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HomeMy WebLinkAboutRBPR-03-2016-23443.TIF • y�$A �� THIS IS NOT A PERMIT Case # RBPR-03-2016-23443 d " R ,� 1 r'Y ; CATAWBA COUNTY HEALTH DEPARTMENT O O Vim►r PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES �'' ?� 184, sM Residential Building Plan Review - Manufactured Home 3• o d .ci IMPROVEMENT - AUTH CONST - EXPANSION .4.•. Gy • Applicant *CLAYTON HOMES # 81 /CMH INC (UNLICENSED), 1230 CONOVER BLVD, CONOVER NC 286 B:828-465-3450F:828-464-0261 JWHOLDER @HOTMAIL.COM Contractor *CLAYTON HOMES# 81 /CMH INC (UNLICENSED), 1230 CONOVER BLVD, CONOVER NC 286 B:828-465-3450F:828-464-0261 JWHOLDER @HOTMAIL.COM Owner DANIEL NERBER, 5696 BOLICK RD, CLAREMONT NC 28610 C:8286126304 NAME TO APPEAR ON PERMIT Daniel Nerber SITE ADDRESS: 5696 BOLICK RD, CLAREMONT NC 28610 PIN # 376401450292 NAME of SUBDIVISION: BETHEL CHURCH PARK Lot# 2 Section/Block PROPERTY SIZE: Square Feet Acres 0.97 DIRECTIONS: Rock Barn Rd to Hwy 16N to Right River Bend RD to Right onto Bolick RD#5696 is on the left PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: New single-wide with 6x6 front and back decks ** Home must meet appearance criteria ---Screen or Remove Towing Tongue, Front Deck must be minimum of 36 sq ft, home must be masonry underpinned (can use vinyl if singlewide). Home must be parallel to road and must face front of property-**If this new home is a replacement for an existing occupied home—that existing home must be removed from the site within 30 days of the issuance of the Certificate of Compliance** 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: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF single-wide EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 14x68 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 16x76 #OF NEW BEDROOMS:: 3 - Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-ehapplication 03/21/2016 16:26 Page 1 of 4 1 BA CATAWBA COUNTY Case# RBPR-03-2016-23443 (:-.71:111•). Public Health Department Subdivision BETHEL CHURCH PARK < hi, Environmental Health Division _ PIN# 376401450292 ��= _jPO Box 389, 100-A Southwest Blvd,Newton,NC 28658 ,, /842 w NAME ON PERMIT: (DANIEL NERBER), 5696 BOLICK RD, CLAREMONT NC 28610 ( Daniel Nerber) Site Address: 5696 BOLICK RD, CLAREMONT NC 28610 Property Size: Square Feet Acres 0.97 Directions: Rock Barn.Rd to Hwy 16N to Right River Bend RD to Right onto Bolick RD#5696 is on the left 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 identificatio rd labe ing of all property lines and corners and making the site acc ssible so th t a complete site evaluation can be performed. Date: 2f 5 ,I 1`Lo Signature of Applicant or Anent f., An Environmental Health Specialist will contact you within 5 working ddys of application date. If you need further information or assistance please call 828-466-7291 AREA2 :'-FEENAME`- DATE FEEAMOUNT"'ll. Authorization to Construct Fee (New/Expansion) 03/21/2016 $150.00 Fee Improvement Permit Fee 03/21/2016 $150.00 TOTAL FEES °" $300.00;:'' 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-chapplicabon 03/21/2016 16:26 Page 2 of 4 R 6N - b3 - 00∎,6 -- a3(443 CATAWBA THIS IS NOT A PERMIT COUNTY _- --_ CATAWBA COUNTY HEALTH DEPARTMENT mow--- , ti. Application for Environmental Services Pagel Improvement Permit Authorization to Construct r. 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 ❑ Existing Facility n Property Address LP /3oLi t gd Subdivision NIA 10(IPell\Arri NC, Lot# Acres f Section/Block/Phase Driving Directions to Property lc Th�{^) aid 7) I-(tt)L/ /(0 N -+c VLl UF.R ( mot. #9 R gkt OW b 1301 r dc.lzcio W 5(o,Lo ) c OA -9-1,0 , l . NAME TO APPEAR ON PERMIT? [ Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name CA0.4 lbiti Vio vI')ec *E31 Em(Abl L-C4 ESQ Address V- D (�nnax,t pills � Phone rZ1S_241_3t(Pg Cell Phone SZR-Z(7- 3/( Owner Contact Information g Name boc l�,t K. e tloer1 Address 5[A aThL)r-t -Ra / 7 yews,,-i t- AU C> Phone %j,3-Lo; 2^1 4,30'4 Cell Phone Contractor Contact Information Name Ki10 -/ J -Address �J License# /t/� 1 l.Y Phone UUU ��" Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner X Applicant ❑ Contractor Description of Existing Structures on Site 3 Ioedr€a en (teSine5se�r'� x- # of Bedrooms *j' 3 Structure Dimensions /'- a # of Occupants Basement ❑ Yes 141 No Basement Fixtures ❑ 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. ❑ Yes No Does the site contain any jurisdictional wetlands? Yes No Does the site contain any existing wastewater systems? ❑ Yes KNo Is any wastewater going to be generated on the site other than domestic sewage? �, ] Yes ,No Is the site subject to approval by any other public agency? ❑ Yes 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 \ ater 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 Any C ^T AST 7 A THIS IS NOT A PERMIT COUNTY �VV 17 CATAWBA COUNTY HEALTH DEPARTMENT eb No„„ 4,;;;-, Application for Environmental Services Pa, CO CO Proposed Facility Type C „x(P Primary Residence n New Residence n Addition to Residence #of New Bedrooms *i lS� wY Project Description NeuhSll/1G,L to/Se . 