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HomeMy WebLinkAboutRBPR-08-2016-24423.TIF e3A i3\G THIS IS NOTA PERMIT Case # RBPR-08-2016-24423 ted CATAWBA COUNTY HEALTH DEPARTMENT 0'ti ;o t"f0 u ... ' � 4.x' • =.io PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 ^� Residential Building Plan Review - Manufactured Home o l roe IF sT EXS SYSTEM ro o-6 • VA Val T Contractor SEAGLE MOBILE HOME SERVICE, 204 CEDAR WOODS RD, TAYLORSVILLE,NC NC 28681 B:828-994-2597 C:8288510004F:828-327-4217 Land Owner KOOL PARK SERVICES LLC, 3102 KOOL PARK RD NE, HICKORY NC 28601 Owner TONYA PATTERSON, 244 6TH AVE SW, HICKORY NC 28602 C:8654068614 NAME TO APPEAR ON PERMIT Tonya Patterson SITE ADDRESS: 3102 KOOL PARK RD NE 61, HICKORY NC 28601 PIN # 372419517897 NAME of SUBDIVISION: Lot# 61 Section/Block PROPERTY SIZE: Square Feet Acres 12.400 DIRECTIONS: 3102 Kool Park Rd NE lot 61 - Hickory PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: 1991 SW mobile home 14 x 70 / 3 x 3 deck on front& rear/ home must be underpinned. Changing out existing 3 BdRm SW for New 3 BdRm SW. Lot#61 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? Yes 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: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF SW in mobile home park EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: SW 14 x 70 Decks: Front& Back 3x3 #OF NEW BEDROOMS:: 3 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: 09-chappliaition 08/03/2016 0850 Page 1 of 4 ` A \ CATARBA COUNTY Case# RBPR-08-2016-24423 FF'lima% Public Health Department Subdivision < *jig cl Environmental Health Division PIM/ 372419517897 ^vv PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 1g42 ,w NAME ON PERMIT: (TONYA PATTERSON), 244 6TH AVE SW, HICKORY NC 28602 ( Tonya Patterson) Site Address: 3102 KOOL PARK RD NE 61, HICKORY NC 28601 Property Size: Square Feet Acres 12.400 Directions: 3102 Kool Park Rd NE lot 61 - Hickory 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 —77.7117.77.-7,R17;!:,;.� 91' o IJP r �, i�`�rFEENAME:'I ,th I �wi�asl�` II'�°'lu,bbt�G11�1�i tl{� Ia�;1�i1i11II�lIDATE it 'i�11FEE'AMOUNT:Ali Existing Tank Check Fee 08/02/2016 $80.00 4011i, 9.TOTAL FLEs/ IfIIFi_ yuliIIIIV6iri1;11, Ith , 1f!I1�1P fbil��`sso oo,II L +Il�{i illl.l�'.'J Wu19C. " rGI:.1t.W'.LWa.il ii,Dut.., ,• I :4iitNIIWWC�..�:J1C116 Illi)I . -911uDul b10111110ii 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) 119-ehnpplication 08/03/2016 08:50 Page 2 of $A �G THIS IS NOTA PERMIT Case # RBPR-08-2016-24423 H CATAWBA COUNTY HEALTH DEPARTMENT ''t0 � '+`' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES • \ Ig 2 �M Residential Building Plan Review - Manufactured Home o ro o EXS SYSTEM 0 0 % o Contractor SEAGLE MOBILE HOME SERVICE, 204 CEDAR WOODS RD, TAYLORSVILLE, NC NC 28681 B:828-994-2597 C:8288510004F:828-327-4217 Land Owner KOOL PARK SERVICES LLC, 3102 KOOL PARK RD NE, HICKORY NC 28601 Owner TONYA PATTERSON, 244 6TH AVE SW, HICKORY NC 28602 C:8654068614 NAME TO APPEAR ON PERMIT Tonya Patterson SITE ADDRESS: 3102 KOOL PARK RD NE 61, HICKORY NC 28601 PIN # 372419517897 NAME of SUBDIVISION: Lot/4 Section/Block PROPERTY SIZE: Square Feet Acres DIRECTIONS: 3102 Kool Park Rd NE lot 61 - Hickory PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: 1991 SW mobile home 14 x 70 /3 x 3 deck on front & rear/ home must be underpinned / 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? Yes 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? APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF mobile home park EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 14 x 70 #OF NEW BEDROOMS:: 3 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-ehapplication 08/02/2016 16:34 Page I of 4 IgA . CATAWBA COUN.TY . Case a RBPR-08-2016-24423 (4,00)LAI , , Public Health Department Subdivision < "3 Environmental Health DivisionPIN#rS ;v 't 372419517897 /f. PO Box 389. 