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HomeMy WebLinkAboutRBPR-09-2016-24641.TIF -4(3 THIS IS NOTA PERMIT Case # RBPR-09-2016-24641 < CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ti. i 1842 w Residential Building Plan Review - Building New roo . IMPROVEMENT- AUTH CONST lith J , VRPS. Land Owner BILLY BRADSHAW, 8552 JACOB FORK RIVER RD, VALE NC 28168 Owner 'JOHN STUBBS,4946 OLD SHELBY RD, VALE NC 28168 C:7326911044 NAME TO APPEAR ON PERMIT *John Stubbs SITE ADDRESS: 6055 OLD SHELBY RD, VALE NC 28168 PIN # 266802767771 NAME of SUBDIVISION: Lot# 3 Section/Block PROPERTY SIZE: Square Feet Acres 3.39 DIRECTIONS: 1-40 West to Exit 121,When approaching end of exit turn right continue on Old Shelby Rd for approx 7 miles property os on the right. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: New-Two story 4 bedroom Single Family dwelling w/attached garage - no basement Old well on the property hoping to be used for new home. New Owner does not think their was ever a septic on this property because house was not directly on this lot. 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 old barn, several bldgs (All to be Removed) EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 52'x 54' 7" #OF NEW BEDROOMS:: 4 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: F9-ehapplirnion 09/01/2016 12:18 Page 1 of 4 CATAWBA COUNTY Case u RBPR-09-2016-24641 .f' /AM .Z Public Health Department Subdivision 4 Environmental Health Division ply// 115 266802767771 -au PO Box 389. 100-A Southwest Blvd.Newton.NC 28658 tg.2 ,u NAME ON PERMIT: (*JOHN STUBBS),4946 OLD SHELBY RD, VALE NC 28168 ( *John Stubbs) Site Address: 6055 OLD SHELBY RD,VALE NC 28168 Property Size: Square Feet Acres 3.39 Directions: 1-40 West to Exit 121,When approaching end of exit turn right continue on Old Shelby Rd for approx 7 miles property os on the right. 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 m„ �,�„�����'nin raulupudumta m�i wr rli+,tlunaum+t 'unn tin itmm'nn'IBmr FEEN1 i\'F' I n�l)��11V,UIi�i,1 p�lIl t �iulir'lit mIIt�f� '�� rlum�O�tnlOiLlivaDATE 91V1"1y�; FEErAMOUNTT11 Authorization to Construct Fee (New/Expansion) 09/01/2016 $300.00 Fee Improvement Permit Fee 09/01/2016 $150.00 nn .,•--mm. ; n ""r((I V r r m I'lw mr ��iill�hu�r111 I�) 1 I"IITOTA LUFEES I I�I!y1�10A1 U���' Y f tio.0lid U Ipmoilllll il�i �idN't, ��YI a���No Uu1S, BO�Ilfl l i lm ^'ll n�+ina n9Dv rv;a➢a4V(ILLL�LlWld1 �"T�I I t i' � � If,n 11 1 ill ��A°,,• •• -�. '; �.r g,.., IIIlUi, .. .. '„tF� 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) Ii9-ehapplicaGnn 09/01/2016 12:18 Page 2 of o A-14 \ THIS IS NOTA PERMIT Case # RBPR-09-2016-24641 ` CATAWBA COUNTY HEALTH DEPARTMENT 0? i0 Kritat F` PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES � ti. {• \842 sM Residential Building Plan Review - Building New ra r IMPROVEMENT - AUTH CONST o El Land Owner BILLY BRADSHAW, 8552 JACOB FORK RIVER RD, VALE NC 28168 Owner *JOHN STUBBS,4946 OLD SHELBY RD, VALE NC 28168 C:7326911044 NAME TO APPEAR ON PERMIT *John Stubbs SITE ADDRESS: 6055 OLD SHELBY RD, VALE NC 28168 PIN # 266802767771 NAME of SUBDIVISION: Lot# 3 Section/Block PROPERTY SIZE: Square Feet Acres 3.39 DIRECTIONS: 1-40 West to Exit 121, When approaching end of exit turn right continue on Old Shelby Rd for approx 7 miles property os on the right. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: 2 story 4 bedroom Single Family dwelling w/attached garage - no basement 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 old barn EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 50x60 NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 52x54 7' #OF NEW BEDROOMS:: 4 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: E9-ehapplication 09/01/2016 10:10 Page 1 of 4 gw CATAWBA COUNTYCase# RBPR-09-2016-24641 tis 2 Public Health Department Subdivision < z1— -' Environmental Health Division PIN# 266802767771't®i PO Box 389. 100-A Southwest Blvd,Ne��2on, NC 28658 1 w NAME ON PERMIT: ( *JOHN STUBBS),4946 OLD SHELBY RD, VALE NC 28168 ( *John Stubbs) Site Address: 6055 OLD SHELBY RD, VALE NC 28168 Property Size: Square Feet Acres 3.39 Directions: 1-40 West to Exit 121, When approaching end of exit turn right continue on Old Shelby Rd for approx 7 miles property os on the right. 