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HomeMy WebLinkAboutRBPR-08-2016-24511.TIF vJ$A •G THIS IS NOTA PERMIT Case # RBPR-08-2016-24511 ge H CATAWBA COUNTY HEALTH DEPARTMENT 7n1:!... 0 mc r t : PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 7842 sM Residential Building Plan Review - Modular i cr 4: IMPROVEMENT - AUTH CONST- NEW WELL Contractor SAME AS OWNER, , Owner PAUL NELSON,2865 MATHIS CHURCH RD, CATAWBA NC 28609 NAME TO APPEAR ON PERMIT PAUL NELSON SITE ADDRESS: 2853 MATHIS CHURCH RD. CATAWBA NC 28609 PIN # 368804746467 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet Acres 0.89 DIRECTIONS: HWY 16 S LEFT ON BUFFALO SHOALS RD RIGHT ON LITTLE MOUNTAIN RD LEFT ON MATHIS CHURCH RD BESIDE 2850 MATHIS CHURCH RD ON LEFT SIDE PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: NEW MODULAR 68X30 FRONT DECK 7X18 BACK DECK 12X20 ATTACHED GARAGE 26X26 THAT HAS. 1/2 BATH ALSO WILL HAVE A DETACHED GARAGE 24X24 FUTURE POOL WITH CONCRETE 22X40 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: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 68 X 30 #OF NEW BEDROOMS:: 3 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: REPLACE WELL?: NO E9-ehapplication 08/16/2016 09:43 Page 1 of 4 BA CATAWBA COUNTY Case# RBPR-08-2016-24511 s : a41 ,-i Public Health Department �� Subdivision -C ._ S Environmental Health Division 'ar�' -c PIN# 368804746467 ' T PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 ifs SII NAME ON PERMIT: (PAUL NELSON),2865 MATHIS CHURCH RD, CATAWBA NC 28609 ( PAUL NELSON) Site Address: 2853 MATHIS CHURCH RD, CATAWBA NC 28609 Property Size: Square Feet Acres 0.89 Directions: HWY 16 S LEFT ON BUFFALO SHOALS RD RIGHT ON LITTLE MOUNTAIN RD LEFT ON MATHIS CHURCH RD BESIDE 2850 MATHIS CHURCH RD ON LEFT SIDE 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 withapplicable laws and rul derstand that I am solely responsible for the proper identification an labefn f all property lines and corners and making the site accessible t com to si va tion can be performed. Date: 'Q�i,���� Signature of Applicant or Agent ,/r-4- roe_ , uu An Environmental Health Specialist will contact you within 2 working days of application date. If you need further information or assistance please call 828-466-7291 AREA1 FEENAME ' F DATE '. FEE AMOUNT Authorization to Construct Fee (New/Expansion) 08/16/2016 5150.00 Fee Improvement Permit Fee 08/16/2016 5150.00 Well Permit& Inspection Fee 08/16/2016 5300.00 .TOTAL:FEES . '-5600,00 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 08/16/2016 09:43 Page 2 of 4 CATAVV BA THIS IS NOT A PERMIT cou ry CATAWBA COUNTY HEALTH DEPARTMENT >„��— Application for Environmental Services Page 1 Improvement PermitPCl Authorization to Construe Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) E Application is for New Construction , Existing Facility ❑ Property Addres Ci; inn- c Ck1R.cL Ro40 Subdiv s '- q .. CA-6164±94 j &C $G 7oq Lot# / _ 5 / Acres 57VSection//BBlock/Phase Driving Directions to Property , _ /?Q _aaees Al /P /1/Dadnhn,f 000, i/�-� Q m 4-&3- G&,erA 20.E — ,esrbe X521 irr9i&r3 C.Cag 2.o Si_ NAME TO APPEAR ON PERMIT? [X Owner ❑ Applicant n Contractor Applicant Contact Information Name Pr}tx_l hleAseYt Address 2._.26C in444_3 C cu4 /20,40 ag-- r,g /✓C Z( tc Phone 7O9-- 901-9- 2-77r Cell Phone 70Y— ? - ZV9'C Owner Contact Information Name Pin-eel , /e<s-Gr1 Address Phone Cell Phone --7O2C 9,,g7.-2jt Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? IN Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site N/(' c( ' #of Bedrooms *1' 3 Structure Dimensions 6P'X S #of Occupants .2._ Basement ❑ Yes No Basement Fixtures a Yes *No —,-- The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the propertyin question. If the answer to any question is "yes", applicant must attach supporting documentation. © Yes $No Does the site contain any jurisdictional wetlands? 