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HomeMy WebLinkAboutRBPR-03-2016-23330.TIF a$A °� THIS IS NOT A PERMIT Case # RBPR-03-2016-23330 rfla CATAWBA COUNTY HEALTH DEPARTMENT O 'a •?'' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES VI ti i /842 sM Residential Building Plan Review - Building Addition y'Da n+45,13 , 'oF IMPROVEMENT - AUTH CONST- EXPANSION Owner DARRELL FOSTER, 5173 BETHEL CHURCH RD, HICKORY NC 28602 C:828-850-3579 NAME TO APPEAR ON PERMIT Darrell Foster SITE ADDRESS: 5173 BETHEL CHURCH RD, HICKORY NC 28602 PIN # 279008894515 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet Acres 6.55 . DIRECTIONS: From Hwy 127 S/left on Zion Church Rd/right on Wallace Dairy Rd/to end/go straight across Bethel Church Rd PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: 28 x 58 bedroom, bath & garage addition 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: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF Single Family Dwelling EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 36 x 42 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 28 x 58 #OF NEW BEDROOMS:: 1 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: YES OTHER: INNOVATIVE: ANY: Other described: 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 under nd that I am solely responsible for the proper identificatigujand I beling of all property lines and corners and making the site ac • so t t a valuation can be performed. s Date: �� — ZOIt Signature of Applicant or Anent 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 E9-ehapplication - 03/07/2016 10:05 Page,'of4 y$w CATAWBA COUNTY Cie# RBPR-03-2016-23330 Public Health Department ;sfy�V2 Subdivision Environmental Health Division PIN# 279008894515 \s, PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 !8 2 N NAME ON PERMIT: (DARRELL FOSTER), 5173 BETHEL CHURCH RD, HICKORY NC 28602 ( Darrell Foster) Site Address: 5173 BETHEL CHURCH RD, HICKORY NC 28602 Property Size: Square Feet Acres 6.55 Directions: From Hwy 127 S/left on Zion Church Rd/right on Wallace Dairy Rd/to end/go straight across Bethel Church Rd FEENAME. DATE +. `FEE AMOUNT Authorization to Construct Fee (New/Expansion) 03/07/2016 5300.00 Fee Improvement Permit Fee 03/07/2016 $150.00 ;TOTAL FEES J.. 5450.00_ 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-ehapplication 03/07/2016 10:05 Page 2 of 4 CeTe\VAe THIS IS NOT A PERMIT COUNTY /w�Ll[ CATAWBA COUNTY HEALTH DEPARTMENT «,,,„<,,., Application for Environmental Services Page 1 Improvement Permit ❑ Authorization to Construct, Septic Repair❑ Septic Malfunction❑ Septic Expansion ,N1 New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection(Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility ❑ Property Address 5173 Bethel Church Rd Subdivision Hickory, NC 28602 Lot# Acres 6.88 Section/Block/Phase Driving Directions to Property From Hickory Hwy 127 South,Left on Zion Church Rd.,Right on Wallace Dairy Rd.,to end.Go straight across Bethel Church Rd. NAME TO APPEAR ON PERMIT? ❑ Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name Rick Foster Address 5173 Bethel Church Rd. Hickory NC 28602 Phone828-850-3579 Cell Phone Owner Contact Information Name Rick Foster Address 5173 Bethel Church Rd. Hickory NC 28602 Phone828-850-3579 Cell Phone Contractor Contact Information Name Max's Digging Service Address Phone 828-256-5349 Cell Phone WHO WILL BE THE PRIMARY CONTACT? E Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site Primary Residence #of Bedrooms *f 3 Structure Dimensions 36 X 42 #of Occupants 2 Basement ❑ Yes ❑ No Basement Fixtures CI Yes :O 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 0 No Does the site contain any jurisdictional wetlands? 