100-A Southwest Blvd,Newton, NC 28658 / M NAME ON PERMIT: Site Address: 3102 KOOL PARK RD NE 61, HICKORY NC 28601 Property Size: Square Feet Acres Directions: 3102 Kool Park Rd NE lot 61 - Hickory 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 comp)et site evalu ion can be performed. Date: / of 6/0 Signature of Applicant or Agent tJ a I aztnet-r—. An Environmental Health Specialist will contact you within 5 work g days of application date. If you need further information or assistance please call 828-466-7291 AREA2 L,FEENAME DATE FEE AMOUNT I Existing Tank Check Fee 08/02/2016 $80.00 F °' TOTAL FEES - $80.00» "I i 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 08/02/2016 16:30 Page 2 of4 T jj . Ilin * HIS IS NOT A PERMIT crfiubxrsl CATAWBA COUNTYHEALTh DEPARTMENT ,.,,„c,,,,:: Application for Environmental Services Page 1 Improvement Permit❑ Authorization to Construct 0 Septic Repair 0 Septic Malfunction 0 Septic Expansion ❑ New Well Permit 0 Replacement Well 0 Wel.Abandonment 0 Well Repair 0 Existing System inspection (Pre-Approval Required) Rqy Application is for New f�Construction�- 0 Existing Facility 0 Property Address Si` )2_ l 1ML .NE Subdivision 4n it(+ yv( Lot ft__Lai Acres Section/Block/Phase Driving Directions to Property NAME TO APPEAR ON PERMIT? ncr crApplicant ❑ Contractor Applicant Contact Information Name —T ���..))A I�PIA—i''.(Snf Address 9 `P. Loth fli i s`"/ Llibi , YC_, Phone I Ce Flame(11050 40-gip 14 Owner Contact Information I Nance .4 / LT 1►III •I . Address 4 tin A t ♦ i - t. I S i 8(09 es I • PhoneCell Piton 01/46) Ly. i- R(ni4 I Contractor Contact:Information _. Name r)a_h01i p le Address �UJJ Phone Cell,Plidne E 2 ,n1 — (3004 • WHO WILL BE THE PRIMARY CONTACT? <iter 0 Applicant . D Contractor I Description of Existing Structures on Site it of Bedrooms *t �j Structure Dimensions ft of Occupants a Basement ❑ Yes iiia—No Basement Fixtures Q Yes 0 No The Applicantshall 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. O Yes 0 No Does the site contain any jurisdictional wetlands? Q Yes ® No Does the site contain any existing+yastewater systems? 0 Yes C No Is any wastewater going to he generated on the site other than domestic sewage? P Yes 0 No Is the site subject to approval by any other public agency? ❑ Yes ❑No Are there any easements or right of ways on this"property? Describe • Existing eater supply in use ❑ Individual Well ❑Comnu nityWell Li Semi-Public Well 0 County/City/Township Water Line Is a public water supply available?" ❑ Yes ❑No If applying for an Improvement Penult or Authorization to Construct, Please Indicate Desired System Type(s): (systems can he ranked in order of your preference) ❑ Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other 0 Any CA�y�+ ``II7� THIS IS NOT A PERMIT TAINT NY' i 9 CATAWBA COUNTY HEALTH DEPARTMENT - .,.,„„a..z. Application for Environmental Services Page 2 • Proposed Facility Type ! 32 [ rimary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms •1' Project Description Structure Dimensions #,of Occupantsi c:/1 Basement ❑Yes 4 Basement Fixtures In Yes ® No I UAccessory Stnictnre(s) Describe. I #of New Bedrooms "tjlapplicable '77 Structure Dimensions . #of Occupants -7 Accessory Dwelling V-Yes ❑ No Plumbing 9 Yes 9 No Describe PlumbingNeedcd U Multi-Family Residence# Units #Bedrooms per Ui itst Total # Bedrooms st. Structure Dimensions L j Food Sen•ice Specify Type i # Seats Floor Space-Entire Food Service Facility (Sy Ft) # Employees per Shift #of Shifts Dining Arca (Sq. rt.) . - Lj Business Specific Type of Business Retail Floor Space_ #of Employees per Shill if of Shifts ❑..Other Facility Type Specify If Church it of Seats Kitchen. 9 Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well 0 Semi-Public Well 9 Community Well Abandonment Type 0 nrillexl 9 Boredi 9 Dug ❑ Unknown Well Repair Requested 9 Yes 9 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.sbould 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 atthe time • of building permit issuance. This may prevent the need for septic-system size increase in the future. f If structure is plumbed but no bedrooms,calculated design flow is required. i " IfNo,a well permit must be issued with the Authorization to Construct. • 1 SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) Improvement Pennts issued us 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 niay be revoked if the information on this application, site plans or intended use changes for the proposed facility. i ' I have read this application and cenify 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 ant 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 ol'Owner orAgent 0, etrt .ThrimpL Date/ /(1J Printed Name of Owner or Agent j 2.ike/ccn . l i CATAWBA Geospatial Permit Center a Information Services _T-7-----,J v 0 ir 1 45 • 1 / r o t} / r -MC) 3...., , I i It' 0 fah ' ' 2) ce-22, Y 47 -k,,c) oa -- `� 9 �r2Jf / fi°p4,7 � y j) `. `, i! - v ilc ;\ 18 50 0 > % 4\i a //}y ;62.7 4/ �V e S g o =, _` Ycli 5.3 W y p�`° ` ..