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HomeMy WebLinkAboutRBPR-03-2016-23418.TIF -JgA e THIS IS NOT A PERMIT Case # RBPR-03-2016-23418• r �' CATAWBA COUNTY HEALTH DEPARTMENT D_ n • d sV4 ti • � � PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES • 1'` 1842 sM Residential Building Plan Review - Building New o -r U AUTH_CONST - NEW WELL '0 14:'' -_ " Contractor *WISE, INC., D.V. (THOMAS WISE), PO BOX 4897, MOORESVILLE NC 28117 8:704-746-6054 MOBILE INFO @DVWISE.COM Owner BRIAN & SHERRY NOE, 1327 MEADE DR, LINDENHURST IL 60046 C:847-980-9913 NAME TO APPEAR ON PERMIT Brian & Sherry Noe SITE ADDRESS: 1080 ASTORIA PKWY, CATAWBA NC 28609 PIN # 471001454271 NAME of SUBDIVISION: ASTORIA Lot# 15 Section/Block PROPERTY SIZE: Square Feet Acres 0.8 DIRECTIONS: Sherrills Ford Rd/left Hopewell Church Rd /cross Monbo/continue on Hopewell Church/right Regal Blvd/right Astoria Pkwy/Gate Code#0015 PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY : Private Well DESCRIBE WORK: 2 story dwelling w/attached garage with unfinished bonus room / 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: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 61 x 79 #OF NEW BEDROOMS:: 4 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: YES INNOVATIVE: ANY: Other described: 25% reduction APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO E9-chapplication - 03/17/2016 10:18 Page 1 of 5 it,A. CATAWBA COUNTY Case# RBPR-03-2016-23418 L Public Health Department Subdivision ASTORIA , °-- Environmental Health Division PIN# 471001454271 .( ; PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 18 2 ,w. . NAME ON PERMIT: (BRIAN& SHERRY NOE). 1327 MEADE DR, LINDENHURST IL 60046 ( Brian & Sherry Noe) Site Address: 1080 ASTORIA PKWY, CATAWBA NC 28609 Property Size: Square Feet Acres 0.8 Directions: Sherrills Ford Rd/left Hopewell Church Rd/cross Monbo/continue on Hopewell Church/right Regal Blvd/right Astoria Pkwy/Gate Code#0015 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 acre o that a complete site evaluation can be performed. Date: 3—/7--/b Signature of Applicant or Agent 1 / 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 FEENAME ° DATE .FEE'AMOUNT ;`'. Authorization to Construct Fee (New/Expansion) 03/17/2016 5300.00 Fee Well Permit& Inspection Fee 03/17/2016 $300.00 TOTAL FEES $600.00'. 1 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 03/17/2016 10:05 Page 2 of 5 CATAWBA THIS IS NOT A PERMIT COUNTY / CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permit ; Authorization to Construct J Septic Repair❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit 501eplacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction Existing Facility ❑ Property Address /D As*�/� Par UJ?L/ Subdivision .4S.-1-ori 0' bibe � /iC rQs&o9 Lot# 15- Acres a 80 '/ jj f Sectio B�Io�JWPhasc Driving Directions to Property SoL/-I'h � �F1prr11ls K// TU(n Z - errs n • g >• / demo , A Sw CC SS M.i bD AAA , nnt,2e cY? neetiei�� ch. 'e 4i Blvd, ''t9 ifl 6-irb As ,4 'kTu//, La ., • $frCD15— NAME TO APPEAR ON PERMIT? 9G' Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name L)J td, ` Address Pb Box 489'7 fopiresii ' ' N/C tXll Phone 70#1/ '74 7- Cell Phone Owner Contact Information Name J3r;GWI + S-p(ry Noe Address 1-73 Clus4-ers Ct.l rr IC- mcorec v//fie Alt, 09g-iii Phone I Cell Phone gq-j qso- ¶q 3 Contractor Contact Information Name DV Wise 2C Address pp Box 4097 P✓Mm,stale/ Ale 8117 Phone 7o'/ 74/b– (ogsy Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant ; Contractor Description of Existing Structures on Site ac_a • i , ,1 7zrC m sw #of Bedrooms *t 'V Structure Dimensions (al/X �8'�O" #of Occupants '- Basement ❑ Yes a No Basement Fixtures Cl Yes ® 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. O Yes 3 No Does the site contain any jurisdictional wetlands? 0 Yes D No Does the site contain any existing wastewater systems? O Yes a No Is any wastewater going to be generated on the site other than domestic sewage? %Yes ' t No Is the site subject to approval by any other public agency? O Yes ®No Are there any easements or right of ways on this property? Describe Existing water supply in use U Individual Well U Community Well U 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) ? �1 ❑ Accepted ID Alternative ❑ Conventional ❑ Innovative ❑ Other P5-27) Roducnn'l7 Any CATAWBA 7gZ A THIS IS NOT A PERMIT LoulnrvL�VV �JL� CATAWBA COUNTY HEALTH DEPARTMENT ,a„„ Application for Environmental Services Page 2 • Proposed Facility Type ?t Primary Residence l' New Residence ❑ Addition to R9idence # of New Bedrooms *t I Project Description /Vpbt-) SI/VW IlyG[IA�?lI/V1� Structure Dimensions G, I 5( -7g i62 i/ # of Occupants oZ Basement ❑ Yes No Basement Fixtures ® Yes ® No ❑ Accessory Structure(s) Describe #of New Bedrooms *1' if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence# Units #Bedrooms per Unit*j' Total # Bedrooms *j' Structure Dimensions H Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) # Employees per Shift #of Shifts Dining Area(Sq. Ft) H Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Church ft of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type Individual Well El Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ No Describe Calculated Design Flow, Commercial t N/A 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. 