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HomeMy WebLinkAboutRBPR-04-2016-23689.TIF • $A �G THIS IS NOT A PERMIT Case# RBPR-04 2016-23689 f-4 "°I p _ y CATAWBA COUNTY HEALTH DEPARTMENT 0 y�oy _ / PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES a': 'r i /80 sM Residential Building Plan Review - Building New o h o o T� IMPROVEMENT- AUTH_CONST .; • Applicant ADRA t3ACA, 2076 MOSTELLER ESTATE AV SE, HICKORY NC 28602 H:6074380012 C:5857559049 HOME:6074380012 Owner ANDREW RIEDER, 804 WYNNSHIRE DR APT A, HICKORY NC 28601 NAME TO APPEAR ON PERMIT Adra Baca SITE ADDRESS: 4013 4TH ST LN NW, HICKORY NC 28601 PIN # 370520904009 NAME of SUBDIVISION: MANLEY K FULLER, JR TRUSTEES Lot# 1 Section/Block PROPERTY SIZE: Square Feet Acres _ 0.65 DIRECTIONS: 1-40, ext 126 McDonald Parkway SE, head North, continue on to 24th St NE, to 29th Av Dr NE, right on N Center St, left on 39th Av Dr NW left on 4th St Ln NW, second lot on left PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Public Water DESCRIBE WORK: 1 1/2 story dwelling w/walkout basement(4 bedrooms) 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: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 61 x 70 #OF NEW BEDROOMS:: 4 BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED?Yes Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: • ALTERNATIVE: CONVENTIONAL: YES OTHER: INNOVATIVE: ANY: Other described: E9-ehapplication 04/19/2016 17:04 Page 1 of5 3ye CATAWBA COUNTY Case p RBPR-04-2016-23689 i Public Health Department Subdivision 2 MANLEY K FULLER, JR TRUS- ada '"1 Environmental Health Division PINdI 719 ov Y 370520904009 PO Box 389, 100-A Southwest Blvd,Newton, NC 28658 NAME ON PERMIT: (ADRA BACA), 2076 MOSTELLER ESTATE AV SE, HICKORY NC 28602 ( Adra Baca) Site Address: 4013 4TH ST LN NW, HICKORY NC 28601 Property Size: Square Feet Acres 0.65 Directions: 1-40, ext 126 McDonald Parkway SE, head North, continue on to 24th St NE, to 29th Av Dr NE, right on N Center St, left on 39th Av Dr NW left on 4th St Ln NW, second lot 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 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 a i —7i'--- j ss 1{airy FEENAME'.' t i Authorization to Construct Fee (New/Expansion) 04/19/2016 $300.00 Fee Improvement Permit Fee 04/19/2016 $150.00 1 - 101. sTOTAL FEES ., "=v* „':-' u $450 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 04/19/2016 17:04 Page 2 of 5 C TL�Vd riA THIS IS NOT A PERMIT T5``�c�0.S @ earnl� COUNTY v v ay. CATAWBA COUNTY HEALTH DEPARTMENT Hoot,Cerellne Application for Environmental Services Page 1 Pe, qdalet x-�;y��" Improvement Permit ® Authorization to Construct 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 ❑ Property Address 4013 4th St. Ln NW Subdivision Lakegrove Hickory, NC 28601 Lot# 79 Acres 0.65 Section/BIocWPhase Driving Directions to Property From 1-40 take exit 126 onto McDonald Parkway SE, Head North on McDonald Parkway SE.Continue on to 24th St NE Continue on to 29th Ave Dr NE. Turn right onto N Center St. (127). Turn left onto 39th Ave Dr. NW. Turn left onto 4th St Ln NW Second lot on the left side NAME TO APPEAR ON PERMIT? ❑ Owner Id Applicant ❑ Contractor Applicant Contact Information Name Adra S. Baca Address 2076 Mosteller Estate Ave SE Hickory, NC 28602 Phone 607-438-0012 Cell Phone585-755-9049 Owner Contact Information NameAndrew Rieder Address 804 Wynnshire Drive Apt. A, Hickory, NC 28601 Phone Cell Phone Contractor Contact Information - Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner 3 Applicant ❑ Contractor • Description of Existing Structures on Site None # of Bedrooms *j' Structure Dimensions # of Occupants Basement 0 Yes 0 No Basement Fixtures Q 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 