92.0-p CRAT Structure Dimensions ffi X, `](p <J # of Occupants Basement ❑ Yes 14 No Basement Fixtures ❑ Yes A No n Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling n Yes n No Plumbing Yes n 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 ft 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 n Yes n No If Daycare Specify.Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type n Individual Well n Semi-Public Well n Community Well Abandonment Type n Drilled ❑ Bored ❑ Dug n Unknown Well Repair Requested ❑ Yes n No 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 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 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. 3 21 1cc Signature of Owner or Agent �ist���% A ic�1.� Date it Printed Name of Owner or Agent '&11,4 A A_ ,_I ' _ I ' Art I GI`-8f Catawba County Environmental Health 0Q 108 160 •--,,. to3.: 1.2 • HID _1Q3S N „fir.\" trial P> . S034.-‘44\- iaq C• ° _., 1 O • 43� f 105 105.39 108.83 Parcel: 376401450292, 5696 BOLICK RD 1 in=60ft CLAREMONT, 28610 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 03/21/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 376401450292 Owner: NERBER DANIEL RICHARD JR Parcel Address: 5696 BOLICK RD Owner2: UPLINGER CARLA ELAINE City: CLAREMONT, 28610 Address: 5696 BOLICK RD LRK(REID): 58434 Address2: Deed Book/Page: 2521/0419 City: CLAREMONT Subdivision: BETHEL CHURCH PARK State/Zip: NC 28610-8163 Lots/Block: 2/ School Information: Last Sale: Plat Book/Page: 17/107 School District: COUNTY Legal: LOT 2 2 PL17-107 BETHEL PK PL 17- Elementary School: OXFORD Middle School: RIVER BEND 107 Calculated Acreage: .970 High School: BUNKER HILL Tax Map: 1701 01002 School Map Township: CLINES State Road #: 1706 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: OXFORD Zoningl: R-40 Building(s) Value: $500 Zoning2: Land Value: $12,700 Zoning3: Assessed Total Value: $13,200 Zoning Overlay: WP-O Year Built/Remodeled: / Small Area: ST STEPHENS/OXFORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-12-18 Building Permits for this parcel. Firm Panel #: 3710376400K Building Details 2010 Census Block: 1010 WaterShed: WS-IV Protected Area 2010 Census Tract: 010101 Precinct: P27 Agricultural District: PROXIMITY 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. �� a, SS ,� 2 2t/Y\ ce inSM we v c/) T S0/2fr SCO SC /ch y. arc c&r e spoilt) http:/ gis.ca awbacountync.gov/nomap/parcel_report.php?key=376401450292&typ=P 3/21/2016 CATAWBA COUNTY HEALTH DEPARTMENT p'S' Telephone: (828)465-8270 TDD: (828)465-8200 WLS # OZ - Co 4 '3 IP AC Rpr. Prmt. Opr. g.tmt. Sy fyp —/ Well Print. Replacement Well X Well Rpr. Prmt. Owner/Agent gjies7 C jtec MT&A, Phone Address Subdivision • -effort/Block/Phast Loth ze„e_�rr r Directio : jffI �tralica� La zar _ fi . �..� .rt I NA Pr.erty Lddress 4 erf Loraree r Facility: House Mobile Home , Business Multi-family . Other: Pin Number 'Mr' 0 - 0 0 Z Other . Zoning Approval k ft Bedrooms .. p Seats ft Employees . Application Rate GPD Flow Hot Tub or Spa ye Special Fixtures Basement yes . 100% Repair Area yes/no Basement Plumbing yes/no Water Supply: Private Well x Public Semi-Public *****4*************4*****************************4**************************************4********************************** Type of System: Trench ed Pu p Rim /Panel Pan LPP Other Septic Tank Si Pu Tank Size trification Field: oral Square Feet Depth i Stone Bed Size Trench 'dth Total L•ngth of All Trench Number of Trenches Trench Length / / / / Fe on Center Maximum Tre h Depth Distance of Nearest `, I *DO NOT INSTAL SEPTIC WHE WET* *WELL RECORD REQUIRED AT COMPLETION* ******************************************************************************************************************iii****** .— — — — — Topo % Slope I — Texture Structure Clay Min. Soil Wetness " Soil Depth H Restric. Hoz. at " Available space yes/no I ' t fJ 0 4zA�C(j Overall Class S PS U (/V �I Comments: ti -h 1- Mt bik Filter Required Riser required when — — — — — tank is more than 6 [.2 / �l �/je inches deep. Fx(rz-[i. V`z **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** ************************************************************raw************************************************************ *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 fr rnr kip n possible urces of contamination. No volume of water is guaranteed at an site by the Health Department. /2 Jdt4 ' Permit Date —2 —1�, E '/ /C i. Owner/Agent •_ �s:rsC�!a� Septic Tank lI e< t , r / — / Date EHS Well Installed By t:1 I h) WS _ Well Grout Approval Date Well Head Approval Date Date Sample Collected , . . Date of Results Results EHS White-Office Yellow-Owner/Agent Pink-Building Inspection Authorization to Construct