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. 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 1 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 Date I6 � 3- lb- 16 Printed Name of Owner or Agent Dina 6 D W l Lj�i DA/ W ;J • Can-iraG-tD f Catawba County Environmental Health ;+. "rf xq `a` rK"" q"`;. yy 'ne i t °� 1� � � , a.A .'-s , i `s v IY; . ev � ir �t ,hf " �'I 'i� 5* :a --(1 k sfr 't-9� ;�.w :n - • • a AillW it) 111\,! _ ‘‘., iarrraqft,_ c... w 4: / ‘,Ai r4irminspoiftr_ - • j....._....... ........H1/ 04 sieravv, . • G/ � . lt /e;N / .../, 4,$-..3 (1X/ 1 o- • A1.24j qST aRlq ptit /, / r. Parcel: 471 001 45427 1, 1080 ASTORIA PKWY 1in=50ft 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. I Copynght 2014 Catawba County NC II 03/16/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 471001454271 Owner: NOE BRIAN K • Parcel Address: 1080 ASTORIA PKWY Owner2: NOE SHERRY LYNN City: CATAWBA, 28609 Address: 1327 MEADE DR LRK(REID): 301234 Address2: Deed Book/Page: 3256/0567 City: LINDENHURST Subdivision: ASTORIA State/Zip: IL 60046-1800 Lots/Block: 15/ School Information: Last Sale: $135,000 on 2014-09-09 Plat Book/Page: 53/134 School District: COUNTY Legal: LOT 15 PLAT 53-134 Elementary School: CATAWBA Middle School: MILL CREEK Calculated Acreage: .800 Tax Map: High School: BANDYS Township: CATAWBA School Map State Road it: TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoningl: R-30 Building(s) Value: $0 Zoning2: Land Value: $180,900 Zoning3: Assessed Total Value: $180,900 Zoning Overlay: CRC-O,WP-O,FPM-O Year Built/Remodeled: / Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2008-03-18 Building Permits for this parcel. Firm Panel #: 3710471000K Building Details 2010 Census Block: 1012 WaterShed: WS-IV Critical Area 2010 Census Tract: 011503 Voter Precinct: P21 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. ©2015, Catawba County Government, North Carolina. All rights reserved. \C� I NO- bi\s od\ PC )1' ° 1 L EdjZo 98Z /Gout http://gis.catawbacountync.gov/nomap/parcel_report.php?key=471001454271&typ=P 3/17/2016 CATAWBA COUNTY HEALTH DEPARTMENT • Telephone: (828) 465-8270 TDD: (828)465-8200 WLS#200/-0/a5-v IP Nee , At Rpr. Print. Opr. Print. Sys. Type Well Prmt. Replacement Well Well Rpr. Print. OwnerYXent �C</ -ic" w`greZ, Phone ‘r,3 -6905` Address / 577)P!A l t.1. _ Subdivision srzhe rg caritas/9 w6R Ali e.. f2id Section/Block/Phase Lot# is— Lot SizeO,8OncRicDirections: ,. r _ _ ..a.r• !.L. 0 ;_. •a. s _ . e .P• :-4 - . ..' • u 4 441 C •► . 1 / - •4. CJ ?a i. :G i , _ . -.• a 4' t&'. . -..,e, .is r r-.. •tit a Property Address A�STn,4//9- s -.-•• Facility: House >( Moth e Home Business Multi-family . Other: Pin Number 5r// 419/0 0/ as 93710 - 3 Other •. Zoning Approval # #Bedrooms y #Seats #Employees . Application Rate_ GPD Flow 410 Hot Tub or Spa ye' 'ecial Fixtures 1/,tBaseme a o . 100% Repair Are !1�, o Basement Plumbinra. o ``Water Supp y: Private Well x Public Semi-Public ****$********444 "+4444 44444444444****444444444444444444*+*4 4444444 44 44 4***4****■4*******#********************44*******444 Type of System: Trench— Bed — Pump X Pump/Panel -- Panel — LPP=Other ... S%terrDctG770/1.1'9151 Septic Tank Size Pump Tank Size Nitrification Field: Total Square Feet ' Depth of Stone_ Bed Size . Trench Width Total Length of All Trenches Number of Trenches Trench Length ----/— / • / /--- —Feet on Center-- Maximum Trench Depth Distance of Nearest Well 4D0 NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* ******4******444444******444444************4444*************************144. 444444444444444*4*44444*4**4s4*4*44*4*4*44*4* Topo % Slope yJ H Texture /451 RJR . A Structure _ Clay Min. ..----i . Soil Wetness " t !„per° .�,..,(G,� Soil Depth >° r �E����.) Restric. Hoz. at " i j Available space yes/no Overall Class S PS U Comments: r /f • -SEA SOIL AIo7 t t �f/3 p, uJ Q. kia-ci 4/',S 4w r/ 0 ,tSfl4Jn S gab,, ��YY��" 7j I • 940 Pt>Jrn I 0 F 1 /}ache I l I d ire 1 O PLO y�� o NI. Filter Required 'Z Riser required when TV y tank is more than 6 inches deep. '- **NO GUARANTEE OR WARRAN • .IED OR GIVEN • TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** 4/4/-4 ***4*****4*****44********4*************** 444*44* . ** 4.************************o*****************************4*4*4*4*4*** *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 years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. The siting of the well by the Health Department staff is to provide protection from known possible sources of contamination. No volume of water is guaranteed at any site by the Health Department. Permit Date ,31,L .• C an Q j EFIS Owner/Agent Septic Tank Installed By Date EHS Well Installed By Well Grout Approval Date Well Head Appro - I• c Date Sample Collected Date of Results Results EHS White-Office Blue-Building Inspection Operation Permit Yellow-Owner/Agent Green-Building Inspection Authorization to Construct