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HomeMy WebLinkAboutRBPR-04-2016-23634.TIF -4 AP, THIS IS NOT A PERMIT Case # RBPR-04-2016-23634 rfill CATAWBA COUNTY HEALTH DEPARTMENT 1] ; ;0 : f ''�' ` PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICESr��' �J• /842 SM Residential Building Plan Review - Building New oy". U• IMPROVEMENT- AUTH CONST r doh Contractor BELOS, CLAUDIU DANIEL (CLAUDIU DANIEL BELOS), 1495 WHITE EAGLE RANCH RD, HIC NC 28602 B:(828)312-7755 C:8283127755 Owner ANA FILIPAS, 1618 MEDISON, HOLLYWOOD FL 33020 H:9549239680 HOME:9549239680 Parcel Owner LONNIE JOHNSON, 2135 DUDLEY SHOALS 12D, GRANITE FALLS NC 28630 NAME TO APPEAR ON PERMIT Ana Filipas SITE ADDRESS: 1234 SAIN RD, HICKORY NC 28602 PIN # 370013231531 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet Acres 2.11 DIRECTIONS: 127 South left Bethel Church RD, Right on Sain Rd, property on left PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: 1 story 3 bedroom single family dwelling w/ attached garage ** mobile home to be removed before construction of family dwelling. 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: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF mobile home SW EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: unsure NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 55x60 #OF NEW BEDROOMS:: 3 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 04/12/2016 12:37 Page 1 of4 �gA CATAWBA COUNTY Case# RBPR-04-2016-23634 r_ 1y i .• Public Health Department Subdivision . ¢ Environmental Health Division •- PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 PINik 370013231531 18.2 ue NAME ON PERMIT: (ANA FILIPAS), 1618 MEDISON, HOLLYWOOD FL 33020 (Ana Filipas) Site Address: 1234 SAIN RD, HICKORY NC 28602 Property Size: Square Feet Acres 2.11 Directions: 127 South left Bethel Church RD, Right on Sain Rd, property on 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 identification and la e(ing of all property lines and corners and making the site accessible so t at a corr(plete t evaluation can be performed. Date: T( /2_ (� Signature of Applicant or Agent dy so _ 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 . s DATE FEE AMOUNT = Authorization to Construct Fee (New/Expansion) 04/12/2016 $150.00 Fee Improvement Permit Fee 04/12/2016 $150.00,,, ;,!TOTALFEES a-3 -`:.$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-ehapplication 04/12/2016 12:37 Page 2 of4 CATAWBA THIS IS NOT A PERMIT 1 `� � - 3 3 W3q COUNTY Y . CATAWBA COUNTY HEALTH DEPARTMENT N HL Application for Environmental Services Page 1 Inw Improvement Permit?k Authorization to Construct Septic Repair n Septic Malfunction n Septic Expansion ❑ New Well Permit n Replacement Well ❑ Well Abandonment n Well Repair n Existing System Inspection (Pre-Approval Required) n Application is for New Construction Ti Existing Facility n Property Address /231t Scan Subdivision �� 1�Kozs AC Z86Q7 Lot# Acres Section/Block/Phase Driving Directions to Prop erty 27 5ou-4 /C k geeel cAu z v-1.514- cain ri-tt e\-L) O n Le NAME TO APPEAR ON PERMIT? n Owner Ti Applicant n Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name 4-ytQ ; p-.a ,,II Address d (g M PG.t sC1Y1 I EZ flu iwod -/-11— 3 3 O 2-6 Phone ( 654) S510 Cell Phone Contractor Co to tt Information License# Address I e • �` i r I Ebro .. I it Zi .6 Z Phone Cell Phon- WHO WILL BE THE PRIMARY CONTACT? ❑ Owner El Applicant /.l Contractor Description of Existing Structures on Site tea 41 dt ' AL I 1 dear."