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HomeMy WebLinkAboutEHPR-03-2016-23306.TIF BA �i THIS IS NOT A PERMIT Case # EI IPR-03-2016-23306 d # ti CATAWBA COUNTY HEALTH DEPARTMENT 0?,' �o ''. .1 0 ��"� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Ig42 :M Environmental Health Plan Review - OSWP • IMPROVEMENT r r o Applicant DARRIN REID,2729 GETTYSBURG PL, CLAREMONT NC 28610 H:8284599699 C:828-312-5119 HOME:8284599699 Owner CHARLES SIMMONS, 1010 CREEKSIDE DR, HIGH POINT NC 27262-7027 C:3368864602 NAME TO APPEAR ON PERMIT CHARLES SIMMONS SITE ADDRESS: 6856 GREEDY HWY, HICKORY NC 28602 PIN # 268901474296 NAME of SUBDIVISION: Lot# 1 Section/Block PROPERTY SIZE: Square Feet 69,696.00 Acres 1.6 DIRECTIONS: HWY 127 South, to Greedy Hwy PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP for Subdividing* 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? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: House 50x60 #OF NEW BEDROOMS:: 3 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: E9-ehapplicationn 03/02/2016 11:30 Page 1 of a$• * CATAWBA COUNTY Case# EHPR-03-2016-23306 Public Health Department Subdivision H Environmental Health Division PIN# 268901474296 PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 1842 ski NAME ON PERMIT: (CHARLES SIMMONS), 1010 CREEKSIDE DR, HIGH POINT NC 27262-7027 ( CHARLES SIMMONS) Site Address: 6856 GREEDY HWY, H ICKORY NC 28602 Property Size: Square Feet 69,696.00 Acres 1.6 Directions: HWY 127 South, to Greedy Hwy 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 lab ling of all property lines and corners and making the site accessi• that a complete site evaluation can be performed. Date: 3/z//� • Signature of Applicant or Agent An Environmental Health Specialist will contact you-telirc, ing . ys of application date. If you need further information or assistance please call 828-466-7291 AREA2 rr`orl 1 r 1 FlPi ills ¢ W H , " -9 '�ti '�s Imo EE i„n; trFEENAMErI�`u?�sf�„ ,,., _:dial. . `aa DATEESt.,vOTTEAMOUNT `d Improvement Permit Fee 03/02/2016 S 150.00 7ir' TOTAL FEES 3 } r` sip .fxr'vY z 4gf3Ji "'felts "° Ie,t9rwalt&: $15000Kt11 aqattatiL it-taissinatisatiwiv FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-ehapplication 03/02/2016 11:30 Page 2 of 4 A CATAWB THIS IS NOT A PERMIT cOUNTY � �—� CATAWBA COUNTY HEALTH DEPARTMENT —nllna� Application for Environmental Services Page 1 Ne�lh C Improvement Permit Authorization to Construct n Septic Repair Li Septic Malfunction ❑ Septic Expansion' New Well Permit n Replacement Well ❑ Well Abandonment_ Well Repair n Existing System Inspection ((Pre-Approval Required) n Application is for New Construction bCl Existing Facility ❑ Property Address 6,lee y 45-4,4, l Subdivision C. 4' .Snyn-,n. e 2(o$g/(7/- Y7 %lino Lot# / Acres / 4 "lc LeJ Section/Block/Phase Driving Directions to Property Ale r?,o # 285'- o/-Y? - ;'zn NAME TO APPEAR ON PERMIT? liKmer ❑ Applicant n Contractor Applicant Contact Information Name PA,e,,, ,J 4., 2' /� Address 2724 6iC $4' '1z ' f ? ce (07,-- n-7 GA) frt Phone qS5— 2d9 9 ,/ Cell Phone 3) Z _57/ 7 Owner Contact Information Name G'. h1 5,,-,n, 0.., s /� (//� Address /oio &eeteideo te,vc - /--//,-; 4„s; /cc- 272z Z Phone 53G zed _ rro o Z Cell Phone Contractor Contact Information Name License # Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner Applicant n Contractor Description of Existing Structures on Site iv 42 n.er 6,, ,4„_,T) #of Bedrooms *t Structure Dimensions #of Occupants Basement n Yes ❑ No Basement Fixtures ❑ Yes ❑ No The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property i3 question. If the answer to any question is "yes", applicant must attach supporting documentation. ❑ Yes No Does the site contain any jurisdictional wetlands? ❑ Yes Et<o Does the site contain any existing wastewater systems? ❑ Yes EYNIo Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes 1t10 Is the site subject to approval by