Feet Acres 3.3 Directions: Hwy 150, right on Shernlls Ford Rd/Right on Hob Ln, 1/2 mile on right RBPR-07-2015-22015 461713124930 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 understan that Iam iolelyn u for the proper identification and labeling of all property lines and corners and making the site access�[, e so th a com ate sit evaluation performed Date: 7 —n�zl- /,5— Signature of Applicant or Agent Lt�� 2i7ni An Environmental Health Specialist will contact you within 5 working days pplication date. If you need further information or assistance please call 828-466-7291 AREA1 FEENAME Authorization to Construct Fee (New/Expansion) Fee Well Permit & Inspection Fee TOTAL FEES DATE FEEAMOUNT 07/24/2015 5150.00 07/24/2015 $300.00 $450.00 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 - chappl[canon 117/24/2015 13 50 Page 2 of 5 ,`�^v THIS IS NOT A PERMIT .A "T,L%TJ C01;N,TV __ - CATAWBA COUNTY HEALTH DEPARTMENT Application for Enviromnental Services Page 1 Improvement Permit ❑ Authorization to Construct Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit,56eplacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre -Approval Required) ❑ Application is for New Construction X Existing Facility ❑ Property Address 416 -V -LT 14101? Z n� Subdivision Lot # 1 Acres S ion/Block/P Driving Directions to Property 1 �C C)C&: rn lb ( , � 0 i \5 !- NAME TO APPEAR ON PERMIT? M Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name Address Phone Owner Contact Information Name Address s �iea� ✓� t�,rU L. •� e Phone 3d L/ g3i- y�YB Contractor Contact Information Name Address Phone Cell Phone Cell Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site # of Bedrooms *t Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures 0 Yes 0 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 �No Does the site contain any jurisdictional wetlands? • Yes ,�No Does the site contain any existing wastewater systems? 13 Yes ,3(No Is any wastewater going to be generated on the site other than domestic sewage? 0 Yes /011 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 bA 4 Z Existing water supply in use Individual Well ❑ Community Well ❑ Semi -Public Well ❑ County/City/Township Water Line Is a public water supply available? a * ❑ 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 0 Alternative 0 Conventional 0 Innovative 0 Other 0 Any THIS IS NOT A PERMIT rT,_ -- CATAWBA COUNTY HEALTH DEPARTMENT hn-nmno Application for Environmental Services Page 2 Proposed Facility Type Primary Residence �ANw�Residence ❑ Addition to Residence # of New Bedrooms *tProject Descriptio Structure Dimensions# of ccupants .2 iw Basement A] Yes ❑ No Basement Fixtures _ Yes No ❑ 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.) ❑ 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 A plication for ..... p � 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 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. 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•liries and corners and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent _ /O���a Date Printed Name of Owner or Agent Parcel Report Parcel Report- Catawba County IVC Parcel Information: Owner Information: Parcel ID: 461713124930 Owner: GERALD BRYAN Parcel Address: 4045 HOB LN City: TERRELL, 28682 LRK(REID): 13927 Deed Book/Page: 3278/0860 Subdivision: Lots/Block: / Last Sale: $10,000 on 2015-02-23 Plat Book/Page: Legal: Calculated Acreage-3-!�6H Tax Map: 013 X 02005F Township: MOUNTAIN CREEK State Road #: 1906 Tax/Value Information: Tax Rates(pdf) City Tax District: All in County County Fire District: SHERRILLS FORD Building(s) Value: $0 Land Value: $33,200 Assessed Total Value: $33,200 Year Built/Remodeled: / Current Tax Bill Miscellaneous: Building Permits for this parcel. Building Details Watershed: WS -IV Critical Area Voter Precinct: P41 Parcel Report Data Descriptions List all Owners Deed History Report Owner2: HARVEY TRACY LEE Address: 4100 CASCADE ST Address2: City: TERRELL State/Zip: NC 28682-9711 School Information: School District: COUNTY Elementary School: SHERRILLS FORD Middle School: MILL CREEK High School: BANDYS School Map Zoning Information: Zoning District: COUNTY Zoningl: R-30 Zoning2: Zoning3: Zoning Overlay: CRC-O,WP-O Small Area: SHERRILLS FORD Split Zoning Districts: / Zoning Agency