HomeMy WebLinkAboutRBPR-06-2016-24001.TIF •
4-,"l; ' THIS IS NOT A PERMIT Case# RBPR-06-20 t 6-24001
"�. CATAWBA COUNTY HEALTH DEPARTMENT 0 h�� ."4:110
C r era': 'j'
°' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES
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Ig }2' v4 Residential Building Plan Review - Budding New
IMPROVEMENT- AUTH_CONST •�R . -'*'�. ''
Applicant t SAME AS OWNER,; a = -
•
. Owner - CONSI'ANTIN BOUREANU,PO BOX 1890,HICKORY NC 28603
NAME TO APPEAR ON PERMIT
SAME AS OWNER
<.,SITE ADDRESS:; 51641 MEADOW PARK I. N, I IICKORY NC 28602 PIN # 279012874471
l ABERNETHY PARK'PH 12 86
1Ab16'afSUBDIVISION: - Lotk Section/Block
PROPERTY,SIZE: square Feet Acres 0.45_;
y
DIRECTIONS: 1 127.S.to Bethel Church RD take Lefty:Pittstown take Right,Abernathy Park take Left, Orchard Park take'Right,
Regentsttake Right, Kensington take Left,at Meadow Park take Right .
PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank
GALLONS PER DAY: 480 WATER SUPPLY: Public Water
DESCRIBE.WORK: new home.63x70 no basement
SITE INFORMATION -
Do any of the following apply to theproperty for which this application is applied?,.
If the answer to any of,thequestionsbelow 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 lo be generated on th 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:" SingleFamily Residence OTHER DESCRIPTION: -
`DESCRIPTION OF '
EXISTING STRUCTURES`
ON SITE(IF ANY)
DIM EXISTING STRUCTURE .
NUMBER OF EXISTING BEDROOMS: 4 #OF OCCUPANTS: .
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: 63270 '
BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes
Desired system types(Improvement.Permit or Authorization.to Construct): ' •
ACCEPTED: t ALTERNATIVE: CONVENTIONAL:
t OTHER:. i INNOVATIVE: ANY YES
'Otherdescribed I e. -;
1
Improvement proveent 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 entryconduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the
'- ;proper identification an lab ling.of all property lines and corners and making the site acce i b
ble so t at complete site evaluation can be performed.
'Date: -6 1 if?cI6 Signature of Applicant or Agent o"7 ' r•-ct r,�r 1 i
- An Environmental Health SpeeialisGwill contact you‘iiihut':5 itrorRmg days,ofapplication date.
If you need further infoimation or assistance please call 828466-7291
AREA2
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59 .hnpplicalion 06t0l'2016 15:41 Page 1 014
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e, CAT Maven COUM1T•1' RBPR-06-2016 24001
Case ft
n y Pubhe Ilealth Dephrtment Subdivision ABERNETHY PARK PH 12
4an@ FmtronmcntalIlcalthDivision 279012874471
PO Box 380,•100-A Southwest Blvd,-Newton,NC 28658 1 (N!!
1 r
NAME,ON;PERMIT: SAME AS OWNER O,,
SAME AS OWNER ( )
Site Address:' 5164 MEADOW PARK 1,N, HICKORY NC 28602
Property Size: Square Feet Acres 10:45
Directions: 1. 127 S to Bethel Church.RD.take Left to Pittstown take Right,Abernathy Park take Left..Orchard Park take.Right, , .
'. Regents take Right, Kensington take Left,at Meadow Park take Right.
' af.ir , r ,7 311 1°,1q k ° z ,iiv l i s u , ' rR`�' 7'iT a s "r .9,',-" ;- ,' '"' T
. mFEENAMF ,as ?r tz :t'a' aJ, DAT E4 EEC AMOUN I rjJ
Ls, a, 4Ft ,E � s.�'P ,il`'7+...u..r..��*i-`ta. d LRN.ilfl� s..di�n$.u,
`Authorization to Construct Fee(New/Expansion) 06/01/2016 $300.00
Fee 1.
