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HomeMy WebLinkAboutRBPR-08-2016-24408.TIF vs4'A •\ THIS IS NOTA PERMIT Case # RBPR-08-2016-24408 y rCATAWBA COUNTY HEALTH DEPARTMENT 0E 71• 3 ;"i0 c440: �'� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES '�' ti 1842 5M Residential Building Plan Review - Building New , p.fik•n . o •� IMPROVEMENT - AUTH CONST- NEW WELL - o. Contractor ZANE MICHAELS. PO BOX 993, DALLAS NC 28034 Owner ZANE MICHAELS. PO BOX 993, DALLAS NC 28034 NAME TO APPEAR ON PERMIT ZANE MICHAELS SITE ADDRESS: 2783 ELBOW RD, NEWTON NC 28658 PIN # 362706302357 NAME of SUBDIVISION: Lot# A Section/Block PROPERTY SIZE: Square Feet Acres 10 DIRECTIONS: 321 TO STARTOWN RD RIGHT ON ELBOW RD, LAND ON RIGHT PAST FARM & LAKE PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: BUILDING NEW 3 BEDROOM SINGLE FAMILY DWELLING 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: PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 51X65 #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-chapplication 08/01/2016 11 26 Page 1 of4 /A CATAWBA COUNTY RBPR-08-2016-24408 Case# � Public Health Department '��? Subdivision " Environmental Health Division Pm,# 362706302357 PO.Sox 389, 100-A Southwest Blvd, Newton, NC 28658 842 NAME ON PERMIT: (ZANE MICHAELS), PO BOX 993, DALLAS NC 28034 ( ZANE MICHAELS) Site Address: 2783 ELBOW RD. NEWTON NC 28658 Property Size: Square Feet Acres 10 Directions: 321 TO STARTOWN RD RIGHT ON ELBOW RD, LAND ON RIGHT PAST FARM & LAKE 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 identificationioand labeling of all property lines and corners and making the site accessible so that a complete filter at�io can be performed. Date: ri /4i Signature of Applicant or Agent �10"*. iii/ An Environmental Health Specialist will contact you within 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) 08/01/2016 5150.00 Fee Improvement Permit Fee 08/01/2016 $150.00 Well Permit & Inspection Fee 08/01/2016 $300.00 TOTAL FEES5600.00 FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED I SYSTEM REDESIGN ANDIOR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-eliapplication 08/01/2016 11:26 Page 2 of 4 CATAWBA THIS IS NOT A PERMIT Louhn'T11 V.-r,aV 1J� CATAWBA COUNTY HEALTH DEPARTMENT � Application for Environmental Services Page Improvement Permit Authorization to onstruc' Septic Repair E Septic Malfunction ❑ Septic Expansion ❑ New Well Permit eplacement Well ❑ Well Abandonment ❑ Well Repair E. Existing System nspection (Pre-Approval Required) ❑ Application is for New Construction Existing Facility ❑ •Property Address 1 Subdivision • ye (NC i cce, Lot# Acres Section/Block/Phase Driving Directions to Property a/ /FJ 5, 1 � _ i,/, „oxe * ir/d0/1 /'ff/t ,n1PTrz,-e/ vZMtretle7�a�� NAME TO APPEAR ON PERMIT? XOwner H Applicant n Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information 4NameZewe 7 zv ,lik%te//f - Addressk4 'Vic/ �7f Zi47/ tf/A✓C -f0Y/ Phone Cell Phone 70K' -22 — Y, Z(f-7 Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? Owner 5 Applicant 5 Contractor Description of Existing Structures on Site Cc* # of Bedrooms *j' 3 Structure Dimensionsrj'f( e(off`— i # of Occupants Z Basement ❑ Yes g No Basement Fixtures 0 Yes 4 No The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property ' question. If the answer to any question is "yes", applicant must attach supporting documentation. O Yes No Does the site contain any jurisdictional wetlands? Cl YesoDoes the site contain any existing wastewater systems? © Yes No 