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HomeMy WebLinkAboutEHPR-04-2016-23617.TIF THIS IS NOT A PERMIT Case# EHPR-04-20 1 6-23 6 1 7 CATAWBA COUNTY HEALTH DEPARTMENT 0 R of 0 L) `''. PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES '���: %. /842 S. Environmental Health Plan Review - OSWP '9uP t • o IMPROVEMENT .-d"� ci o • Applicant EMIL BELOS, 3842 NW 1ST ST CT, HICKORY NC 28601- C:8283127754 Owner CCF ASSOCIATES I LP&CCF, 352 2ND ST NW SUITE 106, HICKORY NC 28601 C:3233040946 NAME TO APPEAR ON PERMIT EMIL BELOS SITE ADDRESS: 4122 4TH ST LN NW, HICKORY NC 28601 PIN # 370520910218 NAME of SUBDIVISION: MANLEY K FULLER, JR TRUSTEES Lot# 1,2,3 Section/Block PROPERTY SIZE: Square Feet 84,070.80 Acres 1.93 DIRECTIONS: Hwy 127 S, Left onto 39th Av Dr NW, Left onto 4th St Ct NW, Left onto 4th St Ln NW, House is 2nd on the Right after Passing 41st Ave NW. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 720 WATER SUPPLY: Public Water DESCRIBE WORK: IP for Purchase 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? No Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House 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:: 60x80 #OF NEW BEDROOMS:: 6 BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED? Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: YES OTHER: INNOVATIVE: ANY: Other described: E7-ehapplicalion 04/08/2016 15:40 Page 1 of 5 CATAWBA COUNTY Case 4 EHPR-04-2016-23617 t Public Health Department Subdivision MANLEY K FULLER, JR TRUS' Q `-°"•dm.- `• Environmental Health Division PIN# 370520910218 � �� PO Box 389,100-A Southwest Blvd, Newton.NC 28658 8• NAME ON PERMIT: ( EMIL BELOS), 3842 NW 1ST ST CT, HICKORY NC 28601- ( EMIL BELOS) Site Address: 4122 4TH ST LN NW, HICKORY NC 28601 Property Size: Square Feet 84,070.80 Acres 1.93 Directions: Hwy 127 S, Left onto 39th Av Dr NW, Left onto 4th St Ct NW, Left onto 4th St Ln NW, House is 2nd on the Right after Passing 41st Ave NW. 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 identificati r I eling of all property lines and corners and making the site ace ble so that a cQmfolete site g`aluation can be performed. Date: �� Signature of Applicant or Agent ( Qn/I 1'j.� V ;(A 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 SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-ehapplimi ion 04/08/2016 15:40 Page 2 of 5 CATAWBA THIS IS NOT A PERMIT )ex,n- w Iv CATAWBA COUNTY HEALTH DEPARTMENT H „c,.oi`i`,e Application for Environmental Services Page 1 Improvement Permit V Authorization to Construct❑ Septic Repair❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspectionn Pre-Approval Required) ❑ Application is for New Construction Existing Facility ❑•Property Address th Sr � H H 4V Subdivision Jo. L . &rott_ H/7kcrie NC 2t foo / Lot# 1 t 2 3 Acres / , q 3 Section/Block/Phase Driving Directions to Property 1 N N s NAME TO APPEAR ON PERMIT? ❑ Owner j Applicant ❑ Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name Address Phone Cell Phone Ili ac n tion Name 'C.'- r/ cc' . Address 38( 2 t S'` 5 F Cr ,-Gt--/ 7i ct y >Y G. ?ft c/ Phone 3; ) 3 j 2 _2.-77:c L Cell Phone / WHO WILL BE THE PRIMARY CONTACT? L Owner 5pplicant [ . '{ontractor Description of Existing Structures on Site . lai%l1ilI 1 . # of Bedrooms *j- Structure Dimensions #of Occupants Basement ❑ Yes ❑ No Basement Fixtures Q 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 to any question is "yes", applicant must attach supporting documentation. ®Yes tp.No Does the site contain any jurisdictional wetlands? ® Yes No Does the site contain any existing wastewater systems? 0 Yes IILNo 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 111No 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? ** g 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 dConventional ❑ Innovative ❑ Other ❑ Any �ATA BA THIS IS NOT A PERMIT cot mrr VV j„� CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 ?less Proposed Facility Type ❑ Primary Residence LE New Residence ❑ Addition to Residence #of New Bedrooms *t v)•_, Project Description Structure Dimensions (pt 'hG #of'Occupants Basement yi Yes ❑ No Basement Fixtures 5lei Yes ® No ❑ Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling E. Ycs ❑ 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 it 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 Ti Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ No Describe Calculated Design Flow, Commercial t Additional information may be required to determine design flow from certain facilities. This value wilt 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 comers and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agents >" Date k ( Printed Name of Owner or Agent 6 yyl,1 t, 3e/o5 Catawba County Environmental Health 1 ate.{r 1, V ,. ' .00 { is r' e rri �•` 1.11 F��+.4144 4 _ (40 a / � } 3 —380.01. ? � `', 2 4.86 ` r F— \` 145.1 ? 00 ' ____1 a /4 nr.8.•3 �' ` `• 180,17 to i— /5 i / i 0.10 — z — — — I • •.�,� . i XS — _ ^ 7 per __0 ? Q E , x00 62 / % so. Q 100J`0 a n i 1 na k \—._ \ f 1 W vc. ,05.a J �\_�\ \ 0 6 2134 � � o ,\‘k � 1 4151 WI t3W� \-- g 0� _ 20� / �1©1.03 q'\ l S i Parcel: 37052091^0218, 4122 4TH ST LN NW 1in=80ft HICKORY, 28601 This map/report product was prepared from the Catawba County,NC Geospalial Information Services. Catawba County has made substantial efforts c 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/repert 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/repon product or die use thereof by any person or entity. Copyright 2014 Catawba County NC 04/082016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 370520910218 Owner: CCF ASSOCIATES I LP & CCF Parcel Address: 4122 4TH ST LN NW ASSOCIATES III LP City: HICKORY, 28601 Owner2: null LRK(REID): 62321 Address: PO BOX 3387 Deed Book/Page: 2588/1703 Address2: null Subdivision: MANLEY K FULLER, JR City: HICKORY TRUSTEES State/Zip: NC 28603-3387 Lots/Block: 2/ null Last Sale: School Information: Plat Book/Page: 38/167 School District: HICKORY Elementary School: JENKINS Legal: LOT 2 2 PL 38-167 PL 38-167 Calculated Acreage: .600 Middle School: NORTHVIEW Tax Map: 200H 01083 High School: HICKORY School Map Township: HICKORY State Road #: 1365 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: HICKORY County Fire District: HICKORY RURAL Zoningl: R-2 Building(s) Value: $0 Zoning2: null Land Value: $54,300 Zoning3: null Assessed Total Value: $54,300 Zoning Overlay: null Year Buill/Remodeled: null/null Small Area: null Current Tax Bill Lo - e(OC10 Split Zoning Districts: null/null (�yo Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2009-07-07 Building Permits for this parcel. Firm Panel #: 3710370500L Building Details 2010 Census Block: 1024 WaterShed: WS-IV Critical Area 2010 Census Tract: 010502 Voter Precinct: P39 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 intormation 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. imp://gis.catawbacountync.gov/nomap/parcel_report.php?key=370520910218&typ=P 4/8/2016