._ Improvement Permit Fee ' � 06101'2016 $150.00
Ii're ' .aTOTAL FEES 1f4-aj R• 114 pro''�ry,i��r50' .,sr' *fC?Eny, S450004`
f. '.s.. .. htaWU-.uj'vyw.`u: dIr r. fa -+ r..t(.a,4R,yhry. „��=tdity u.�.� .ue:t4Y.a«°Y..zis`,
1 - FEES•ARE NON'-REFUNDABLE
ONCE A SEE-VISIT IS MADE OR
WORK ON A PLAN REVIEW HAAS COMMENCED
•
SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
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£9 -h•.pplicatinn' Jw 06'01/2016,15'41, - Page 2 of 7
CATAWBA THUS IS NOT A PERMIT
COUNTY ......,-C.,7",•.„‘1/4 CATAWBA COUNTY REALT,L-I DEPARTMENT Page 1
r...0 ,,a Application for Environmental Services
Improvement Permit 2/ Authorization to Construct kJ Septic Repair❑ Septic Malfunction❑
Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment❑
Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑
f ' Application is for New Construction ❑ Existing Facility ❑
Property AddrCSs
Sf G. Me_Qio peat-k Ln Subdivision 94 ct,e -� ("4-,...c- -..
FriQ 40(�I' /PC' LPe02_ Lot# 6c, Ares
// Section/Block/Phase /2_
Driving Directions to Property
NAME TO APPEAR ON PERMIT? ❑ Owner ❑ Applicant U Contractor
Applicant Contact Information
1 Name
Address
Phone I Cell Phone
Owner Contact Information
• Name
Address el
Phone I Cell Phone
•
Contractor Contact Information
Name CoNSTA-t N gc%1/4i>`-eP '
Address c t'17 7 QnS`ih ,1/2,3,-, A"Qrk, C r iR,CICcit( N C
Phone
U Cell Phone is:1.t 3A.° 'iaA5-
WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant 9-Contractor
Description of Existing Structures on Site_ __
#of Bedrooms *j' Structure Dimensions _ _ II of Occupants
Basement 0 Yes [1 No Basement Fixtures ® Yes [ 2 t io
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.
0 Yes ' to Does the site contain any jurisdictional wetlands?
O Yes Iiirgo Does the site eontaiti any existing wastewater systems?
p,Yes ErNo Is any wastewater going to be generated on the site other than domestic sewage?
0 Yes ' 0 No Is die site subject to approval by any other public agency?
0 Yes F4 No Are there any easements or right of ways on this property? Describe
Existing water supply in use U Individual Well .❑ Community Well ❑ Semi-Public Well
County/Citylfowtiship 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 Any
/fiTA THIS IS NOT A PERMIT
COUNTY', ;,s e .., CATAWBA COUNTY HEALTH DEPARTMENT
."'kat
«,�c, ;;;-. Application fin Environmental Services Page 2
Proposed Facility Type ii -
❑ Primary Residence Lj New Residence ❑ Addition to Residence #of New Bedrooms *j 2-j •
Project Description Ncta.> o& se-
Structure Dimensions C3' K 70 #of Occupants ri 13/4;I J;n9 fa Sett
Basement ❑Yes tJ tJo Basement Fixtures ® Yes No
Accessory Structures) Descrihe,, _
#of New Bedrooms *j if applicable _ Structure Dimensions
#of Occupants Accessory.Dwelling ❑ Yes ❑No
Plumbing ❑ Yes ❑No Describe Plumbing Needed
u Multi-Family Residence#Units //Bedrooms per Unit*f
Total#Bedrooms *j Structure Dimensions
❑ Food Service Specify TYPe
#Seats Floor Space-Entire Food Service Facility (Sq Ft)
it Employees per Shift #of Shills - Dining Area(-Sq.Ft.)
❑ Business Specific lype of Business ' Retail Floor Space
#of Employees per Shift #of Shifts
•
❑ Other Facility Type Specify*
If Church# of Seats _ Kitchen ❑ 'Yes ❑ No If Daycare Specify Occupancy
Application for Well`Construction/Abandonuient/Repair
Proposed Well Type ❑ Individual Well ❑Semi-Public Well . ❑ Community Well
Abandonment Type ❑ Drilled ❑ Bored ❑' Dug ❑ Unknown
Welt Repair Requested ❑ Yes ❑No Describe
Calculated Design Flow,Commercial t Additional information may be required to determine
design 11on from certitn'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 RE1'I2II'WILL INCUR'AN ADDITIONAL CHARGE (SEE FEE SCHEDULE)
Improvement Permits issued as a result of this information are valid fors years or may be nom 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 wanted right of entry to conduct necessary;inspections to determine compliance with applicable iaws 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. r
Signature of Owner or Agent \C� 4,,,A, p,,,,_ Date �� ! 1 / 2J C.''
