Loading...
HomeMy WebLinkAboutRBPR-06-2016-24073.TIF THIS IS NOT A PERMIT Case # RBPR-06-2016-24073 m� CATAWBA COUNTY HEALTH DEPARTMENT U v "�U PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES . . ' • l JS42 sM Residential Building Plan Review - Building New • o;. '•o -+ o IMPROVEMENT - AUTH CONST • a o o" Contractor SAME AS OWNER. . Owner TERRELL SETZER, 1469 ZION CH RD, HICKORY NC 28601 C:82 83 1207 12 NAME TO APPEAR ON PERMIT TERRELL SETZER SITE ADDRESS: 4851 HICKORY LINCOLNTON HWY, LINCOLNTON NC 28092 PIN # 361701270521 NAME of SUBDIVISION: Lot# PT 1-4 Section/Block PROPERTY SIZE: Square Feet Acres 17.66 DIRECTIONS: Hwy 10 to Hickory Linc Hwy, turn left 3 miles on right PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: New 72x77 single family dwelling, 3 bedroom, 360 gpd, 5230 sq ft, with unfinished basement, attached garage with no bonus room 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 EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 30x30 Barn NUMBER OF EXISTING BEDROOMS: -#OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 72x77 single family #OF NEW BEDROOMS:: 3 BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED?Yes Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-ehapplication 06/09/2016 16:20 Page 1 of4 CATAW BA COUNTY Case# RBPR-06-2016-24073 �1- Public Health Department Subdivision t `4, Environmental Health Division PIN# Q.= ^C 361701270521 PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 Ig 2 sM NAME ON PERMIT: (TERRELL SETZER), 1469 ZION CH RD, HICKORY NC 28601 ( TERRELL SETZER) Site Address: 4851 HICKORY LINCOLNTON HWY, LINCOLNTON NC 28092 Property Size: Square Feet Acres 17.66 Directions: Hwy 10 to Hickory Linc Hwy, turn left 3 miles on right 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 identificatiopn and labelin}of a l l property lines and corners and making the site acces i sot t a c I e site evaluation can be performed. Date: (D — — / 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 FEENAME DATE FEE AMOUNT Authorization to Construct Fee (New/Expansion) 06/09/2016 S150.00 Fee Improvement Permit Fee 06/09/2016 5150.00 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-ehapplication 06/09/2016 16.20 Page 2 of 4 CAT/� 1 }1' THIS IS NOT A PERMIT ` '"` "� - �� � CATAWBA COUNTY HEALTH DEPARTMENT 1 „�o;��c Application for Environmental Services Page 1 Improvement Permit Authorization to Construct Septic Repair❑ Septic Malfunction❑ Septic Expansion ❑ New Well Permit n Rep ace ent Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction xisting Facility 7 G I Property Address t p 5 ( c /Cv A l vrCD I kv l subdivision Lot# Acres Section/Block/Phase Directions to Property iA 4J ( 0 14`c k ki f (Lyn_ (-SA- 3 ;tom 0 > q NAME TO APPEAR ON PERMIT? %Owner ❑ Applicant El Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name"-fevvcll 5-c±zeR LL Address ) t{Gcl 2(e•v Ck4�,ck tZC (f Lc 1<am i(JC 2s�c� 2 Phone q2 5, 3( 2 3 2 ( 2_ Cell Phone 5-2_cI 3 I z is 7 12 Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? wner ❑ Applicant ❑ Contractor Description of Existing Structures on Site 1 ,(1\ J3oC ( #of Bedrooms *j' Structure Dimensions #of Occupants Basement ❑ Yes ❑ No Basement Fixtures Q Yes ® No r 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. O Yes *o Does the site contain any jurisdictional wetlands? © Yes KiroiCo Does the site contain any existing wastewater systems? ID Yes 9To Is any wastewater going to be generated on the site other than domestic sewage? ® Yes ■o Is the site subject to approval by any other public agency? Yes eo Are there any easements or right of ways on this property? Describe Existing water supply in use ! Individual Well ❑ Community Well El Semi-Public Well County/City/Township Water Line Is a public water supply available? ** 110eYes ❑ 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) L/ ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other ` Any CATAWBA THIS IS NOT APERMIT , lLWC1JLy__ CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type n Primary Residence e/New Residence n Addition to Residence # of New Bedrooms *t 3 Project Description µcQ(45."e- N4.