0 No Does the site contain any jurisdictional wetlands? ❑ Yes El No Does the site contain any existing wastewater systems? Q Yes 0 No Is any wastewater going to be generated on the site other than domestic sewage? CI Yes 0 No Is the site subject to approval by any other public agency? o Yes ID No Are there any easements or right of ways on this property? Describe easement for future utilities Existing water supply in use U Individual Well Li Community Well U Semi-Public Well 0 County/City/fownship Water Line Is a public water supply available? ** r, 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 1E1 Conventional ❑ Innovative ❑ Other ❑ Any CATAWBA jll A THIS IS NOT A PERMIT COUNTY LL �V'I! E� CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Nafh Canal Proposed Facility Type ® Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *t 4 Project Description 4 bedroom 1.5 story house with walkout basement, 2700 square feet heated Structure Dimensions 60.5'x 69.5' # of Occupants 3 Basement '!'4 Yes ® No Basement Fixtures O Yes a No LI Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling 0 Yes 0 No Plumbing ® Yes ® No Describe Plumbing Needed LI Multi-Family Residence# Units #Bedrooms per Unit*t Total #Bedrooms *t Structure Dimensions LI Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) # Employees per Shift # of Shifts Dining Area (Sq. Ft.) LI Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Church # of Seats Kitchen 0 Yes 0 No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ® Yes 0 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 4- S. / A Date T/g/1‘0, Printed Name of Owner or Agent Ad ra S , e6a ecu �LLSL•IY♦ LAC 1. vv v...rt....u. meal tstale bearcn Information Services 158.89 • 4Th ST LN NW 129.55 '...°It. , 46.60 4 ,z7d/ / 123.6 6 ' ' ,i 60.04 ii ' ' 1 °ik o 13 i 55, I )--1,12.2..u,i .. deck So' f i 8 • 143:31 1 60.83 • --�.. 54.73 i+!:..,, 739THAVDRNW . CT"-..1/2-..... .." N w±e 1in=50ft s Parcel: 370520904009, 4013 4TH ST LN NW HICKORY, 28601 Owners: RIEDER ANDREW, RIEDER MARIE Owner Address: 804 WYNNSHIRE DR APT A Values - Building(s): $0, Land: $68,300, Total: $68,300 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. Catawba County Environmental Health x4.17 „ /! IS.. I I I 10,00 } 1.87 158.89 4TH ST LN NW 129.55 55 i � . I 46.60 50.02 I 123.86 I ' 60.04 i I . I I 1 I I I I 7 i S I 91 i i i 1 I 1 1 • r 1 1 1 1 i t t 60.83 1 i 54.73 i • 57.19 ,39TH AV DR NW • Parcel: 370520904009, 4013 4TH ST LN NW 1 in=50ft HICKORY, 28601 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. Coovriaht 2314 Catawba County NC Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 370520904009 Owner: RIEDER ANDREW Parcel Address: 4013 4TH ST LN NW Owner2: RIEDER MARIE City: HICKORY, 28601 Address: 804 WYNNSHIRE DR APT A LRK(REID): 92394 Address2: null Deed Book/Page: 2064/0602 City: HICKORY Subdivision: MANLEY K FULLER, JR TRUSTEES State/Zip: NC 28601-7346 Lots/Block: 1/ null Last Sale: $60,500 on 1998-01-01 School Information: Plat Book/Page: 31/63 School District: HICKORY Legal: LOT 1 TR 1 PL 31-63 PL 31-63 Elementary School: JENKINS Middle School: NORTHVIEW Calculated Acreage: .650 Tax Map: 200H 01144A High School: HICKORY Township: HICKORY School Map 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: $68,300 Zoning3: null Assessed Total Value: $68,300 Zoning Overlay: null Year Built/Remodeled: null/null Small Area: null 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 #: null Building Details 2010 Census Block: 1026 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 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. New&pc, pis() fr -J cf6A 41o3PI http://gis.catawbacountync.gov/nomap/parcel_report.php?key=370520904009&typ=P 4/12/2016