Printed Name of Owner or Anent CON STAtt i i!Y acule,E14 rev �.
... �..
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Catawba County Environmental Health
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Parcel: 279012874471, 5164 MEADOW PARK tin=50ft
LN HICKORY, 28602
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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 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. -Copyright 2014 Catawba County NC
06/01/2016
Parcel Report Page 1 of 1
Parcel Report - Catawba County NC
Parcel Information: Owner Information:
Parcel ID: 279012874471 Owner: BOUREANU CONSTANTIN C
Parcel Address: 5164 MEADOW PARK LN Owner2: BOUREANU DANIELA
City: HICKORY, 28602 Address: PO BOX 1890
LRK(REID): 607015 Address2: null
Deed Book/Page: 3325/1121 City: HICKORY
Subdivision: ABERNETHY PARK PH 12 State/Zip: NC 28603-1890
Lots/Block: 86/
School Information:
Last Sale: $28,000 on 2016-01-19 School District: COUNTY
Plat Book/Page: 74/59 Elementary School: MOUNTAIN VIEW
Legal: LOT 86 PLAT 74-59 Middle School: JACOBS FORK
Calculated Acreage: .450 High School: FRED T FOARD
Tax Map: null School Map
Township: HICKORY
Slate Road #:
Tax/Value Information: Tax Rates(pdf) Zoning Information:
City Tax District: All in County Zoning District: COUNTY
County Fire District: MOUNTAIN VIEW Zoningl: R-40
Building(s)Value:1$0 Zoning2:
Land Value: $23,800 Zoning3:
Assessed Total Value: $23,800 Zoning Overlay: WP-O
Year Built/Remodeled: null/null Small Area: MOUNTAIN VIEW
Current Tax Bill Split Zoning Districts: /
Zoning Agency Phone Numbers
Miscellaneous: Firm Panel Date: null
Building Permits for this parcel. Firm Panel #: null
Building Details 2010 Census Block: 2002
WaterShed: WS-III Protected Area 2010 Census Tract: 011801
Voter Precinct: P23 Agricultural District:
Parcel Report Data Descriptions
List all Owners Deed History Report Assessment Report
This map/repon product was prepared from the Catawba county.NC Geospatlal 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 mapnopon product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be
hold liable for any and all damages.loss or liability,whether direct,indirect or consoquenllal which arises or may arise from this map/report product or the use
thereof by any person or entity.
! Cl 2016,Catawba County Government,North Carolina.All rights reserved.
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http://gis:catawbacountvnc gov/nomap/parcel_ceport.php9ke 279012874471&tvp P 6/1/2016
sc7'A • CATAWBA COUNTY •
G 100A SOUTHWEST BLVD
t--, NEWTON, NORTII CAROLINA 28658 RECEIPT
s�►�`� PHONE: 828.465.8399 •
U „vj�o K Wednesday,June 1, 2016
X842 stir www.catawbacountync.gov
•
PAYOR:
Boureanu,Constantin
PAYMENTS
TRANSACTION-NUMBER: TRC-683544-01-06-2016,
PAYMENT DATE: 06/01/2016
PAYMENT TYPE: Credit Card
165026266
INVOICE NUMBER' FEE NAME FEE AMOUNT
06-16-328953 Improvement Permit Fee SI50.00
a, 13 -rte-- r„ : 1'1'1 +;7tl e 30000
0616-328953" . �1 „' "` ; ' Autfionzation tConst[uct,Fee, , • 1
(New/Expansion)tF.ee•TOTAL PAYMENTS . $450.00
RBPR-06-201/2-24.001
CASE TYPE: • Residential Building Plan Review WORK CLASS: Building New
