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HomeMy WebLinkAboutEHPR-05-2016-23800 (2).TIF qA THIS IS NOT A PERMIT Case# EHPR-05-2016-23800 ' OI rl "�•f0 v ; tsv11 CATAWBA COUNTY HEALTH DEPARTMENT o• 111 .. PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES . I842 sM Environmental IIealth Plan Review - OSWP to ?OA' en • -� o f 4 IMPROVEMENT O Y. Applicant PAUL MAJOR, 1615 MAGNUM RD, HICKORY NC 28602 H:8285141423 C:8285140996 HOME:8285141423 Owner BARRY DELLINGER, 5150 RUTH DR, HICKORY NC 28602 NAME TO APPEAR ON PERMIT Paul Major SITE ADDRESS: 1765 WALLACE DAIRY RD, HICKORY NC 28602 PIN # 279120901883 NAME of SUBDIVISION: Lot# A Section/Block PROPERTY SIZE: Square Peet 18,730.80 Acres 0.43 DIRECTIONS: Hwy 127 South, Zion Church Rd, Left at Walgreens onto Wallace Dairy Rd, 3/4 mile on Left at bottom of the hill. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 240 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 Vacant Lot EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 48x30 #OF NEW BEDROOMS:: 2 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: P9-ehapplication 05/05/2016 11:37 Page 1 of 4 ..%\-5A CATAWBA COUNTY Case a EHPR-05-2016-23800 `Q r.�:,�y Public Health Department Subdivision 4� �: Environmental Health Division PIN# 279120901883 '"u� PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 18,2 ,. NAME ON PERMIT: ( PAUL MAJOR), 1615 MAGNUM RD, HICKORY NC 28602 ( Paul Major) Site Address: 1765 WALLACE DAIRY RD, HICKORY NC 28602 Property Size: Square Feet 18,730.80 Acres 0.43 Directions: Hwy 127 South, Zion Church Rd, Left at Walgreens onto Wallace Dairy Rd, 3/4 mile on Left at bottom of the hill. 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 an. orrect. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws • • rules. I nde s = d that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site acce.. 's. t -tf co • - Is' . - ii ationr can be performed.• Date: S - 7 Signature of Applicant or Agent ALL An Environmental Health Specialist will contact you within 5 working days of app.Aation date. If you need further information or assistance please call 828-466-7291 AREA2 �FFEN,777, 1i;n�s llY !tloppilLuw„�i�� i474 Imip; vi jkC)! u . N)i l j�i� "n411�1 iior l �(���i� ,l iSI I l;l IODATE'( „ �FEPAMOUNT Improvement Permit Fee 05/05/2016 $150.00 �I pf. l i l 1TOTA ?FEES ,r � t ,fl'I 011Illi1l 11llt iI(ll k 1Il1l Ill' l$]5 0Y0 , :. } rim. .,l ytW211WW r��W ,nr J JA t: tlP! llulu9u aladU1 , .j11U1 flA ' -"PUWI{Ulys ` 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-ehapplicahon 05/05/2016 11:37 Page 2 of 4 CATAWBA THIS IS NOT A PERMIT COUNTY rn = CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Norlh Cwrolu.. Improvement Permit J'. Authorization to Construct ❑ Septic Repair IT Septic Malfunction IT Septic Expansion IT New Well Permit IT Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) Application is for New Construction 4 Existing Facility ❑ Property Address /77c e Dfl, yfl Subdivision / //�— /�/GKcEy /Vic , Lot# Acres , Section/Bloch/Phase Driving Directions to Property _AO U/ ' i • / c • ! A .Si el_ NAME TO APPEAR ON PERMIT? X Owner IT Applicant ❑ Contractor Applicant Contact Information Name rgUL gT1j2 /� Address /l75-4/4—a ftwi? /C/7- � mce-404), Phone Cell Phone 2,e1, 574L Owner Contact Information / .8 - - / a,3 Name _52977,4 -- 45 A--A/5 V '\\ Address Phone Cell Phone Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? IT Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site \/(eel{ ( C3� # of Bedrooms *t Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures IT 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 F No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes Lg No Is the site subject to approval by any other public agency? ❑ Yes EX 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 Water Line Is a public water supply available? **X" 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) \V❑Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other $ Any cArrAj'( BA THIS IS NOT A PERMIT COUNTY • 17 CATAWBA COUNTY HEALTH DEPARTMENT North Application for Environmental Services Page 2 Proposed Facility Type Primary Residence ❑ New Residence _ Addition to Residence #of New Bedrooms *t Z Project Description 44 f% _z - Structure Dimensions%Li i ,apt _ # of Occupants ,{ Basement H Yes X No Basement Fixtures n Yes W No ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes H No Plumbing H 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 # 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 H Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type n Individual Well H Semi-Public Well I Community Well Abandonment Type H Drilled ❑ Bored ❑ Dug H Unknown Well Repair Requested U Yes H 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 dine of building permit issuance. This may prevent the need for septic system size increase in the future. 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 infonnation 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 / G�� % Date 51 Printed Name of Owner or Agent ,'*tlL /14/9c/o,k Catawba County Environmental Health (---- t � cy o° o° ti 41. oo ^ . °. lee'00 • r ¢O 4,4:y OR s'Q CJ ^�. o. Q Parcel: 279120901883, 1765 E DAIRY tin=50ft RD 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 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 04/2812016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 279120901883 Owner: DELLINGER BARRY WILLIAM Parcel Address: 1765 WALLACE DAIRY RD Owner2: null City: HICKORY, 28602 Address: 5150 RUTH DR LRK(REID): 48069 Address2: null Deed Book/Page: 1646/0286 City: HICKORY Subdivision: null State/Zip: NC 28602-9450 Lots/Block: A/null Last Sale: $5,500 on 1989-12-01 School Information: Plat Book/Page: 26/133 School District: COUNTY Legal: LOT A A P26-133 WALLACE DA PL 26- Elementary School: MOUNTAIN VIEW Middle School: JACOBS FORK 133 Calculated Acreage: .430 High School: FRED T FOARD Tax Map: 132H 01015U School Map Township: HICKORY State Road #: 1177 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: MOUNTAIN VIEW Zoningl: R-20 Building(s) Value: $0 Zoning2: null Land Value: $10,300 Zoning3: null Assessed Total Value: $10,300 Zoning Overlay: 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 #: 3710279100J Building Details 2010 Census Block: 2026 WaterShed: null 2010 Census Tract: 011102 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,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. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=279120901883&typ=P 5/5/2016 y14'A • CATAWBA COUNTY 100A SOUTHWEST BLVD /� , r i NEWTON,NORTH CAROLINA 28658 RECEIPT I' W P,_....F 1 C� `islt; o PHONE: 828.465.8399 Thursday, May 5, 2016 win $ /842 SM www.catawbacountync.gov PAYOR: Major, Paul PAYMENTS TRANSACTION NUMBER: MC-667311-05-05-2016 PAYMENT DATE : 05/05/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 05-16-328041 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EHPR-05-2016-23800 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 1765 WALLACE DAIRY RD, HICKORY NC 28602 Applicant PAUL MAJOR, 1615 MAGNUM RD, HICKORY NC 28602 H:8285141423C:8285140996 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner BARRY DELLINGER, 5150 RUTH DR,HICKORY NC 28602 receipt 05/05/2016 11:37 Page 1 of 1