- # of Bedrooms *t _ Structure Dimensions_ #of Occupants Basement ❑ Yes n No Basement Fixtures 1 1 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 'No Does the site contain any jurisdictional wetlands? `Yes tNo Does the site contain any existing wastewater systems? ❑ Yes LEO Is any wastewater going to be generated on the site other than domestic sewage? )9.Yes F NN Is the site subject to approval by any other public agency? ❑ Yes n No Are there any asements or right of ways on this property? Describe Existing water supply in use Individual Well n Community Well Ti Semi-Public Well Z---1\116—n County/City/Township Water Line Is a public water supply available? ** Ti Yes � ' 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 cAIAY V BA THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT ..,,b ;;;;-a—, Application for Environmental Services Page 2 Proposed Facility Type n Primary Residence New Residence Addition to Residence #of New Bedrooms *t Project Description " ` ,i 6it Structure Dimensions - . 6 I #of Occupants .3 .3 Basement ❑ Yes U No Basement Fixtures n Yes FKivo ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling n Yes ❑ No Plumbing ❑ Yes No Describe Plumbing Needed n Multi-Family Residence# Units_ #Bedrooms per Unit*j _ 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.) n 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 n Yes n 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 transferable. 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 evalua ion can b perfomied. • Signature of Owner or Agent Date 4 Re. (* Printed Name of Owner or Agent Catawba County Environmental Health 0 ,,--.7:\;\ rii CIS i TO C)) s..00 -N4,4 ' AN \lhc s- , gsoSYs� \\SN1/4S-N7 eit_ R'kSited 1;e 77.' A79) -r 101, ' - /003) 9 1 4 \\\1 Kb 01C (102) X1rb. r`- 1 Parcel: 370013231531, 1234 SAIN RD tin=60ft 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 mapheport 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 1 04/12/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 370013231531 Owner: JOHNSON LONNIE R Parcel Address: 1234 SAIN RD Owner2: JOHNSON KATHLEEN T City: HICKORY, 28602 Address: 2135 DUDLEY SHOALS RD LRK(REID): 58707 Address2: null Deed Book/Page: 2724/0456 City: GRANITE FALLS Subdivision: null State/Zip: NC 28630-8685 Lots/Block: null/null Last Sale: School Information: School District: COUNTY Plat Book/Page: Elementary School: MOUNTAIN VIEW Legal: ROAD 1133 Calculated Acreage: 2.110 Middle School: JACOBS FORK Tax Map: 173H 01010A High School: FRED T FOARD Township: HICKORY School Map State Road #: 1133 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: MOUNTAIN VIEW Zoningl: R-40 Building(s) Value: $700 Zoning2: null Land Value: $28,500 Zoning3: null Assessed Total Value: $29,200 Zoning Overlay: DWMH-O,WP-O Year Built/Remodeled: null/null Small Area: MOUNTAIN VIEW Current Tax Bill Split Zoning Districts: null/null Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710370000J Building Details 2010 Census Block: 3004 WaterShed: WS-III Protected Area 2010 Census Tract: 011801 Voter Precinct: P23 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NG 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 hold 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. ip/Qc NeuisetOnc 3i3,7 3665Pd http://gis.catawbacountync.gov/nomap/parcel_report.php?key=370013231531&typ=P 4/12/2016 r CATAWBA COUNTY HEALTH. DEPARTMENT • NEWTON;`-NORTH CAROLINA COMPLETION PERMIT FOR~.SEPTIC TANKS PERMIT 1p C - 2052 DATE : :-..2, /S1/S$0 OWNER Ace, e„7„, ADDRESS ' . BUILDING CONTRACTOR UBDIVISION / o.