— Structure Dimensions 72 Y 77 # of Occupants Basement Yes I No Basement Fixtures ltes C2 No n Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing I I Yes H No Describe Plumbing Needed Multi-Family Residence#Units ((Bedrooms per Unit*t Total# Bedrooms *t Structure Dimensions I I Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) # Employees per Shift #of Shifts Dining Area (Sq. Ft.) (I Business Specific Type of Business Retail Floor Space #of Employees per Shift # of Shifts n Other Facility Type Specify If Church # of Seats Kitchen ❑ Yes r No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well n Semi-Public Well n Community Well Abandonment Type ❑ Drilled n Bored ❑ Dug n 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 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 RETRH'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 a a / �' Date �f is S yl` Printed Name of Owner or Agent l�-��VL c LeV� Catawba County Environmental Health 4827 Ili , S (238 vs Nsii Cke `2a61 / / • . J A ( . •4651 r 15t . 35 2^ ‘ ( 414 \ diet Lit' </ / •3629 (� ` / 7 *s.,A / ,G / yP / _a0 r / C` / irk 0 /` 32 0 / • 263M • / / / Parcel: 361701270521, 3687 WARD LN / tin=80ft LINCOLNTON, 28092 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 06/09/2016 Catawba County Environmental Health ike.0 it 0 ... r kik r y 1$'r, la ' o o� (1:9: o �$ >s y / ta r El 1 ` 8So w y i Y,PRp 04 65�` e 4 t _;15 t,a to 2:9�, A3:'9 .: • L 655 y • nO :), , 9� *1/87 u •48 'p / .L 30/ A � G,+ e� yPa„ ... 0 00:. ;” 3jdl 044.ciki, a J:: 011110 !! 0 ; )11 ( 8 4er 7 _______.----C\__ ._ Parcel: 361701270521, 3687 WARD LN 1 in=300ft LINCOLNTON, 28092 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 maplreport product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 06/09/2016 Parcel Report Page 1 of 1 Parcel Report- Catawba County NC Parcel Information: Owner Information: Parcel ID: 361701270521 Owner: SETZER TERRELL H Parcel Address: 3687 WARD LN Owner2: SETZER SUSAN P City: LINCOLNTON, 28092 Address: 1469 ZION CHURCH RD LRK(REID): 9870 Address2: null Deed Book/Page: 2399/0640 City: HICKORY Subdivision: State/Zip: NC 28602-9112 Lots/Block: PT 1-4/ School Information: Last Sale: School District: COUNTY Plat Book/Page: 56/1 Legal: LOT 4 PL 56-1 Elementary School: BLACKBURN Middle School: JACOBS FORK Calculated Acreage: 17.660 Tax Map: 010 J 04032 High School: FRED T FOARD School Map Township: JACOBS FORK State Road #: 1008 Tax/value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: PROPST Zoningl: R-40 Building(s) Value: $0 Zoning2: null Land Value: $33,600 Zoning3: null Assessed Total Value: $6,000 Zoning Overlay: null Use Land Value: $6,000 Small Area: PLATEAU Year Built/Remodeled: null/null Split Zoning Districts: null/null Current Tax Bill Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710360600J Building Details 2010 Census Block: 1045 WaterShed: null 2010 Census Tract: 011702 Voter Precinct: P3 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. ©2016, Catawba County Government, North Carolina. All rights reserved. EM I"fell C� a'D,48, 4300 t\INAAdr6S LI i 5\-1 iii i-+t 3 Tam 3 .SH1 1�'�� Lncdrvin zP2 z httn•//cric catawharnnntvnaanv/nnman nac rcel renort.nhn?kev=361701270521&tvn=P 6/9/2016