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HomeMy WebLinkAboutEHPR-08-2016-24405 (2).TIF �y13A \ THIS IS NOT A PERMIT Case # EHPR-08-2016-24405 Q7 aGG ti• 4 ���e CATAWBA COUNTY HEALTH DEPARTMENT DWI El " '""r PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 6I - . 1842 SA! Environmental Health Plan Review - OSWPa a o.: IN.tr f•Ltj r IMPROVEMENT g.Stirlik Owner JUSTIN & CARON WEIDNER, PO BOX 1418, I-IILDEBRAN NC 28637 H:8283819281 C:8283106168 I-IOME:8283819281 NAME TO APPEAR ON PERMIT Justin & Caron Weidner SITE ADDRESS: 6764 JACOB DR, HICKORY NC 28602 PIN # 278114238105 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 528,818.40 Acres 12.14 DIRECTIONS: 1-40 Exit 119 onto Henry River Rd, Left onto Jacob Dr, follow to road end property is on the left inside the gate. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: IP Only at this time* Will use well on neighboring property. 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? Yes Property Easements Description: 2-45 ft ROW- Neighbor to access his property. APPLICATION FOR: New Structure .STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF Old Barn EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 25x25 NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: House w/attached garage 60x60 #OF NEW BEDROOMS:: 4 BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: F9-chappli cation 08/01/2016 08.56 Page 1 of $\3A , CATAWBA COUNTY Case# EHPR-08-2016-24405 C L Public Health Department Subdivision 4 „tip E nvironmental lHealth Division PIN# 278114238105 PO Box 389. 100-A Southwest Blvd,Newton,NC 28658 tail , NAME ON PERMIT: (JUSTIN & CARON WEIDNER), PO BOX 1418, HILDEBRAN NC 28637 ( Justin & Caron Weidner) Site Address: 6764 JACOB DR, HICKORY NC 28602 Property Size: Square Feet 528818.40 Acres 12.14 Directions: 1-40 Exit 119 onto Henry River Rd, Left onto Jacob Dr, follow to road end property is on the left inside the gate. 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 an9I lab ling of all property lines and corners and making the site acces i le so that a mplete site evaluation can be performed. Date: 6' / 7/ Co Signature of Applicant or Agent w An Environmental Health Specialist will contact you v in 5 working days of application date. If you need further information or assistance please call 828-466-7291 AREA2 npurn,F ENAME%I i'i8 11 iiiiiiII�I��itiiiiIDIATF I Ai CATAWBA THIS IS NOT A PERMIT counnY��.-� -� CATAWBA COUNTY HEALTH DEPARTMENT do„„���,- Application for Environmental Services Page I Improvement Permit Authorization to Construct❑ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit❑ Replacement Well H Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction Existing Facility ❑ ' i l Property Address LP /(PLT ,JO Cob Dr. Subdivision -11rLnic NC 2q(0,97____ Lot# Acres Jq Section/Block/Phase Driving Directions to Property 1-90 tK 1 4 (I I tTY +v I-011-L.l Rl vt v Rood 4 turf leR do ; 10mh Dr I&na -Nilotic -n road PVI d ( pnper I- 7 ')5 Mf le-F-1 �1051Gh The. G/A-k) NAME TO APPEAR ON PERMIT? Ownerv ❑ Applicant n Contractor Applicant Contact Information Name J11.5-H R i C YD Wei dveX 4 Address T 127n' - y-)S” -1k11 rk-e va In N c- 2g03-7 Phone sZR - g) - cii2F 2_ ` Cell Phone S22 3)O -6?) IDS/ Owner Contact Information Name Address Phone Cell Phone. Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? Owner ❑ Applicant H Contractor In Description of Existing Structures on Site ad # of Bedrooms *'r Structure Dimensions #of Occupants Basement ❑ Yes [ No Basement Fixtures 0 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 p34o Does the site contain any jurisdictional wetlands? C Yes ,No Does the site contain any existing wastewater systems? 