-..l0f rconp_ - i�.„.6.o..�3 .l'-�wJ Yt o-t.. /(3 3 C�^.^��� LOCATION a�, 44,�.._, .p ad,gyif (tai za.Gc. r.. ,,,,./b1 LOT # LOT SIZE I BLOCK OR SECTION HOUSE ( ). MOBILE HOME (,.....)/BUSINESS ( ) OTHER ( ) FHA-VA LOAN ( ) SEPTIC TANK: (SIZE Roo GALS) WATER SUPPLY: NO . BEDROOMS 3 NO FIXTURES )7:7 INDIVIDUAL PUBLIC GARBAGE DISPOSAL UNIT: YES ( ) NO ( t)/IF WELL, TYPE : BORED LRILLED DUG AUTO WASHING MACHINE : YES ( -Y.-NO ( ) DISTANCE FROM SEPTIC TANK OR NEAREST NITRIFICATION FIELD : 9-p O SQ . FT. POLLUTION : /oo '+-t- FT. 1) NUMBER OF LINES 3 SEPTIC TANK INSTALLED BY : 2) LENGTH AND WIDTH OF LINES -5;6-4° DeL....0J a) BED SYSTEM (� CERTIFICATE 0? COMPLETION ON BY: b) TRENCH SYSTEM ( ) $ _ __ —3). _DEP_TH-OF STONE- IN-LINES .i_Q f.'L._ REMARKS.:___. _ --------, -.------------,T--= --,- ----- ADEQUATE FALL (GRADE) ON : 1) BUILDING (HOUSE) SEWER LINE : YES ( ) NO { ) 2) NITRIFICATION LINES : DATE INSTALLED: 2,- /S - SO YES ( a------NO ( ) SEPTIC TANK LAYOUT 7/ 1 m tz / /a ' o H • '60 /7k/S" SJI "C -titS�o t yo Rai s Q�` HEALTH DEPARTMENT COPY (/(I(`� n/ ( CATAWBA COUNTY HEALTH DtPARTMENT ��, �� PROVEMENT'PERMIT FOR SEPTIC TANKS Permit No. 0 6 OF R , DATE . - $ - $Q DDRESS OF OWNER l.4-1� /3_,,,./.,54, f2 -J r A At— Al.C. . PHONE 2 9'1 - I( 3 3, • AME OF CONTRACTOR / ADDRESS DCATION 6L i l3/__tea<-o- f�J--,ii?-4- ../_ �` ci 7a J 7`r�?1 l` AY' a'n�' �„ a-..0 / UBDIVISION / LOT NO. SECTION OR BLOCK DT SIZE ,1 0 Dna-}-f-. FHA, VA LOAN - DUSE ( ) MOBILE HOME ( .S -B4lINESS ( ) OTHER ( ) SEPTIC TANK LAYOUT D. BEDROOMS (3) NO. FIXTURES ()/ ARBAGE DISPOSAL UNIT: YES ( ) NO (L.------ LULLING UNDER BASEMENT FLOOR: YES ( ) NO k — ft"- ' IZE OF TANK . ,!Ad tj LIQUID GALLONS ITRIFICATION FIELD: 1. Number of lines 3 . 0� Art.._t 2. Length and width of lines: u✓E tt. a. Bed System 906 (Co Ws ')ft. 120i { b. Trench system ft. 3. Total Depth of stone /0 '1/ inches 0 -S' oN NO ROUNDWATER INTERCEPTOR DRAIN: e-+ ' DoT (IF REQUIRED) ATER. .SUPPLY: .PRIVP.TE ( ._ . BLIC ( ) l -__ --_-- WNER NOTIFIED TO CHECK ZONING: YES (-3O ( ) � WNER AGREES WITH LAYOUT: YES (ENO ( ) 3 WNER AGREES WITH SPECIAL INSTRUCTIONS: YES i(�-NG ( ) I (0 ( X is WNER OR CONTRACTOR SIGNATURE G' , y, se ERMIT FEE $ 30. D0 ERMIT VOID AFTER 36 MONTHS SEPTIC TANK CONTRACTOR MUST FOLLOW ALL !U ROVEMENT PERMIT ISSUED BY DETAILS OF THIS PERMIT (LAYOUT) •ANITARIAN .ell.Ij . s yg. HEALTH DEPARTMENT COPY DIL CLASSIFICATION: SUITABLE ( ) PROVISIONALLY SUITABLE (.Y UNSUITABLE ( ) ITE FACTORS: . SLOPE (%) S - PS U 7. SOIL PERMEABILITY S -(g?- . SOIL TEXTURE (12-48 IN.) S ')/- U UNDER 60 MIN. - OVER 60 MIN. SANDY LOAMY CLAYEY 8. OTHER S -0S- i . SOIL STRUCTURE 12-48 IN. S PS U (SPECIFY) . SOIL DEPTH IN. S - Pc - U 9. SOIL SERIES : . RESTRICTIVE HORIZONS (IN.) S —Itigp U A. CECIL ( 4.----t. HIWASSEE ( ) (IMPERVIOUS STRATA, ROCK) C. MADISON ( ) D. APPLING ( ) . SOIL DRAINAGE - GROUNDWATER S -(S U E. PACOLET ( ) F. FLOOD PLAIN ( ) (EXTERNAL - INTERNAL) G. 2-1 CLAY SOIL H. OTHER-SPECIFY •