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? ® vo Yes kr 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 E1-11-lo If applying for an Improvement Permit or Authorization to Construct, Please Indicate Desired System Type(s): (systems can be ranked in order of yo preference) 0 Accepted 0 Alternative Conventional 0 Innovative 0 Other yAny C ATAwL? A THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT • Application for Environmental Services Page 2 Proposed Facility Type 1.1 Primary Residence New Residence Addition to Residence #of New Bedrooms *j f Project Description A/{49 CC i/tg4, N' fly/cc ,�vayC 7sr� pY//4epi Structure Dimensions_?"g GS #of Occupants 2 Basement ❑ Yes 0No Basement Fixtures ® YesF NTo ❑ 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 it Units #Bedrooms per Unit*t Total # Bedrooms *j Structure Dimensions E 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 ❑ Other Facility Type Specify If Church# of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy • Application for Well Construction/Abandonment/Repair Proposed Well Type gIndividual_Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes E No Describe Calculated Design Flow, Commercial j 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 comers and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent /%�„ - - Date- 8 / /1/� Printed Name of Owner or Agent 47(C.AClc C iCatawba County Environmental Health E `�., --� 40 \`‘.,4----) • - -... -- -: , .... i I. 0h • \ (01 D 4 - C...; ' 88 1 ECBpW Rp • t —8fip 885 1 1 I • 141 I / -., I� 1 Parcel: 362706302357, NEWTON, 28658 1 in=150ft 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 BVI r ���� 1V \\ I (911411pr t \\:1( 00000 I 1. 4�i�lryil '1pl b4111'' t6 I / t II0 Prat �,i�lpf Il�h 'r�llllIdA 1 ai@ DIiI e. �mliiCgiu�l1uiiih tot,CI r0 / i� .tiill ,L ,��il 850 ,' k it �tGI���I��L�1 'p�"p�I����III�� ���I�I��t1t111 cc --+8. IjGi� . 11 'lill� utit9�llt .�I�tI�I�lh�uU��1070 — Li * up�.iP�...;I tU�iF;i�iN�Ujlitli1(a1't, - \4V'nptluN�IpWiy�- lI -° I (i2 .5 �._ 8'601 0w R 1,1111111111"elalt I ...BB° • 745,--iFilt • , 7.--"4-`• :X Parcel: 362706302357, NEWTON, 28658 lin=300ft 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 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 362706302357 Owner: MICHAELS ZANE TODD Parcel Address: Owner2: City: NEWTON, 28658 Address: PO BOX 993 LRK(REID): 701242 Address2: Deed Book/Page: 3341/0293 City: DALLAS Subdivision: State/Zip: NC 28034-0993 Lots/Block: A/ School Information: Last Sale: $40,000 on 2016-05-11 Plat Book/Page: 75/14 School District: COUNTY Legal: LOT A PLAT 75-14 Elementary School: MAIDEN Middle School: MAIDEN Calculated Acreage: 10.000 High School: MAIDEN Tax Map: Township: JACOBS FORK State Road it: TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: MAIDEN RURAL Zoningl: R-40 Building(s) Value: $0 Zoning2: Land Value: $62,600 Zoning3: Assessed Total Value: $62,600 Zoning Overlay: ED-O Year Built/Remodeled: / Small Area: STARTOWN Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: Building Permits for this parcel. Firm Panel it: Building Details 2010 Census Block: 2072 WaterShed: 2010 Census Tract: 011702 Voter Precinct: P34 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 fram this map/report product or the use thereof by any person or entity. ©2016, Catawba County Government,erNorth/ y�Carolina. AM rights reserved. New Achos?: 2 /n 83 £JI..R _ Y Y t l 4 cDca -3 Toiza, 300 gal http://gis.catawbacountync.gov/nomap/parcel_report.php?key=362706302357&typ=P 8/1/2016