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HomeMy WebLinkAboutRBPR-07-2015-22058.TIF�yA Q a 1842 sM Owner THIS IS NOT A PERMIT Case # RBPR-07-2015-22058 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Building New AUTH_CONST TERRANCE LANG. 183 23 RD ST NW, HICKORY NC 28601 C:828-308-0558 NAME TO APPEAR ON PERMIT Terrance Lang SITE ADDRESS: 9206 REEPSVILLE RD, VALE NC 28168 PIN # 360602685976 NAME of SUBDIVISION: Lot# 2 Secuon/I31ock PROPERTY SIZE: Square Feet Acres 831 DIRECTIONS: Hwy 10 West to Hlckory-Lincolnton Hwy/turn left/Go to Reepsville Rd/turn right/Go about 2 miles to Property on right PRIMARY CONTACT: Contractor SEWER TYPE: Public Sewer GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: 30 x 60 Metal building w/320 sq ft living space to include bedroom, kitchen & bathroom REf RBPR 04-2015-21268 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? Yes Property Easements Description: 45' ROW to Lot 1 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: 1 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 30 x 60 # OF NEW BEDROOMS:: 1 Desired system types (Improvement Permit or Authorization to Construct) ACCEPTED: ALTERNATIVE: CONVENTIONAL OTHER. INNOVATIVE ANY. YES Other described: E9 - chapphcanon 07/31/2015 14 42 Page I of gA CATAWBA COUNTI' case 4 RBPR-07-2015-22058 8 Z Public Health Department Subd 6 �� 14 Environmental Health Division PIN3Zivrsion 360602685976 PO Bos 389, 100-A Southwest Blvd. Newton. NC 23658 2g 2 w NAME ON PERMIT: (TERRANCE LANG), 183 23 RD ST NW, HICKORY NC 28601 ( Terrance Lang) Site Address: 9206 REEPSVILLE RD, VALE NC 28168 Property Size: Square Peet Acres 8.31 Directions: Hwy 10 West to Hickory-Lincolnton Hwy/turn left/Go to Reepsville Rd/turn right/Go about 2 miles to Property on right 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 accessi le so that a complete site valuation can be performed. '-7/-Z/Date: '�'7/ Signature of Applicant orAeent 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 AREA2 FEENAME Re -Trip or Redesign Fee 'TOTAL FEES DATE FEE AMOUNT 07/31/2015 $70.00 570.00 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 - chapplicanon 07/31/2015 14:42 Paac 2 of 4 k � � THIS IS,NOI' A PERMIT +,ukrti CATAIYBA COUNTY HEALTH DEPARTMENT Application for Enviromnental Services Page I Improvement Permit ❑_ Authorization to Construct [i'' Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre -Approval Required) ❑ Application is for New Construction Z Existing Facility ❑ Property Address gaotn RPa75y?r)l,o- 4Zrj Subdivision_4z_�,/_/ V, -to At t' i S1 tom-- Lot m Acres { y' Section/Block/Phase D//riving Directions to Property NAME TO APPEAR ON PERMIT? 2 -Owner +❑ Applicant ❑ Contractor Applicant Contact Information Nante—rr .nn, Address !8"� ,�Z71 �4- vtJ r#.4..�! ![! 2Y10! Phone CelIPhone if2 8 30rs c»s 8 f Owner Contact I nformation Name c �2M t. ;�s Apni,�an� Address 7 Phone ( Cell Phone Contractor Contact Information Name Address — - Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? Owner ("Applicant ❑ Contractor ._ ., ..._ 'e' .. - Description of Existing Structures on Site done A of Bedrooms f Structure Dimensions 9 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 many question is "yes", applicant must attach supporting documentation. 0 Yes OM1a Does the site contain any jurisdictional wetlands" 0 Yes &NO Does the site contain any existing wastewater systems? 