0 Yes g No Does the site contain any existing wastewater systems? © Yes No Is any wastewater going to be generated on the site other than domestic sewage? )(Yes IgNo Is the site subject to approval by any other public agency? ® Yes jiti No Are there any easements or right of ways on this property? Describe Existing water supply in use [i Individual Well H Community Well in Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes KNo If applying for an Improvement Permit or Authorization to Construct, Please Indicate Desired System Type(s): v (systems can be ranked in order of your preference) O Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other X Any CArrA�Z71� A17L 1 THIS IS NOT A PERMIT • COUNTY CATAWBA COUNTY HEALTH DEPARTMENT • Application for Environmental Services Page 2 Proposed Facility Type ic Primary Residence ❑ New Residence *� ❑ Addition to Residence # of New Bedrooms l fief- 3 Project Descri tion c / c%r/*2 %b,'ne- on f�?c i/t v�lcto,:244. s�eP/y xa6 .15 1 p �G�(/ 7k1 C¢ ayXay y ore,'- /304e Structure Dimensions (�,2 x30 • # of Occupants / 9 ,V& D2 v? 7x/d' Basement ❑ Yes g No Basement Fixtures ® Yes ,aNo ❑ Accessory Structure(s) Describe ,9-4/»04ati 09-6Xge Gia edw a;� ay 63972,4-re#of New Bedrooms *1- rR if applicable7C Structure Dimensions t.) theefe 22 Xqo -41 # of Occupants Accessory Dwelling ❑ Yes 7 No r To t I-c Plumbing X Yes ❑ No Describe Plumbing Needed faq{� 86n . '� a/G&79724r, SPIk 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. 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 Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes n 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. U i1 *Any room that will be intended for sleeping at the time of caistfuction or for-figure 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 'ej7t� �ersDate Printed Name of Owner or Agent /�/-�(� /yegOrg (8181 ?Is) s 73HYYHO SIHI V/V X7/7 Gz/ We.o„enay _ �_j�� .SS'SB 1 M.91 L£.90 s a 11 Zl £l _ u�/_- �j N moo' �l _ s9aJY 46{'0 °i !/b NI mss- 3 tp9/�L�£t �-- _ _ w — — -- _ — •'N._=Y )Il'0 O 9041 86 W N ze S cc 3 awl ora�'° k< `f :nay_y�ola oa' �m -� --2br�3S1K Co1-_so ml-KN to. R�•cOW -�`. F`9 t . 'xi/ . 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I aaT-N p00Z�1., I. �o 0 1, ooQzo CoQ / �n � azr:��cDo I pWo7� U 00=1— p a Z I � ^m ` o �ooz� � �z 01 0 I Wwy�o � p OU pcnww QO I ke��co i ) Z � maJZQt I .--1y„g0 / n000� � w� / O. �' I— n � O0 Z 00 oW: cnz �w �w al Dm / cLuj O < w O K N Z d Y / W Kmoz00000 I / V) < WODZsmF // lO ^ w 0_' Q.Z O J 7w iii�CCC) ~ W QUZZQNN ) V M < aJ 0 W / / / C Catawba County Environmental Health / \I ?s :4 y3 _r/ 41.0.0 cNiir (71 ? i. �� n N .-W sta I U Th_...,.1,0 r Cr) ° U Co 0 1Z 227-s7 I / 0 • / Ino h 4 2850r R * wCn iiry •2048 ji — ' 227,E ( \ .7/ -"'-'N'll46i) ......- , 77-.'....2.: Parcel: 368804746467, MATHIS CHURCH RD lin=150ft CATAWBA, 28609 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 08/15/2016 Parcel Reportr ra Page 1 of 1 a ' Parcel Report - Catawba County NC 3 Parcel Information: Owner Information: Parcel ID: 368804746467 Owner: NELSON PAUL W Parcel Address: MATHIS CHURCH RD Owner2: NELSON BETTY ANN City: CATAWBA, 28609 Address: 2865 MATHIS CHURCH RD LRK(REID): 801068 Address2: Deed Book/Page: 3233/1437 City: CATAWBA Subdivision: State/Zip: NC 28609-7924 Lots/Block: / School Information: Last Sale: Plat Book/Page: School District: COUNTY Elementary School: BALLS CREEK Legal: Middle School: MILL CREEK Tax Map: High School: BANDYS Township: MOUNTAIN CREEK State Road #: 1818 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax istrict: County Fire District:lIn County Zoning BANDYS Zoningl District:R-40OUNTYpom o 5 n.^ `n, Building(s) Value: $0 Zoning2: W Land Value: $12,400 Zoning3: r Assessed Total Value: $12,400 Zoning Overlay: WP-O Year Built/Remodeled: / Small Area: SHERRILLS FORD 1 r Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers 2,33 ,(� `5 c ,i ''Q 11 `` Miscellaneous: Firm Panel Date: 2007-09-05 n Building Permits for this parcel. Firm Panel #: 3710368800J ` � Building Details 2010 Census Block: 2023 WaterShed: WS-IV Protected Area 2010 Census Tract: 011501 Voter Precinct: P1 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 from this map/report product or the use thereof by any person or entity. c' 2016, Catawba County Government, North Carolina. All rights reserved. Nouodulor C0 , �'`) c`1 WP.I. ( 4Cl D 12 20 Medal Lr Zcpt2 Goa_ 3 j afr Seai . wept, SOC Th" oi( p1-Z' u4i1ekZ-2 hp1g tawbac 5 bov/nona, PortrP � y 36804746467&tYp— P 8/15/2016