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 corn,'' uthorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and r,- understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible-. -t a rpmplete site evaluation can be performed. Date: "( — I — I ce -Signature of Applicant or Agent An Environmental Health Specialist will contact you within 5/orking days of application date. If you need further information or assistance please call 828-466-7291 AREA2 FEENAME DATE i" ' FEE AMOUNT Authorization to Construct Fee (New/Expansion) 09/01/2016 $300.00 Fee Improvement Permit Fee 09/01/2016 $150.00 TOTAL FEES 5450.00 FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-ehapplication 09/01/2016 10:10 Page 2 of 4 CATAWBA THIS IS NOTA PERMIT R 16�2"-* -- 02 -au 4(0(.4tcritomismizt coupCATAWBA COUNTY HEALTH DEPARTMENT � Application for Environmental Services Page I Improvement Permit Authorization to Construct [X Septic Repair❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction Existing Facility ❑ Property Address QS \ 0 L.Q. S t41/ ��C?}� Subdivision �� f (�C, 22"1 (c., Lot# Acres Section/Block/Phase Driving Directions to Property '- 140 WC-0- O Ems(1 (ZI , WN&.1 Fig�ACr tPS CI D 81- coPtArA-, „ er 2_, 1-.1 ;. cocciOra u0 .St -c.2--1 &Ao cote_ >W2o -74 i LES 2oPC y Ic 4e (leiHT NAME TO APPEAR ON PERMIT? Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name —TO j gat ne �± Address 49 Li (o ©W S HtL `�-G_W Vettei N _L 2t( (�6 Phone Cell Phone 37,C)0r I i 0 4 (r, Owner Contact Information Name o F-4 A ZA(' W S f Address k_k_0(41), 0li) 1 H-C`�-& `1 &AD VA—Le— t /V C-t 2$ Hop- Phone 10p- Phone Cell Phone 332.. (og ( (0Le(. . Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ►C/ Owner ❑ A..licant ❑ Contractor Description of Existing Structures on Site LIBILTWAVIEWak # of Bedrooms *t Structure Di sic is #of Occupants Basement ❑ Yes ❑ No Basement Fixtures Qi 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. • YesNo Does the site contain any jurisdictional wetlands? ® Yes No Does the site contain any existing wastewater systems? ID Yes )4 No Is any wastewater going to be generated on the site other than domestic sewage? )(Yes *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 water supply in use Individual Well LJ Community Well U Semi-Public Well ❑ 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): ystems can be ranked in order of your preference) ❑ Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other _ MAny CATAWBA THIS IS NOT A PERMIT COUNTY --�-- a CATAWBA COUNTY HEALTH DEPARTMENT NNaxamassi „„� , Application for Environmental Services Page 2 Pr posed Facility Type 12�(Primary Residence .4 New Residence ❑ Addition to Residence #of New Bedrooms *t Li- Project Description tAtjo Structure Dimensions.12-11- x 64t' 7 /A # of Occupants R Basement ❑ Yes 1No Basement Fixtures ® Yes ::Xi 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. 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 ❑ 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. f 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, i s 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'•spections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the prop-. . tification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can b med. Signature of Owner or Agent Id Date ci , I — K. Printed Name of Owner or Agent' 3 S }-4.3 -g w�j S • n CEJ TdQ 0.p t — r.00n 4 t 6 Z 3 N \ \ \ J R c3 oa^ 1 • Ie ' ` J N _0 v g Sig 50� • �\ CD ,n o \ O 1N S Ni � e81 ` / ti5f,. .4 / a n Q \�o = JJ 3a I. Laic W I _ _ I. i- c�. II< O I jIN N 0 m ulU - ii- Z alNo'inn a c1525 1 I c. nn•no 7- N c St'J- •33"‘N I I u �•7 m b h in 'vr ;-°:. _ o 0 0 z�z o to VI N eI-', aI I J N3) < In 'V , J J J J J J I J , 1 1 ,\ ,- I2 \ 1• 1 ne �� ' A \ \ ,�oft u,4ub7 ii :iP \ • Eo I • wog °4' 0t° I ' k. , I A o 4. r mpl C. a - / �~ \ uEE_ ^ / ' •ca/ O. 4 ^i . 4 1 O 2 =< • _ 6 \ . 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N, w 'm, etc Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 266802767771 Owner: BRADSHAW BILLY STEPHEN Parcel Address: 6055 OLD SHELBY RD Owner2: BRADSHAW KIMBERLY City: VALE, 28168 Address: 8552 JACOB FORK RIVER RD LRK(REID): 100944 Address2: Deed Book/Page: 3240/0612 City: VALE Subdivision: State/Zip: NC 28168-8938 Lots/Block: 3/ School Information: Last Sale: Plat Book/Page: 59/67 School District: COUNTY Legal: LOT 3 PLAT 59-67 Elementary School: BANOAK Middle School: JACOBS FORK Calculated Acreage: 3.390 High School: FRED T FOARD Tax Map: Township: BANDYS School Map State Road #: 1002 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: COOKSVILLE Zoningl: R-40 Building(s) Value: $0 Zoning2: Land Value: $22,100 Zoning3: Assessed Total Value: $22,100 Zoning Overlay: WP-O Year Built/Remodeled: / Small Area: PLATEAU Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710266800J Building Details 2010 Census Block: 1005 WaterShed: WS-III Protected Area 2010 Census Tract: 011802 Voter Precinct: P2 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. ©2016, Catawba County Government, North Carolina. All rights reserved. / l—' 4-ext‘tteuci -11 Pia 4\53`0,eiciLa23(1))icn, a *m q(sG► Idd, http://gis.catawbacountync.gov/nomap/parcel_report.php?key=266802767771&typ=P 9/1/2016