10 Yes Flo Is any wastewater going to be generated on the site other than domestic sewage? n� 0 -yes r) No Is the site subject to approval by any other public agency? e -Yes Z3 No Are there any easements or right of ways on this property? Describe 9,&t Existing water supply in use ❑ Individual Well ❑ Community Wel]—Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? a`* ❑ Yes [s; o 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 a_gGy CATA",tli THIS IS NOT A PERMIT COUNT _ -=L� CATAWBA COUNTY HEALTH DEPARTMENT Application for Enviromuental Services Page 2 Proposed Facility Type ❑ Primary Residence a New Residence ❑ Addition to Residence # of New Bedrooms * j Project Description /-77,f,, / o, 14, ns t04� / yr �czf Structure Dimensions yt # of Occupants % Basement ❑ Yes []'No Basement Fixtures 0 Yes �o H Accessory Structure(s) Describe # of New Bedrooms *j' if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Dlulti-Family Residence # Units Total # Bedrooms * j ❑ Food Service Specify Type #Bedrooms per Unit*'l Structure Dimensions # 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 Application for Well Construction/Abandonment/Repair Proposed Well Type Abandonment Type Well Repair Requested [PI'lodividual Well ❑ Drilled ❑ Yes ❑ No If Daycare Specify Occupancy ❑ Semi -Public Well ❑ Community Well ❑ Bored ❑ Dug ❑ Unknown Describe Calculated Design Flow, Commercial f 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 an 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. SY STEM REDESIGN AND/OR RE TRIP NA'ILL 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 maybe 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 malting the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent jO N(/ . % Date -1-AJ // 5— o Printed Name of Owner or Agent Parcel Report Parcel Report- Catawba County NC Parcel Information: Parcel ID: 360602685976 Parcel Address: 9206 REEPSVILLE RD City: VALE, 28168 LRK(REID): 14867 Deed Book/Page: 3122/1806 Subdivision: Lots/Block: 2/ Last Sale: $40,000 on 2012-04-19 Plat Book/Page: 74/198 Legal: LOT 2 PL 74-198 Calculated Acreage: 8.310 Tax Map: 014 J 02010B Township: JACOBS FORK State Road #: 2024 Tax/Value Information: Tax Rates(pdf) City Tax District: All in County County Fire District: PROPST Building(s) Value: $0 Land Value: $39,000 Assessed Total Value: $39,000 Year Built/Remodeled: / Current Tax Bill Miscellaneous: Building Permits for this parcel. Building Details Watershed: Voter Precinct: P3 Parcel Report Data Descriptions List all Owners Deed History Report Owner Information: Owner. LANG TERRANCE G Owner2: Address: 183 23RD ST NW Address2: City: HICKORY State/Zip: NC 28601-5755 School Information: School District: COUNTY Elementary School: BLACKBURN Middle School: JACOBS FORK High School: FRED T FOARD School Map Zoning Information: Zoning District: COUNTY Zoningl: R-40 Zoning2: Zoning3: Zoning Overlay: DWMH-O,FPM-O Small Area: PLATEAU Split Zoning Districts: / Zoning Agency Phone Numbers Firm Panel Date: 2007-09-05 Firm Panel #: 3710360600J 2010 Census Block: 1053 2010 Census Tract: 011702 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 tntormatmn con\ained on iMs 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 arse from this map/report product or the use thereof by any person or entity © 2015, Catawba County Government, North Carolina. All rights reserved. 4i?p�zoo-z/zcob http://gis.catawbacountNme.gov/noniap/parcel_report.plip?key=360602685976&tN,p=P 7/31/2015 Catawba County Environmental Health Parcel: 360602685976, 9206 REEPSVILLE RD 1in=300ft VALE, 28168 This map/report product was prepared from the Catawba County, NC Geospahal 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 07/31/2015 �P Q�P�- oy-aol5- is Peelr h0� E*V'AeA , syr G 5,[56v\141�Gi�c��Dlj{ lob Mus{ be, Wo(d?A vriof b i55ogv\rG Ab rY4. 4 Ao� Ai'Ne, e, ac6, CUA, or f( (l 6uQ,V iC. 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