1/ Yes ® No Does the site contain any existing wastewater systems? 0 Yes b. No Is any wastewater going to be generated on the site other than domestic sewage? it/es *No Is the site subject to approval by any other public agency? C Yes :o 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) ❑ Accepted ❑ Alternative ® Conventional ❑ Innovative ❑ Other El Any CATAWBA THIS IS NOT A PERMIT couN-rs CATAWBA COUNTY HEALTH DEPARTMENT „„„1,11111 Application for Environmental Services Page 2 Proposed Facility Type In Primary Residence ❑ New Residence ,Addition to Residence #of New Bedrooms *t t Project Description Adding Bedroom, Bath,and Garadge on ground level Structure Dimensions Approx 28'X 58 #of Occupants 2 Basement LI Yes 0 No Basement Fixtures ® Yes 0] 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 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 IJ No Describe Calculated Design Flow, Commercial t Additional information may be required to determine design Bow 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. it 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.Ari=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. Signature of Owner or Agent ritaDate 3 - 1` ZD/6. Printed Name of Owner or Agent egtic F*srE2 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 279008894515 Owner: FOSTER DARRELL RICK Parcel Address: 5173 BETHEL CHURCH RD Owner2: FOSTER TERESA W City: HICKORY, 28602 Address: 5173 BETHEL CHURCH RD LRK(REID): 59376 Address2: Deed Book/Page: 1456/0686 City: HICKORY Subdivision: State/Zip: NC 28602-8201 Lots/Block: / Last Sale: $86,000 on 1986-07-01 School Information: Plat Book/Page: School District: COUNTY Legal: PL 21-113 RD 1176 Elementary School: MOUNTAIN VIEW Calculated Acreage: 6.550 Middle School: JACOBS FORK Tax Map: 175H 03048B High School: FRED T FOARD Township: HICKORY School Map State Road #: 1176 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: MOUNTAIN VIEW Zoningl: R-20 Building(s) Value: $148,900 Zoning2: Land Value: $61,800 Zoning3: Assessed Total Value: $210,700 Zoning Overlay: WP-O Year Built/Remodeled: 1932/1969 Small Area: MOUNTAIN VIEW Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710279000J Building Details 2010 Census Block: 2000 WaterShed: WS-III Protected Area 2010 Census Tract: 011801 Voter Precinct: P24 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report 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 he 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. ©2016, Catawba County Government, North Carolina. All rights reserved. P�f{C s�'p�;C et-96 4c 14. s.pcj http://gis.catawbacountync.gov/nomap/parcel_report.php?key=279008 8945 1 5&typ=P 3/7/2016 Catawba County Environmental Health ,<S 7% 05158 oco 99 P .89 V di .‘9'9. 4271 J el., cy �Pv • Rb Si 111. //• 0 . • . / /iNc sC" ® 5 .5273 "'Y..> (-"1/441:44‘■ '' >NN, '. \lir s . \\\\ IS, N. iiis ,,, '1. „, '"--4-Nst\H ) • h QD Soo •oo it \ lip Parcel: 279008894515, 5173 BETHEL CHURCH 1in=100ft RD 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 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. Coovriaht 2014 Catawba County NC 0 C) C.; ° • , I - . , , 40017 9 i J Cl / 3 5 S 3 d ,9 D' 9 9 9 " 9 s I r I N 9 9 19 r N I ° • ° r____.7 ti ° • : , (� 0, / YJO ) / YY 1I ' O 1 I I ,I frJMOJ an • •0,r 1 '' VII VrYY9 0 1 140 aP�a1/ I i , • 1 (\date] \ \ V\\ •77.0 \ L r/Vr J ; /Ui1/45v '€ATAWBA COUNTY HEALTH DEPARTMENT Telephone: (704) 465-8270 TDD: (7 ) 465-8200 Improve. Permit_AuthorizJatio-n to Construct Repair