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HomeMy WebLinkAboutRBPR-06-2016-24094.TIF y14'A •G THIS IS NOT A PERMIT Case # RBPR-06-2016-24094 Q CATAWBA COUNTY HEALTH DEPARTMENT D o f 0 U k9� '° PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ?. 7842 SM Residential Building Plan Review - Modular o_ ' ro o • { IMPROVEMENT- AUTH CONST- NEW WELL �;e r o, -, �/)') 0 Contractor CLAYTON HOMES (BOBBI *LASAGE), PO BOX 132, TAYLORSVILLE NC 28681 C:8282I73168 JWHOLDER@nHOTMAIL.COM Owner TERRY LIDEY, 3719 RHONEY FARM RD, VALE,NC 28168 NAME TO APPEAR ON PERMIT TERRY LIDEY SITE ADDRESS: 6021 W NC 10 HWY, HICKORY NC 28602 PIN # 269801274107 NAME of SUBDIVISION: Lot Section/Block PROPERTY SIZE: Square Feet Acres 5.27 DIRECTIONS: Hwy 10 W,just past Plateau Rd, property on left PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: New off-frame modular, 30x60 w/Decks: front & back 6x6 and 24x24 attached garage w/ no bonus room, No basement 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:: Modular 30x60 w/decks: F&B 6x6&att garage 24x24 #OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO G9-eliapplicatlon 06/14/2016 13:43 Page 1 of4 ....rygA CATAWBA COUNTY Case# RBPR-06-2016-24094 fart. Public Health Department Subdivision Alain 4 ° y Environmental Health Division PIN# 269801274107 PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 lg.2 s. NAME ON PERMIT: (TERRY LIDEY), 3719 RHONEY FARM RD, VALE,NC 28168 ( TERRY LIDEY) Site Address: 6021 W NC 10 HWY, HICKORY NC 28602 Property Size: Square Feet Acres 5.27 Directions: Hwy 10 W,just past Plateau 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 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 I i j ( 1�1�I��� I t 1JI i, ' hII I (h�I 1�IIRII,1 bA,,r ROfl01�ffi1 flfl Itiwun Ma lIlldll� c 'FEEN'AME�� ��I-j�'IL.i.4hh `r�, ',u ,IMV 2a PIu II,'. �i 1�;IIULIDATE!,(" 'lit,FEE'{AMOUNT , Well Permit & Inspection Fee 06/14/2016 $300.00 Authorization to Construct Fee (New/Expansion) 06/14/2016 5150.00 Fee Improvement Permit Fee 06/14/2016 $150.00 I'i'I I , y h {l,.TOTAi FEES } r li ui jS60°00� higiu Wll 94 ,. i rLhIIlJ glaili lliv4u .k ihagim nmplai 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) 69-ehapplicmion 06/14/2016 13:43 Page 2 o14 ..1—t?* G THIS IS NOT A PERMIT Case # RBPR-06-2016-24094 � g` a � � d a a CATAWBA COUNTY HEALTH DEPARTMENT 0• . 0 �' �ao', '' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES r . iIF 1842 5M Residential Building Plan Review - Modular o •o -' 0 _p1 . ' IMPROVEMENT - AUTH CONST- NEW WELL •0 s• ��a n Contractor CLAYTON HOMES (BOBBI *LASAGE), PO BOX 132, TAYLORSVILLE NC 28681 C:8282173168 JWHOLDERrr)HOTMAIL.COM Owner TERRY LIDEY, 3719 RHONEY FARM RD, VALE, NC 28168 NAME TO APPEAR ON PERMIT TERRY LIDEY SITE ADDRESS: 6021 W NC 10 HWY, HICKORY NC 28602 PIN # 269801274107 NAME of SUBDIVISION: Lot ft Section/Block PROPERTY SIZE: Square Feet Acres 527 DIRECTIONS: Hwy 10 W,just past Plateau Rd, property on left PRIMARY.CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: New off-frame modular, 30x60, 3 bedroom, with 6x6 front and back decks, with 24x24 attached garage w/ no bonus room, No basement 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? WO 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: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 30x60 House and 24x24 Garage #OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO • E9-ehapplicruion 06/14/2016 10:57 Page 1 of 4 eA N CATAWBACOUNTY Case# RBPR-06-20 1 6-24 094 /gin,. Public Health Department Subdivision <(,rt Environmental Health Division PIN# 269801274107 �'� PO Box 389, 100-A Southwest Blvd.Newton,NC 28658 NAME ON PERMIT: (TERRY LIDEY), 3719 RHONEY FARM RD, VALE,NC 28168 ( TERRY LIDEY) Site Address: 6021 W NC 10 HWY. HICKORY NC 28602 Property Size: Square Feet Acres 5.27 Directions: Hwy 10 W,just past Plateau 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,a,nd label' g of all property lines and corners and making the site accespj$k so that a complete site evaluation can be performed. Date: CS/I 'L/(/� Signature of Applicant or Agent An nvironmental Health Specialist will contact you with work _days of application date. If you need further information or assistance please call 828-466-7291 AREA2 FEENAME ' DATE FEE AMOUNT -i Well Permit& Inspection Fee 06/14/2016 $300.00 Authorization to Construct Fee (New/Expansion) 06/14/2016 $150.00 Fee Improvement Permit Fee 06/14/2016 $150.00 • TOTAL PEES .,. , a.„'. 5600.00 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-ehappl(cation . 