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HomeMy WebLinkAboutRBPR-03-2016-23377.TIF �gA • THIS IS NOT A PERMIT Case # RBPR-03-2016-23377 ti� L7 CATAWBA COUNTY HEALTH DEPARTMENT 0; . 1 r.,� 0 VD T, PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES r ti \842 sM Residential Building Plan Review - Building New r o •o o n s- . A.p. IMPROVEMENT - AUTH_CONST 01. d ?e,(Asetr) -thla Applicant TRAVIS NORMAN, 9376 JACOBS FORK RIVER RD, CONNELLY SPRINGS NC 28612 C:8283085667 Owner TEDDY LAIL, 5026 CAROLINA MILL RD, HICKORY NC 28602 NAME TO APPEAR ON PERMIT Teddy Lail SITE ADDRESS:63402NC 18 HWY, VALE NC 28168 PIN # 265702567551 NAME of SUBDIVISION: Lot# 2 Section/Block PROPERTY SIZE: Square Feet Acres 15.32 DIRECTIONS: Hwy 10 to 18 take a right 2 miles on right PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: 1 story single family dwelling and attached garage 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: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 51x73 #OF NEW BEDROOMS:: 2 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-ehapplication 03/11/2016 11:51 Page 1 of 4 a,• • CATAWBA COUNTY Case# RBPR-03-2016-23377 C' r Public Health Department Subdivision Q *0g Environmental Health Division PIN# 265702567551 PO Box 389,100-A Southwest Blvd,Newton,NC 28658 /82 :M NAME ON PERMIT: (TEDDY LAIL), 5026 CAROLINA MILL RD, HICKORY NC 28602 ( Teddy Lail) Site Address: 3402 NC 18 HWY, VALE NC 28168 Property Size: Square Feet Acres 15.32 Directions: Hwy 10 to 18 take a right 2 miles 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 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 AREA2 teFEENAME i t a il, i t '3s f 1. ` ' "3 ik DATEI�'� FEE°AMOUNTS �,i >itaA.e.t$ik'�.,,aa�.z s �.c.=.:wb'�.wS'�'�t-nn . x. _�..,. .,i � _. s.? Authorization to Construct Fee (New/Expansion) 03/11/2016 $150.00 Fee Improvement Permit Fee 03/11/2016 $150.00 iiPil i-PIp1r�! F'�.TOTALFEESAtA ilkd li iiiitkitAiiiiiii 4t-z 3i.,.4 #11 tfip!I t1 30000nj ifrbaa.:ii a ifr p% Tyan s lall.t. .ifiliirai, C.J '"a _ejlet t:Mli.Rtrtegge 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 03/11/2016 11:51 Page 2 of 4 vJYA �G THIS IS NOT A PERMIT Case# RBPR-03-20 1 6-23 377 irF" AR ti CATAWBA COUNTY HEALTH DEPARTMENT D'y� o '"=i Cl ' cola'. . ...� . .. PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 sM Residential Building Plan Review - Building New ,s -ro . a T . - • . .' IMPROVEMENT- AUTH_CONST •D -..o, f .o Applicant TRAVIS NORMAN, 9376 JACOBS FORK RIVER RD, CONNELLY SPRINGS NC 28612 C:8283085667 Owner TEDDY LAIL, 5026 CAROLINA MILL RD, HICKORY NC 28602 NAME TO APPEAR ON PERMIT :3102, Teddy Lail SITE ADDRESS: 3*84=NC 18 HWY, VALE NC 28168 PIN # 265702567551 NAME of SUBDIVISION: Lot# 2 Section/Block PROPERTY SIZE: Square Feet Acres 15.32 DIRECTIONS: Hwy 10 to 18 take a right 2 miles on right PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: 1 story single family dwelling and attached garage 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: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 51x73 #OF NEW BEDROOMS:: 2 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-ehapplication 03/11/2016 09:53 Page 1 of 4 g \ CATAWBA COUNTY Case# RBPR-03-2016-23377 I iV� 1 L Public Health Department Subdivision V z-�° K, Environmental Health Division PIN# 265702567551 4 ~ / PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 Ig 2 SM NAME ON PERMIT: (TEDDY LAIL), 5026 CAROLINA MILL RD. HICKORY NC 28602 ( Teddy Lail) Site Address: 3401 NC 18 HWY, VALE NC 28168 Property Size: Square Feel Acres 15.32 Directions: Hwy 10 to 18 take a right 2 miles 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 a so that comp) site evaluation can be performed. Date: _. —.