Permit /�Oper. Permit/ System Type Owner/Agent J2e 3 Phone gl�(� —G2l/o . Address c/7 e/ , /7c/ Subdivision hi-nwa-ry AX. p Section/Block/Phase Lot# Lot Size Directions: 07 s (C e-,< / 04 /%S{ zrw 2r61A , e r5 Fri c744 a/ACt C 0402y /t i5/7.3 l5 Ac/rz /2F✓ Facility: House Mobile Home Business . Other: Tax Map # Multi-family Other . Zoning Approval # # Bedrooms 3 # Seats # Employees . Application Rate GPD Flow Hot Tub orSa yes/no Special Fixtures 100% Repair Are e no Basement no Basement Plumbing yes& Water Supply: Private Well >6 Public Type of System: Trench Bed X Pump Pump/Panel Panel LPP Other i • Tank Size: Septic Tank Size EX/STTtt/Q Pump Tank Size Nitrification Field: Total Square Feet o0a Depth of Stone /Z Bed Size /0‘)(60 Trench Width Total Length of All Trenches Number of Trenches Individual Trench Length / / / / Feet on Center Maximum Trench Depth Distance of Nearest Well *DO NOT INSTALL WHEN WET* Topo % Slope Texture _ j..,......... Structure A Structure , $t.'1 � New % (qwe✓ Clay Min. ~ - ,/ - Soil Wetness .4.� T'� Soil Depth N bD Restric. Hoz. at " • `\ PX/S S Available space yes/no \ S//.t�.�\ u Overall Class S PS U \ ' Comments: \ / \ :L.J \ E1hEI7— • C Q 5776 61'40/ ('4 /zc **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility. An Authorization to Construct is valid for (5) five- s f-ont date issued and is not transferable. Permit Date AU C Owner/Agent ��i2s. ZOO i���� Sanitarian A MA . / �� Installed By r A0 ' Date 7 -2 24 S-nitari? /,Ic� �fJ `� OO White-Office - Yellow-Owner/Agent s'°U / ----- et--N° 05181 • CATAWBA COUNTY `-FtEALPH DEPARTMENT (704) 465-8270 Lot, Ilval. Improve. Permit Repair Permit X Cert. of Comp. Permit Oper. Permit Owner/Agent 2Ictic Pos\-e-c Phone 6 - 2 1 Z Address 2r 17 Rex SZo Subdivision H-ida 0 -v Section/Block/Phase Lot# Lot Size el wc. Directions: (2r) S (0 13P14-e \ CC, ad ivy 6..1 a-cs\fr 'c Ross YLOn 8 Rrp., (.,Jr k\✓4e.a ; +--!`R-.j (1tC Facility: House )0 Mobile Home_ Business . Other: Zoning Approval yes/no # Multi-family_ Other . Tax Map # Bedrooms Seats Employees . Application Rate GPD Flow Hot Tub or Spa yes/no Special Fixtures . 100o Repair Area yes/no REPAIR NOTICE: Basement yes/no Basement Plumbing yes/no . REPAIRS RUST BE WITHIN 30 DAYS OR Water Supply: Private_ Public_ . DAYS FROM DATE OF PERMIT. Type of System: Trench X Bed Pump Pump/Panel Panel LPP Other Tank Size: Septic Tank L tisi'c Pump Tank Nitrification Field: Total Square Feet (pot Depth of Stone it Bed Size Trench Width 36 " Total Length of All Trenches 200 Number of Trenches c-/ Individual Trench Length50/ 5O/ 5O/50/ Feet on Center \l Maximum Trench Depth 2y I Distance of Nearest Well CD Lot Evaluation: Approved yes/no (Void After 24 months) Topo % Slope Sketch of lot Evaluation Site - System Design - Final Texture Structure usy,Pl\ hie;"-) 1 if Clay Min. S ‘t5l,4-H Lt L° 'r Soil Wetness ∎` ,. Soil Depth cn 1 e x rsrU Restric. Hoz. at " Available space yes/no Overall Class S PS U Q Comments: 5 _CF- LY/S=�N Co A WY V _ _ _ _ -a _ _ 3 X50 _ r.1 if _ Q Septic Tank Contractors MUST contact the Sanitarian BEFORE ner / A - /Cri changing permit. **NO GUARANTEE OR WARRAN IS IMPLIED OR GIVEN THROUGH THE ISSUANCE OF THIS PERMIT** Permit Date // 3—5 . (Improvement Permit voi• fter 60 months) Owner/Agent/ ,K, -� Sanitarian .4-' Installed By -j a _: ;. Dated?-//' 3 Sanitari- ' %- '���� /9-S' (Note any changes/information in red or by sketch on b-6.k) IF A PERMIT HAS TO BE REDESIGNED AND/Ojt.Rn'RIP$ MADE TO THE PROPERTY, THERE IS AN ADDITIONAL $25 CHARGE. - White-Office Blue-Bldg. Insp. Comp. Yellow-Owner/Agent Green-Bldg. Insp. I.P.