0 Yes ASINo Is any wastewater going to be generated on the site other than domestic sewage? ® Yes ytho Is the site subject to approval by any other public agency? AYes C No Are there an easements or right of ways on this property? Describe 45 RD Existing water supply in use [ individual Well ❑ Community Well ❑ Semi-Public Well H 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) V- 0 Accepted 0 Alternative 0 Conventional 0 Innovative ❑ Other a Any CATAWBA THIS IS NOT A PERMIT counrx CATAWBA COUNTY HEALTH DEPARTMENT Na„� Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence New Residence ❑ Addition to Residence # of ew Bedrooms *j Project Descriptio 4—'"ptpse Lor-1-11 °Rome go Gage, 2 5 4 Structure Dimensions leo/ (pD ' # of Occupants %% Basementpi Yes ElNo Basement Fixtures i.1 Yes ® No ] Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ] No Plumbing [ 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. Pt.) ❑ Business Specific Type of Business Retail Floor Space ft 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/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well [ Community Well Abandonment Type ❑ Drilled ❑ Bored n Dug [ 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 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 �a zt,��Q/ e _ Date I l Printed Name of Owner or Agent g 0 roil b . AJ? ILt{lPX Catawba County Environmental Health • \ ops \\\K..' \\CHN-1\\*,-.../7"\I 1 . - aA. ' -00yS 6'0 • 142.0 ` . ,,....“..... ..1/2...\\\ Ilk 1.. .r-4%;>\\1/4\1 O ' 111 io . V ° sall x_____.., C1111tt . /7/17://11N2c, h ,Qf� C \\NI\ .."----<-711-7/(7„...7.\77 _____,N1/2„..„.„\___,,,...„1/2.\\ _ _• i 7.---,:\ C.) Parcel: 2781 1 42381 05, HICKORY, 28602 1in=100ft 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 08/01/2016 Catawba County Environmental Health g ) -----....„ N.3 ii, ------ - °rtes „�• LS i � ,�► ,t4sid rill •.s' � A" te -- c"--------.---------5- .9.8 .... \ M ,. .-%--1/4.--N------1/4.)975 ----13/41 1 ,rigimi\I\ cn X5 4 111\i‘Hilsiliihia SS\iiiiimiri. 11111111111111111°•111110116, ^- . ' ' ) o 2: 10 / 2 citill,kit) lale 1 CaN.\$.. *.\\) \ ) ... - Parcel: 2781 1 42381 05, HICKORY, 28602 lin=200ft This map/report product was prepared from the Catawba County,NC Geospatial Informalion 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 08/01/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 278114238105 Owner: WEIDNER JUSTIN Parcel Address: Owner2: WEIDNER CARON City: HICKORY, 28602 Address: PO BOX 698 LRK(REID): 59594 Address2: Deed Book/Page: 3349/1359 City: HILDEBRAN Subdivision: State/Zip: NC 28637-0698 Lots/Block: / Last Sale: School Information: School District: COUNTY Plat Book/Page: Elementary School: MOUNTAIN VIEW Legal: OFF ROAD 1002 Middle School: JACOBS FORK Calculated Acreage: 12.140 Tax Map: 177H 02015 High School: FRED T FOARD Township: HICKORY State Road #: TaxNalue 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: $500 Zoning2: Land Value: $46,400 Zoning3: Assessed Total Value: $46,900 Zoning Overlay: Year Built/Remodeled: / Small Area: MOUNTAIN VIEW Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel It: 3710278100J Building Details 2010 Census Block: 2052 WaterShed: 2010 Census Tract: 011101 Voter Precinct: P24 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. Nem ADd C C9r)C1)(1 pet C60I C http://gis.catawbacountync.gov/nomap/parcel_report.php?key=278114238105&typ=P 8/1/2016 r�A CATAWBA COUNTY (�� 100A SOUTHWEST WEST BLVD ��� V NEWTON, NORTH CAROLINA 28658 RECEIPT Q sea i.,,, ,,.. �P PHONE: 828.465.8399 /U 'rot Monday, August 1, 2016 842 sm www.catawbacomnvnc.gov PAYOR: Weidner, Justin&Caron PAYMENTS TRANSACTION NUMBER: TRC-760588-01-08-2016 PAYMENT DATE : 08/01/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-331071 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EHPR-08-2016-24405 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 6764 JACOB DR, HICKORY NC 28602 Owner JUSTIN R CARON WEIDNER, PO BOX 1418, HILDEBRAN NC 28637 H:828381928IC:8283106168 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 08/01/2016 08:56 Page 1 of