06/14/2016 10:57 Page 2 of4 CATAWBA THIS IS NOT A PERMIT COUNTY �- CATAWBA COUNTY HEALTH DEPARTMENT Page 1 Application for Environmental Services e Improvement Permit% Authorization to Co truct Septic Repair _ Septic Malfunction U Septic Expansion ❑ New Well Permit Replacement Well ❑ Well Abandonment❑ Well Repair U Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction Existing Facility n Property Address ho 21 U C5t- No 10 lit.O ti Subdivision 44(rit Oa , , NC c Stop I Lot# Acres Section/Block/Phase y, Driving Directions to Property ((e.,),,��0r� h c�5 �'I� CAt t — I9fril `.' C thIr, 'Q? W 4C • s/_ A_'—. A-._ _zl NAME TO APPEAR ON PERMIT? i4rOwner Applicant ❑ Contractor Applicant Contact Information Name 0jczr tot S e_LA tics-I - t Las a t. Address /, 0 Ccvjtt _et Alf op .-o Phone 32Z-2.4 2-3 /(De Cell Phone R2S-— a/ 7-3/[x8 Owner Contact Information Name —rP/Llz y L / /� / Address 00�/ ./ /VC r! um/ /Q i 11 Gt--cYZc NG Ot Lop 1 Phone -•82 F,- t/u 5 - gm() Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? U)Owner ❑ Applicant Contractor Description of Existing Structures on Site ,er v( },L/ GI # of Bedrooms *'t' Structure Dimensions #of Occupants Basement U Yes ❑ No Basement Fixtures ® Yes :A 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? 0 Yes %No Is any wastewater going to be generated on the site other than domestic sewage? CI Yes No Is the site subject to approval by any other public agency? O Yes 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? ** ❑ 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 ❑ Conventional ❑ Innovative ❑ Other MAny CATA\�j BA THIS IS NOT A PERMIT oounll CATAWBA COUNTY HEALTH DEPARTMENT No„„ Application for Environmental Services Page 2 (uo(i, Parr posed Facility Type 3 U " �J Primary Residence "New Residence ❑ Addition to Residence # of New Bedrooms *t/ \ Project Description _ 4,0 - (f Dar a ',At; ■A kJ C.. .Li a 2"-1 1-t Structure Dimensions 0 X(pc) # of Occu ants 3 Basement ❑ Yes No Basement Fixtures ® Yes No i I Accessory Structure(s) Describe # of New Bedrooms *.t. if applicable Structure Dimensions #of Occupants Accessory Dwelling Yes n No Plumbing ❑ Yes n 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.) n Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Church#of Seats Kitchen E Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type l Individual Well ❑ Semi-Public Well n Community Well Abandonment Type r Drilled ❑ 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. j 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 evaluation can be performed. friAt Signature of Owner or Agent .% Date {)Printed Name of Owner or Agent c J '.'/ t/15247‘..-- Catawba County Environmental Health rcA 0 1408.• 99 -,��i�%IA iti 41. 985 / ` to cm 0 } �9BS \ 799.90-5 \\ 97-5 See 970 N........................,...„,__ Parcel: 269801274107, 6021 W NC 10 HWY 1in=80ft 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 06/14/2016 Catawba County Environmental Health `13) 1 i I',.,1 I ,) d r 1 A14. �l I c� i II r 1404 No •e � ,, if ' / (140 ,„,,,,16 Nik, / J ....„ 2 , (11 oCr (483) a / 1 0•00 0411/4 1.1.111t / Peallikir 1111.111 14 \ .rl/ 7,--------- \-. Parcel: 269801274107, 6021 W NC 10 HWY 1 in=150ft 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 06/14/2016 Parcel Report Page 1 of 1 • Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 269801274107 Owner: LIDEY TERRY LEE Parcel Address: 6021 W NC 10 HWY Owner2: LIDEY LUCINDA JOHNSON City: HICKORY, 28602 Address: 3719 RHONEY FARM RD LRK(REID): 70011 Address2: null Deed Book/Page: 3242/0629 City: VALE Subdivision: State/Zip: NC 28168-8983 Lots/Block: / School Information: Last Sale: $32,000 on 2014-05-29 Plat Book/Page: 63/69 School District: COUNTY Elementary School: BANOAK Legal: PLAT 63-69 Middle School: JACOBS FORK Calculated Acreage: 5.270 Tax Map: 005 B 07009A High School: FRED T FOARD Township: BANDYS School Map State Road #: 10 TaxNalue 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: Land Value: $20,600 Zoning3: Assessed Total Value: $20,600 Zoning Overlay: Year Built/Remodeled: null/null Small Area: PLATEAU 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 #: 3710269800J Building Details 2010 Census Block: 3005 WaterShed: null 2010 Census Tract: 011802 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/repod 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. Dth -ciT ? Rot 0 3 W-17) 3 Bei\ lotALS- Afieltdboo5e Zqf 2C1 http://gis.catawbacountync.gov/nomap/parcel_report.php?key=269801274107&typ=P 6/14/2016