any other public agency? ❑ Yes 01 o Are there any easements or right of ways on this property? Describe Existing water supply in use . ---individual Well ❑ Community Well n Semi-Public Well El County/City/Township Water Line Is a public water supply available? ** n Yes n 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)te B CCepted lE A ternative L-kd nventional ❑ Innovative ❑ Other ❑ Any CATAWBA THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT „cT�,, Application for Environmental Services Page 2 Proposed Facility Type fa- New• Primary Residence fa New Residence ❑ Addition to Residence #of New Bedrooms *j' 3 Project Description cZoposee/ 3 /3 ee/(2-oo-� Structure Dimensions So y g 0 #of Qccupants Basement Yes n No Basement Fixtures Yes H No ❑ Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑Yes H No Describe Plumbing Needed ❑ Multi-Family Residence if Units #Bedrooms per Unit*j' 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 H Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type H Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type H Drilled [ Bored ❑ Dug H Unknown Well Repair Requested ❑ Yes H 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 i / Date .7/2 3/4 4 Air Printed Name of Owner or Agent i re-,J /a c' Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 268901474296 Owner: SIMMONS CHARLES H Parcel Address: GREEDY HWY Owner2: City: HICKORY, 28602 Address: 1010 CREEKSIDE DR LRK(REID): 1371 Address2: Deed Book/Page: 3226/0675 City: HIGH POINT Subdivision: State/Zip: NC 27262-7027 Lots/Block: / Last Sale: $37,500 on 1986-04-01 School Information: Plat BooWPage: School District: COUNTY Elementary School: BANOAK Legal: Calculated Acreage: 24.480 Middle School: JACOBS FORK Tax Map: 002 B 01031A High School: FRED T FOARD Township: BANDYS State Road #: 1120 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: PROPST Zoningl: R-40 Building(s) Value: $0 Zoning2: Land Value: $111,400 Zoning3: Assessed Total Value: $5,500 Zoning Overlay: WP-O Use Land Value: $5,500 Small Area: PLATEAU Year Built/Remodeled: / Split Zoning Districts: / Current Tax Bill Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710268900J Building Details 2010 Census Block: 1020 WaterShed: WS-III Protected Area 2010 Census Tract: 011801 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 hom this map/report product or the use thereof by any person or entity. ©2015, Catawba County Government, North Carolina. All rights reserved. Lk+ 3 '1— Nithme: (0 B-19 breeck http://gis.catawbacountync.gov/nomap/parcel_report.php?key=268901474296&typ=P 3/2/2016 Catawba County Environmental) HHealth ',-\;:,,,„\\ %Air 6. ;or 1:i6. t" 111: 1- 3: C\Cr-s. ' LNI7----/H-\-----C1H---- -\: iS Ott lir lic. :a . i f'"4 .. (3Y' Al a z , ``4 J a Sir lilt i w " ' ti I • 14‘,.., � ii 4/9 ,....t, • \\ie i S , . 4 . 1 ° -T. ,:- tir€:'. r r I t a ug pititfrill”%%-eornimi.....-Ars's ro '-' \.s.' 1 t\ 4 \\\C N . 4 , .,i4 \\„, � � # a Q _ , , • Lir 50+ >> ...... :60 immi `4 v nt h� �r _ � f,,�,�f / Ind— / 6 Parcel: 268901474296, GREEDY HWY 1in=300ft HICKORY, 28602 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 03/02/2016 $.A CATAWBA COUNTY i� �� � IOOA SOUTHWEST BLVD NEWTON, NORTH CAROLINA 28658 RECEIPT iG 3 PHONE: 828.465.8399 U\ vds+ "5 t, /84'1 sM www.catawbacountync.gov Wednesday, March 2, 2016 PAYOR: REID, DARRIN PAYMENTS TRANSACTION NUMBER: TRC-630360-02-03-2016 PAYMENT DATE : 03/02/2016 PAYMENT TYPE: Check 8196 INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-325765 Improvement Permit Fee $150.00 TOTAL PAYMENTS : 5150.00 EHPR-03-2016-23306 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 6856 GREEDY HWY, HICKORY NC 28602 Applicant DARRIN REID, 2729 GETTYSBURG PL,CLAREMONT NC 28610 1-1:8284599699C:828-312-5119 ** NO PEOPLESOFI'ACCOUNT ASSIGNED ** Owner CHARLES SIMMONS, 1010 CREEKSIDE DR, HIGH POINT NC 27262-7027 C:3368864602 receipt 03/02/2016 11:29 Page 1 of 1