Phone Numbers Firm Panel Date: 2008-03-18 Firm Panel #: 3710461700K 2010 Census Block: 5030 2010 Census Tract: 011504 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 11rights reserved. we o UA 4 ISO UOXA http://gis.catawbacountync.gov/nomap/parcel_report.php?key=461713124930&typ=P 7/24/2015 G au, a�Q CATANVBA COUNTY Public Health Department Environmental Health Division PO Box 389, 100A Southwest Blvd, Newton NC 28658 j 42 yh (828),165-8270 Fax (828),105-8276 TDD (828} 165-x200 SITE PLAN "Do not grade, drive, or fill over any septic area. Scale I � u Permit li Name Address Lot# a f � c 28 rlr� f[ o I r[ Z ] ' i" ,� od v d 4, � L h IMPV-6-2015-062253 David 3arrell 4045 Hob Ln, Terrell I Catawba County Environmental Health Parcel: 461 71 31 24930, 4045 HOB LN TERRELL, 28682 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 07/24/2015 CATAWBA COUNTY Public Health Depat7me11t Environmental Health Division PO Box 389, 100-A Southwest Blvd. Newton, NC 28658 84? w 0 0 Ai 10 Case 4 IMPV-06-2015-062253 Subdivision PINfi 461713124930 LOT# 1 NAME ON PERMIT: DAVID JARRELL, 528 ACORN DR, RACINE WI 25165 Site Address: 4045 HOB LN, TERRELL NC 28682 Property Size: Square Feet 47,175.48 Acres 1.083 Directions: Hwv 150 right on Sherrills Ford Rd, right on Nob Ln., 112 mile on right Improvement Permit Facility: Primary Residence - House Permit Category: New Septic Bedrooms 3 WATER SUPPLY: Private Well Basement? Yes Basement Plumbing? Yes INITIAL SYSTEM SPECIFICATIONS Permit Valid: Expires In Five Years: —X_ No Expiration: Projected Daily Flow 360 g.p.d Proposed Wastewater System: 25% REDUCTION Type: HIG - OTHER NON -CONY TRENCH SYSTEMS PUMP *MAY BE* REQUIRED Permit Conditions: 'Do not grade, drive, or fill over any designated septic area. REPAIR SYSTEM SPECIFICATIONS Repair System Required? Required Proposed Wastewater System: 25% REDUCTION Type: IIIB - SYSTEM W/SINGLE EFFLUENT PUMP PUMP REQUIRED Landscaping or other site alterations that potentially divert groundwater or surface water toward the septic system, or prevent proper drainage away from the septic system, including the direction of gutter flows or foundation drains, is not aooroved, and may result in failure to aoorove the initial system installation. or the suspension/revocation of existing permits. The issuance of this permit by the Health Department docs trot guarantec the issuance ofother permits. II is the responsibility of the applicant/property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements arc met. This Improvement Permit is subject to revocation if the site plan, plat or the intended use changes, or if site conditions are altered. The Jtnprovement Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina 'Laws rand Rules forSewaee 7reninnew rind Disposal Srslerns' (15A NCAC 18A .I900). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for any given period of time. Robbie Pizelps 0613012015 AU'T'HORIZED STATEAGENT APPROVAL DATE Permit Expiration Date: 06129/2020 No grading or construction activity is allowed irr areos designated for sy-stem and repair ivithout approval of the Health Department. ebpennit 07/06/2015 14:10 Page I ot'3 11 DEPAXTUM40FENMOWENT AND NATUR.A1.Rr50M= Shed DraSZN OF MAUMMENTAL RZALT11 PROPERTY ID *- .oN-sm wAsTEwATERsEcnUN COUNTY: SOJUSM EVALUATION for ON-SnZ WASTEWATER SYS"!' f -12 11 AppUCAnON DATE 7,( 3 - 6 1.11 DATE EVALUATEM- _jZL--jZ PROPOSED FACMnY-, 64- PROPOSED DFSl(NFLAW (.IW): 44%0 PROPMaYSIZE LOCATION OF M- PROPERTY REMRDED-. WTEK SUPPLY: Ef M"a Q PLbtic R'We3 0 SpdnZ 0 Ochry EYALUMMUIMHOD.- 0 ADgmBaing ff Pit 0 Cut rrpp-oFwAmrwA,rm- Tse-wa= G indust,,Wpm= 0 lriixod DESCKDTtow NITLkL Sysnu REPAIR M,7EII OTHER FACTORS (.1946x SITE CLASSMCATTO.V (.1949); S5%t- TY*S) EVALUATED BY: OTHMS) PRFZENT. 'Ut LTAI 1-� 17, C- 4K DESCKDTtow NITLkL Sysnu REPAIR M,7EII OTHER FACTORS (.1946x SITE CLASSMCATTO.V (.1949); S5%t- TY*S) EVALUATED BY: OTHMS) PRFZENT. 'Ut LTAI 1-� STATE OF NORTH CAROLINA IS I A761". 11 111—Ol L OCA MAP CT 10 SCALE -------------- "3541"'ll IT IAI Is INI—S HI -11 eV E F.TIIN IF 1111—I AREA 2.162 ACRES LET #1 A - 1.111 ACRES llIFF F) RE TRGE— FILED 11121,1111 1239 IIIL ID 111-1111� 1. 2.2 11 CATAWBA COUNTY NC BOOK 00075 GWAT Ho..E DONNA HICKS SPENCER PAGE OD23 REGISTER OF DEEDS INST# 1205e AID1 11 If 111TH 110— GITE IIHAAY $Y -N. DAII '