-1( t - `6- Signature of Applicant or Agent ccessibl 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 . DATE. .., FEE AMOUNT Authorization to Construct Fee (New/Expansion) 03/11/2016 $150.00 Fee Improvement Permit Fee 03/11/2016 $150.00 TOTAL FEES " 3300.00,, FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-el application 03/11/2016 09-53 Page 2 of4 ., RNA& - 03 ao�w - 0)331 THIS IS NOT A PERMIT COUNTY ` a CATAWBA COUNTY HEALTH DEPARTMENT ---gip N ,, Application for Environmental Services Page 1 Improvement Permit Authorization to Constructt Septic Repair n Septic Malfunction ❑ Septic Expans on n New Well Permit❑ Replacement Well ❑ Well Abandonment n Well Repair n Existing System Inspection (Pre-Approval Required) n 2 Application is for New Construction ❑ Existing Facility ❑ Property P ldress 3 Li 0 + N1 , r$ a 4 Subdivision VI 3 11"--' Vat t D. 9-/ S' Lot# Acres // Section/Block/Phase Driving Directions to Property (-42,7(-42,7 /c) +c- f to L e rt' 21— n I /- ill NAME TO APPEAR ON PERMIT? Owner n Applicant fl Contractor Applicant Contact Information Name GYiJtj 0/ (12 e.4,-,Address • -% cv '✓k i 'c-! La n ( e - 4 c ‘ Phone 9-,2_, --- 30I' SCE ! Cell Phon- SG .-2-t— Owner Contact Information Name TecIoic Lot I Address 50 2i Cc<<rc.,,-,-, in 1/ (4 1 Phone ,(f- g- 3/2 f 7 '2 Cell Phone SG•u Contractor Contact Information Name 50 License # Address Phone Cell Phone / . WHO WILL BE THE PRIMARY CONTACT? n Owner f Applicant n Contractor Description of Existing Structures on Site nom L # of Bedrooms *t Structure Dimensions # of Occupants ,a-a. Basement ❑ Yes [ No Basement Fixtures n Yes n 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 L3 No Does the site contain any jurisdictional wetlands? ❑ Yes 0-No Does the site contain any existing wastewater systems? ❑ Yes E I-No' Is any wastewater going to be generated on the site other than domestic sewage? 111-Yes ❑ 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 Existing water supply in use !individual Well ❑ Community Well ❑ Semi-Public Well n County/City/Township Water Line Is a public water supply available? ** n 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 l;-Any CATAWBA 1 HIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence New Residence n Addition to Residence # of New Bedrooms *t 2_ Project Description_ 57 x -2 3 13 fl. 14 Cx,frez, (-Li", _t Structure Dimensions 3. 7.. —7 "; #of Occupants 2.--- Basement ❑ Yes o Basement Fixtures ❑ Yes n-Na ❑ Accessory Structure(s) Describe # of New Bedrooms *f if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes n No Plumbing ❑ Yes ❑ No Describe Plumbing Needed Ti Multi-Family Residence# Units #Bedrooms per Unit*t Total # Bedrooms *f Structure Dimensions Ti Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift # of Shifts Dining Area(Sq. Ft.) n Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Church # of Seats Kitchen Ti Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type Ti Individual Well Ti Semi-Public Well ❑ Community Well Abandonment Type n Drilled Ti Bored ❑ Dug ❑ Unknown Well Repair Requested Ti 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 lines and corners and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent i/'&<S fi ✓i Lr r� Date 3 - /( -/4 Printed Name of Owner or Agent It Catawba County Environmental Health • . , ,, . " . • : \ z = f U, c X J r w ... . r. :try f r 0 0 0 0 0 0 1007. - . r . Or f• Eel Parcel: 265702567551, NC 18 HWY VALE, 1in=200ft 28168 0) 10orr■ 4303 . cL f`/""' 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. Convrioht 2014 Catawba County NC Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 265702567551 Owner: LAIL TEDDY RAY Parcel Address: NC 18 HWY Owner2: LAIL SHERRY YOUNG City: VALE, 28168 Address: 5026 CAROLINA MILL RD LRK(REID): 15901 Address2: Deed Book/Page: 3323/1039 City: HICKORY Subdivision: State/Zip: NC 28602-9559 Lots/Block: 2/ Last Sale: $64,000 on 2015-05-13 School Information: Plat Book/Page: 74/139 School District: COUNTY Legal: TRACT 2 PL 74-139 Elementary School: BANOAK Middle School: JACOBS FORK Calculated Acreage: 15.320 Tax Map: 015 B 03001 High School: FRED T FOARD Township: BANDYS State Road #: 18 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: COOKSVILLE Zoningl: R-40 Building(s) Value: $0 Zoning2: Land Value: $69,900 Zoning3: Assessed Total Value: $69,900 Zoning Overlay: WP-O Year Built/Remodeled: / Small Area: PLATEAU Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2008-02-20 Building Permits for this parcel. Firm Panel #: 3710264600L Building Details 2010 Census Block: 1018 WaterShed: WS-III Protected Area 2010 Census Tract: 011802 Voter Precinct: P2 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 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. ©2016, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=265702567551&typ=P 3/11/2016