- 7 a t . W 1 in=200ft 5 Parcel: 372419517897, 3102 KOOL PARK RD NE HICKORY, 28601 Owners: KOOL PARK SERVICES LLC, null Owner Address: PO BOX 138 Values - Building(s): $89,300, Land: $237,600, Total: $326,900 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 08/02/2016 NCatawba County Environmental Health �'] i6 0, iI N 1 W � Ilib1 az, a..• 08Q % 411-- a e, -1140, „, :lc , N....- Mt , . ..., ' --- _ yjt" aik 7. V / �',y „7., , I St 4 a 0 4 f' rnthi:, a 4:5) i•••• / If , \ V 29TH AVE NE ,NIIISSsr 111 "\ ; 4 Y ' 1 lk �� ply `F T 8 fVJf2aCti 1 aL . A ' 1 \' / \ � Parcel: 372419517897, 3102 KOOL PARK RD 1in=200tt NE HICKORY, 28601 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 08/03/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 372419517897 Owner: KOOL PARK SERVICES LLC Parcel Address: 3102 KOOL PARK RD NE Owner2: City: HICKORY, 28601 Address: PO BOX 138 LRK(REID): 56171 Address2: Deed Book/Page: 3139/0400 City: REDMOND Subdivision: State/Zip: WA 98052-0138 Lots/Block: / Last Sale: School Information: School District: COUNTY Plat Book/Page: Elementary School: SNOW CREEK Legal: Middle School: ARNDT Calculated Acreage: 12.400 Tax Map: 165H 01001 High School: ST STEPHENS Township: HICKORY School Map State Road #: 1400 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: HICKORY County Fire District: ST STEPHENS Zoningl: R-1 Building(s) Value: $89,300 Zoning2: Land Value: $237,600 Zoning3: Assessed Total Value: $326,900 Zoning Overlay: Year Built/Remodeled: / Small Area: Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710372400J Building Details 2010 Census Block: 1002 Watershed: 2010 Census Tract: 010301 Voter Precinct: P29 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. ©20 6, Catawba County Government, North Carolina. All rights reserved. L http://gis.catawbacountync.gov/nomap/parcel_report.php?key=372419517897&typ=P 8/3/2016 CATAWBA C010•1111 HEALTH DEPARTMENT 0O� fG � Telephone: (828)465-8270 TDD: (828)465-8200 IP AC / ii_°I pr. - Prmt. X' Sys. Type G H Well Prmt. Replacement Well Well Rpr. Prmt. Owner A ent Phone � r � Address Subdivision L,�1 �i4 //'i/ Section/Block/Po Lotlfr 6 Lot Size _ Directions: 110Vifrff 4!- ac' F rl!6Y Property Address 5fd1 'f-j11)/ kFacility: House Mobile Home'" Business Multi-family . Other: Pin Number ?2 i9 ` -7 Other . Zoning Approval# #Bedrooms q #Seats #Employees . . Application Rate GPD Flow yi Hot Tub or Spa yes O.••cial Fixtures Basement y, �� . 100% Repair Area yes/no Basement Plumbing • . Water Supp - 'vale Well Public Semi-Public , Type of System: Trench_ Bed y Pump Pump/Panel Panel LPP Otherglitir"� Septic Tank Size614569.... Pump Tank Size Nitrification Field: Total Square Feet Depth of Stone Bed Size "X _Trench Width Total Length of All Trenches �! Number of Trenches Trench Length / / / / / Feet on Center Maximum Trench Depth &/ Distance of Nearest Well *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* *************************************************************************************************************************** Topo % Slope Texture L' Structure Clay Min. . t? Soil Wetness C� �� 1 Soil Depth- Restric. Hoz. at j I Available space yes/no N / /: ! i Overall Class S PS U V Comments: II 1 ' 4 i (k. .___±_c. 0 c- �z7v lei ,..----•! 0 y CV' bed 171, Sind Dr f Zai( s _ Filter Required Riser required when tank is more than 6 inches deep. **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed qt facility. An Authorization to Construct is valid for(5) five years from date issued and is not transferable. Well Permit valid for 5 years T provided site conditions do not change. Well location,installation,and protection must meet state and local regulations, and must be " inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. p The siting of the well by the Health Department staff is to provide protection from known possible sources of contamination. No volume of- water is guaranteed a 'te by the Health Department. IllikX Permit Date Cl "9„ ?..,,— EIIS �i Owner/Agent 6z'` �,e,s1-2— Septic Tank 1 ii( f:/// i.h ptom`. =•A_ Date ld'3�O�.- ' EHS J ,r � Well Installed By Well Grout Approval Date r Well Head Approval Date- Date Sample Collected 1 Date of Results Results EHS White-Office Yellow-Owner/Agent Pink-Building Inspection Authorization to Construct