SITE ADDRESS:- 5164 MEADOW PARK LN. HICKORY NC28602
Applicant SAME AS OWNER, ,
Owner CONSTANIIN BOUREANU, PO BOX.1890, HICKORY NC 28603
** NO PEOPLESOFT ACCOUNT ASSIGNED **
•
receipt - 06/01/2016 15:40 Page 1 of 1
A CATAWB.A COUNTY D '--- p C Case N IMPV-03-2014-047620
.TII�G Public Health Department f++,•' - u Subdivision ABERNETHY PARK PH 12
6 mpg® -1 Environmental Health Division PIN# 279008974976
PO Box 389, 100-A Southwest Blvd,Newton, NC 28658 - v• - t. , • LOT# 86
ig
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NAME ON PERMIT: ABERNETHY PARK LIMITED, 2850 SAINT GEORGE RD, WINSTON SALEM NC
27106
Site Address: 5164 MEADOW PARK LN, HICKORY NC 28602
Property Size: Square Feet 19,602.00 Acres 0.45
Directions: BETHEL CHURCH RD TO PITTSTOWN RD TO ABERNETHY PARK DR TO ORCHARD PARK DR TO
REGENTS PARK DR TO KENSINGTON PARK DR TO MEADOW PARK LN
Improvement Peiniit
Facility: Primary Residence - house
Permit Category: New Septic Bedrooms 4
WATER SUPPLY: Public Water
Basement? No Basement Plumbing? No
INITIAL SYSTEM SPECIFICATIONS
Permit Valid: Expires In Five Years: _X_ No Expiration:
Projected Daily Flow 480 g.p.d
Proposed Wastewater System: 25% REDUCTION
Type: IIIG -OTHER NON-CONY TRENCH SYSTEMS
PUMP *MAY BE* REQUIRED
Permit Conditions:
REPAIR SYSTEM SPECIFICATIONS
Repair System Required? Required
Proposed Wastewater System: 50% REDUCTION
Type: IVA-ANY SYSTEM WITH LPP DISTRIBUTION
PUMP REQUIRED ***** OPERATOR REQUIRED
Landscaping or other site alterations that potentially divert groundwater or 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 existing permits.
The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the
applicant/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 'Laws and Rules for Sewas'e Treatment and Disposal Systems' (iSA NCAC 18A.1900), Neither
Catawba County nor the Environmental Ilealth Specialist warrants that the septic tank system will continue to function
satisfactorily for any given period of time.
Megen McBride 03/07/2014
AUTHORIZED STA'T'E AGENT APPROVAL DA'Z'E
03/05/2019
Permit Expiration Date:
No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department.
159-chpe m it 03/12/2014 09:54 Page I of 3
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DEPARTMENT OFENVIRONMENT AND NATURAL RESOURCES Sheer_of
DIVISION OF ENVIRONMENTAL HEALTH PROPERTY ID#:
ON-SITE WASTEWATER SECTION COUNTY:
SOIL/SITE EVALUATION
II\\` � i D f for OIR�-T SITEWASTEWAT1RSYSTEM ``no
OWNER: ('i'.1,EVMl-1 1 VO I(-- U vMI-i6 APPLICATION DATE 12-1311 13 Lii R� it-ZO 3'1X 3t,
ADDRESS: - - DATE EVALUATED: 214 114
PROPOSED FACILITY: 4 I3R- HtsA1AuC.'' PROPOSED DESIGNFLOW-(1949): 4g0 . PROPERTY SURE: (�.145aC475`
LOCATION OF SITE: 51h W .dCW PRO— Ln -4-k7.,KovV l04 r6G PROPERTYRECORDED:
WATER SUPPLY: 0 Private a Public 0 Well U Spring U Other
EVALUATION METHOD: 0 Auger Boling $ Pk 0 Cut
TYPE OF WASTEWATER: n Sewage 0 Industoal Pm:ss 0 Mixed ,
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DESCas'noN I INITIAL SYSTEM RD AIR SYSTEM OTHER FACTORS� (.1946):
( SITE CLASSIFICATION(.1948):f;Avaibhle Spate(_1945) I G it11�� 4
1_...q EVALUATED BY: l Y l -,1 r ".C'.b cca''
ISystemTypxs) MCI\ G^1 Ol H:R(S)PRESENT:
Site LIAR 0 3 \ 0,3
COMMENTS: