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HomeMy WebLinkAboutRBPR-06-2016-24126.TIF vS�A *G THIS IS NOT A PERMIT Case # RBPR-06-20 1 6-24 1 26 Ein '1st; CATAWBA CATAWBA COUNTY HEALTH DEPARTMENT U . a* Y f D n PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Nits st, Residential Building Plan Review - Building New qo ro v X YEN: . AUTH_CONST • Owner HOLLY LYNNE HALFORD, 2705 N CENTER ST APT 32, HICKORY NC 28601 H:8285691836 C:8285146746 HOME:8285691836 NAME TO APPEAR ON PERMIT Holly Lynne Halford SITE ADDRESS: 4205 WILSON RI), VALE NC 28168 PIN # 268704501375 NAME of SUBDIVISION: Lot# Section/Mock- PROPERTY SIZE: Square Feet Acres 12.79 DIRECTIONS: 10 W/left Banoak Rd/left Wilson Rd/approx 1 mile/right onto gravel driveway/to top of driveway/then to far right at double silver gates PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY : Private Well DESCRIBE WORK: new dwelling /no garage/ no basement 33 x 43 / no zoning permit issued at this time (ok per Chris T.) will be approx 1 year before construction will begin 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 Barn , well house & shed at front of property EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 33 x 43 #OF NEW BEDROOMS:: 2 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: E9-ehapplieation 06/17/2016 IS II Page I of 4 a¢A CATAW BA COUNTY Case RBPR-06-2016-24126 :vita.z Public Health Department Subdivision dyw;,< Environmental Health Division PIN# 268704501375 PO Box 389, 100-A Southwest Blvd, Newton. NC 28658 lg.2 sM NAME ON PERMIT: ( HOLLY LYNNE HALFORD),2705 N CENTER ST APT 32, HICKORY NC 28601 ( Holly Lynne Halford) Site Address: 4205 WILSON RD. VALE NC 28168 Property Size: Square Feet Acres 12.79 Directions: 10 W/left Banoak Rd/left Wilson Rd/approx 1 mile/right onto gravel driveway/to top of driveway/then to far right at double silver gates 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 corn lete s e evaluation can be performed. Date: 6-/7—/Le Signature of Applicant or Agent 71 7 An Environmental Health Specialist will contact you within 5-v4orking days of application date. If you need further information or assistance please call 828-466-7291 AREA2 FEENAME - DATE ' ,.FEE E AMOUNT: Authorization to Construct Fee (New/Expansion) 06/17/2016 $150.00 Fee r �p( 1 TOTAL FECSr z $150.00T L t 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 06/17/2016 15.11 Page 2 of 4 CAT•A��G 71R A THIS IS NOT A PERMIT coul\�1t.I�ID�I�Y IL➢ CATAWBA COUNTY HEALTH DEPARTMENT T"`i „b„h oor. Application for Environmental Services Page 1 Improvement Permit Authorization to Construct)( Septic Repair❑ Septic Malfunction [J Septic Expansion ❑ New Well Permit In Replacement Well ❑ Well Abandonment ❑ Well Repair El Existing System Inspection (Pre-Approval Required) E Application is for New Construction Existing Facility ❑ Property Address 4)5 lS16(v(( i) ValJ /cC Subdivision 4\ nl�ic Lot# Acres %a Section/Bplooyckp/Phase p Driving Directions to Property Al /0 U,e6---k; Lo ( at TYJ' P Po m#:*4 m• .grt j•r . Is,... o - 1 (l NAME TO APPEAR ON-PERMIT? 7 Owner , ❑ Applicant ❑ Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information _.1Name +`�, I ) , 4 d� nR4 // Address �y�Ci 7S. Ce eRS} 3, (�1\1)/N�- a)Ub i Phone Cell Phone gVH/C/-10]4,/({ Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? [ 5wner U Applicant Contractor Description of Existing Structures on Site' cn fly � ` ?��—• #of Bedrooms *t Structure Dimensions #of Occupants Or} (. 3,.( Basement ❑ Yes ❑ No Basement Fixtures Q Yes 0 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 D'No Does the site contain any jurisdictional wetlands? 0 Yes l—N'o Does the site contain any existing wastewater systems? O Yes O,,�y'N,�o Is any wastewater going to be generated on the site other than domestic sewage? Yes ;WO_ Js the site subject to approval by any other public agency? O Yes t3-]4o Are there any easements or right of ways on this property? Describe Existing water supply in use i Individual Well in Community Well n Semi-Public Well County/City/Township Water Line Is a public water supply available? ** ❑ Yes ❑ No 1 If applying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s): If can be ranked in order of your preference) V/ ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other O/Any CC`,LN,t tY" CATAWBA COUNTY HEALTH DEPARTMENT �- �� Application for Environmental Services Page 2 Proposed Facility Type �/ ❑ Primary Residence M New Residence ❑ Addition to Residence # of New Bedrooms *i.9, Project Description 1..),'Q.l-D thi +211;'6, ND Sc Structure Dimensions 3S x 2-)3 I # of Occupants 9 Basement n Yes D'No Basement Fixtures ® Yes D No Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling n Yes n No Plumbing _ Yes n No Describe Plumbing Needed I I Multi-Family Residence#Units #Bedrooms per Unit*t Total#Bedrooms *t Structure Dimensions El 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 E Other Facility Type Specify If Church# of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well I Community Well Abandonment Type n Drilled ❑ Bored n 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 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 �l r�, (we Date 70-7 �LO Printed Name of Owner or Agent g_td ly /, Ha(- ofrSo I ;It nis': e .tea Via^ 4 , .,r, is'ga <'u:.#N!•5 + .✓f. ._.�`•`L'.k' i x":Tx55 +'s. x?5.';.�:km .J,x,., a., «?errala;`+ re°«.i,€+ur :::; E41PR 04-2016-23587 4205 Wilson Rd, Vale • Do not cut, drive, fill, or grade over septic or repair areas. • This is an improvement permit only and is not intended for septic installation purposes. thin hack ef, . �� 61e tEC .< wtlsa� or- J \ Ilay== ILS:1 Nu,x ll �sy yr ` 1 t CP ti Catawba County Environmental Health, „ ....*„. • J lQ d ` c as * fl cg i s o • l► }, ❑ * P y 44 jorift . r IS .„,rit r , OH ilr III e r oli, . • All, 454) Qpp I 40 >h W. trill t 55 .■ / d/r\ Parcel: 268704501375, 4205 WILSON RD VALE, 1in=200ft 28168 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 06/17/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 268704501375 Owner: HALFORD HOLLY L Parcel Address: 4205 WILSON RD Owner2: null City: VALE, 28168 Address: 2705 N CENTER ST APT 32 LRK(REID): 13731 Address2: null Deed Book/Page: 3179/0002 City: HICKORY Subdivision: State/Zip: NC 28601-1344 Lots/Block: / Last Sale: $40,000 on 2013-03-22 School Information: School District: COUNTY Plat Book/Page: Elementary School: BANOAK Legal: RD 2043 WILSON RD Middle School: JACOBS FORK Calculated Acreage: 12.790 High School: FRED T FOARD Tax Map: 013 B 04015 Township: BANDYS School Map State Road #: 2043 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: $500 Zoning2: Land Value: $55,400 Zoning3: Assessed Total Value: $55,900 Zoning Overlay: DWMH-O 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 #: 3710268600J Building Details 2010 Census Block: 3019 WaterShed: null 2010 Census Tract: 011802 Voter Precinct: P2 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 Goospatial 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 shalt 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. i( # 159 �( � 2 zeal Zqo http://gis.catawbacountync.gov/nomap/parcel_report.php?key=268704501375&typ=P 6/17/2016 4 CATAWBA COUNTY 0: 111 g 0 Cased IMPV-05-2016-072900 /+ OA Public Health Department T , •r�y��d Subdivision ¢I c�,i4 Environmental health Division iL ' r� PINii 268704501375 �Oe�Y % PO Box 339, 100-A Southwest Blvd,Newton.NC 23658 ' d{• 't , LO I N of . 1 NAME ON PERMIT: HOLLY LYNNE HALFORD, 2705 N CENTER ST APT 32, HICKORY NC 28601 Site Address: 4205 WILSON RD, VALE NC 28168 Property Size: Square Feet:557,132.40 Acres:12.79 Directions: Hwy 10 west, Left onto Banoak Rd beside Banoak Elementary School, Travel about 1 mile, Left onto Wilson Rd, about .6 mile Right onto gravel driveway. Go to top of driveway, Go to the far Right at double silver gates. Improvement Permit Facility: Primary Residence Permit Category: New Septic Bedrooms 2 WATER SUPPLY: Private Well Basement? No Basement Plumbing? No INITIAL SYSTEM SPECIFICATIONS Permit Valid: Expires In Five Years: _X_ No Expiration: Projected Daily Flow 240 g.p.d Proposed Wastewater System: 25% REDUCTION Type: l[IG - OTHER NON-CONY TRENCH SYSTEMS Permit Conditions: REPAIR SYSTEM SPECIFICATIONS Repair System Required? Required Proposed Wastewater System: 25% REDUCTION Type: IIIG -OTHER NON-CONV TRENCH SYSTEMS Landscaping or other site alterations Clot potentially divert groundwater at surface water toward the septic system, or prevent proper drainage away from the septic system. including the direction of gutter flows or foundation drains,is not approved,and may result in failure to approve the initial system installation. or the suspension/revocation of existna permits. The issuance or this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the applicanl'property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are met. This Improvement Permit is subject to revocation if the site plan,plat or the intended use changes,or if site conditions are altered. The Improvement Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina 'Lou's am/Rules jar Sewage Treatment and Disposal Systems' (15A N'CAC 18A .1900). Neither Cutlass ha County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for any given period of ti me. Steven Price 05/31/2016 AUTHORIZED STATE AGENT APPROVAL DAIL 05/28/2021 Permit`expiration Date: No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Deportment. ehpetmii 05/31/2016 13:17 Page 1 ol'3 t sx.p w Yt^. b ,4" Z` - °°'' ' {t�-4 R .<5 Y $?5?�*. X�zGd�i'a ..5 r•`•.;. avle,'.''+.e�x?t��i f..f;,�.f.� u�m�.N:3:.. • _�;• i5:c_ e w.�i:';:,�� .: .r. -r eye c<ti.,..�ra-n .a.:...- a3 .r_r. #., EHPR 04-2016-23587 4205 Wilson Rd, Vale • Do not cut, drive, fill, or grade over septic or repair areas. • This is art improvement permit only and is not intended for septic installation purposes. 61" fe w;tSc1 e • tt�� 11Wx 41 pry of lJo° . , ' N'I /— J DEPARTMENT OF HEALTH AND HUMAN SERVICES OC{� 6 _ 2-35111 Sheet ( of! D[VISION OF PUBLIC HEALTH,ENVrROENTAL IIEALTH SECTION L��� PROPERTY[D it ON-SEE WATER PRO'IECrION BRANCH COUNTY:_Catawba_ SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM // 1D,,1 (Complete all fields in MI) OWNER:_ PA I 1 14 __ APPLICATION DATE ADDRESS: DATE EVALUATED: '04 PROPOSED FACILITY: 2.64- PROPOSED DESIGN FLOW(.1949): 2'(o PROPERTY SIZE: LOCATION OF SITE: 9 L •r LJ C fso-. /4 _ PROPERTY RECORDED: WATER SUPPLY: 0 Private 0 Public t well 0 Spring 0 Other EVALUATION METHOD: 0 Auger Boring r.Pit 0 Cut TYPE OF WASTEWATER: X.Sewage 0 Industrial Process 0 Mixed o SOIL MORPHOLOGY OTHER `:'F, (1941) PROFILE FACTORS `. .L :[ 1940:. .•, -) LAnDSCAPE IIORIYON ` E - - PROFILE POS1T10N/y' •DEPT 11 ,.,19J2 s'�� r' - � a d SLOPE% (IN) - - :1956 1944 CLASS 1941 F9S1 SOIL � 1943 SIRUCIURL/ CO\SISTEVCE NETNESS/ ▪ SOIL StPRO -RESTRr &LTAR TEXTURE 1 s�i AIINERALOGY . COLOR ▪ DLPCII C[ASS, ;H0R14 , 1 O -(f 6r- SL fit Se LS I S' 3`1 s61c- L S� 'Qt., ve N a eg- I '� 3y-yg wslk CL_ J6e -re- ��dz b,27_5- Irsh, 0,6 0 1 z us& sit Art se" y6 ,1, M N /S l y r -30 ‘511(4 c r'+c sc 2 S°6 Jo-- 4 6 v Cc-`73.v Fit Se- e Ptt-,_ .-1444 AI I 1 o-l6 i us6k. .5c-k- �ft Se-- Lis` L 5 4e ,i)4- N4 N 3 /g •o'`tr IusaL cL f -c l ,m.tr, „-e tr-y, 91- 4Y 1056k. CL- rclt Se- 0.2c tdt�( o-l>. LA581c SC f2 5K' `7 h i p e5 /‘ -3z .S61c se-c- f) se / LtK r/R— NA /- 4 _S-1- 31- �y S6� L /SO re, Je— sfiit`-t E /dL-1.cr•- fi r. Se t- 17 wsot c F/ Se th-L, /4," 0.7-S-- DESCRIPTION INITIAL SYSTEM REPAIR SYS'I Era _ OTHER FACTORS(.1946). SUE 1 E CLASSIFICATION(.1948): p f Available Space(.1945) e) 0,5 ,v/ A I 2� EVALUATED BY: S-4,..... �•"� System Type(s) ii00 CLZ ' OTHER(S)PRESENT: Site LIAR D.2,7 f 0.225 COMMENTS: Updated February 2014 L-'NP2 oy - 2,(t. - Z35f�1 Catawba County Environmental Health fr ,,.„*,f •Vey �.-' \-......, ~OP O 0e° i4o' fo 001111,40111\ 41d ir.c \ 111111rAr‘ -Ili \ Ndi \ e /I I fri O "1 4.11/ er A ) , , Parcel: 268704501375, 4205 WILSON RD VALE, 1in=60ft 28168 This maprreport 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 , Uie Independent verification of any data contained on this mapreport product by the user.The County of Catawba,its employees,agents,and i t, dF.arn�d rai+'cWrt {t zta -!te 1, i. %Z, iZi nti 2l kr.c. FL vii' ."�Y^.;,,,:<ftc2. 1. y;, 1 t? a