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HomeMy WebLinkAboutEHPR-06-2016-24054.TIF 1• A - oG THIS IS NOT A PERMIT Case# EHPR-06-2016-24054 CATAWBA COUNTY HEALTH DEPARTMENT p .ra -y 0 0, '� `C PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 842 sM Environmental Health Plan Review - OSWP s • . a o IMPROVEMENT •� 4 0 Applicant *STEVE A DELLINGER (STEVE A DELLINGER), 3599 KELSIE LN, MAIDEN NC 28650 B:704-483-5568 C:704-400-7396F:704-489-6612 Owner VICKIE BLANTON,2074 CORDIA CIR,NEWTON NC 28658 H:704-20I-2033 HOME:704-201-2033 NAME TO APPEAR ON PERMIT *STEVE A DELLINGER (STEVE A DELLINGER) SITE ADDRESS: 3273 BIRD DOG LN,MAIDEN NC 28650 PIN # 367804505486 NAME of SUBDIVISION: QUAIL CREEK Lot# 39 Section/Block PROPERTY SIZE: Square Feet 23,522.40 Acres 0.54 DIRECTIONS: Hwy 16 South to Quail Creek Development on the Left side of Road, Left onto Pine Leaf Dr, Right Briar Creek Rd, Left onto Bird Dog Lane, 3rd Lot on the Left. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP for Purchase* 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 Vacant Lot EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 62x62 #OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-ehapplieation 06/08(2016 12:07 Page 1 of 4 ,_v,A CATAWBA COUNTY Case# EHPR-06-2016-24054 Public Health Department-L P Subdivision QUAIL CREEK -C --^' „5, Environmental Health Division PINK 367804505486 �dM®f PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 lg.2 x NAME ON PERMIT: *STEVE A DELLINGER ( STEVE A DELLINGER), 3599 KELSIE LN, MAIDEN NC 28650 `STEVE A DELLINGER ( STEVE A DELLINGER) Site Address: 3273 BIRD DOG LN, MAIDEN NC 28650 Property Size: Square Feet 23,522.40 Acres 0.54 Directions: Hwy 16 South to Quail Creek Development on the Left side of Road, Left onto Pine Leaf Dr, Right Briar Creek Rd, Left onto Bird Dog Lane, 3rd Lot on the Left. 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/arrect. Authorized cou9ty-:nd state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws a r+ r es. I understand tb5t I -m solely responsi. - for the proper identification arid labeling o property lines and corners and making the site��e es . .lete V- v- 'on can be -rformed. Date: —7— Signature of Applicant or Ageht /��//�a� -,���� - An Environmental Health Specialist will contact you withi working days o application e:te. If you need further information or assistancvplease call 828-466-7291 AREA1 ENM Y iI . F Ili!mil,' I l `` l INt FEA E -. val.I l' ` t3N!, it ,, El 1IDATE .4 '� FEEAMOUT Improvement Permit Fee 06/08/2016 $150.00 ' �)� ,.`TOTnu�u�uu �u P��l III��II���IIIihHl�hdl,fib"� I' .t PrsBU llvllI��N r fli_fU l '05 ,, : solo ,,- 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) G9-elmpplication 06/08/2016 12:07 Page 2 of 4 CAIN,\ i A THIS IS NOT A PERMIT alPk—N(53 cou�r� l C-ll CATAWBA COUNTY HEALTH DEPARTMENT -=r � „, Application for Environmental Services Page 1 Improvement Permit Authorization to Construct n Septic Repair❑ Septic Malfunction ❑ Septic Expansibu ❑ New Well Permit in Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New(C'Construction Existing Facility Property Address ( n1�^V^cC� '-), L- \ Subdivision If PAN N an Lot# Acres �/ Section/Block/Phase Driving Directions to Property !� /6 S �O G U R■ t (-Leek Dc 1/47,/d/ r� e-✓f Ohl ( � �` L vi-n- e2ee- < Z ly n+i lic •6 se 0 Q a 04 Le44 ko f o r/ kc f�-bdut 0D F NAME TO APPEAR ON PERMIT? ❑ Owner [ Applicant . Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name /7/C t2t 29'm4 ” Address Phone Cell Phone Contractor Contact Information Name 57%j/c- `7c/C(�rieza Address Ojg C A-CIS<a GEC, /04-za 3' /9// Phone Cell Phone 76) 4>& -73?L WHO WILL BE THE PRIMARY CONTACT? ❑ Owner/ 1❑ Applicant contractor Description of Existing Structures on Site Valan- _ -- CA CR H-10_5Q '.- OMA iyA�r' # of Bedrooms *1- Structure Dimensions #of Occupants Basement ❑ Yes ❑ No Basement Fixtures 0 Yes CA 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. © Yes *No Does the site contain any jurisdictional wetlands? %Yes ICI No Does the site contain any existing wastewater systems? d Yes o 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? O Yes li o' Are there any easements or right of ways on this property? Describe Existing water supply in use `Individual Well ❑ Community Well I I 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): 'systems can be ranked in order of your preference) ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other ❑ Any c /ATA A THIS IS NOT A PERMIT cou�t� _ CATAWBA COUNTY HEALTH DEPARTMENT —!o Application for Environmental Services Page 2 Proposed Facility Type n Primary Residence New Residence ❑ Addition to Residence # of New Bedrooms *j Project Description Structure Dimensions R- # of Occupants Basement n Yes o Basement Fixtures ® Yes ® No Accessory Structure(s) Describe # of New Bedrooms *j' if applicable Structure Dimensions # of Occupants Accessory Dwelling in Yes n No Plumbing n Yes n No Describe Plumbing Needed Multi-Family Residence#Units #Bedrooms per Unit*t Total#Bedrooms *j Structure Dimensions ❑ Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift #of Shifts Dining Area(Sq. Ft.) n 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 IT Individual Well n Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled n 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. j 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 c., be performed. Signature of Owner or Agen Date 03//6 Printed Name of Owner or Agent Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 367804505363 Owner: BLANTON VICKIE GLOVER Parcel Address: 3281 BIRD DOG LN Owner2: null City: MAIDEN, 28650 Address: 2074 CORDIA CIR LRK(REID): 6297 Address2: null Deed Book/Page: 1633/0928 City: NEWTON Subdivision: QUAIL CREEK State/Zip: NC 28658-7814 Lots/Block: 40/null Last Sale: $92,000 on 1989-10-01 School Information: Plat Book/Page: 21/243 School District: COUNTY Legal: LOT 40 QUAIL CR PL 21-243 Elementary School: BALLS CREEK Middle School: MILL CREEK Calculated Acreage: .460 Tax Map: 006AK 01040 High School: BANDYS Township: CALDWELL School Map State Road #: null TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: BANDYS Zoningl: R-40 Building(s) Value: $0 Zoning2: null Land Value: $16,000 Zoning3: null Assessed Total Value: $16,000 Zoning Overlay: WP-O Year Built/Remodeled: null/null Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: null/null Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710367800J Building Details 2010 Census Block: 2027 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. ©2016, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=367804505363&typ=P 6/8/2016 Catawba County Environmental Health i 32 " „� 38 s cn / rn 39 90 R) \Ot 7)8 •lq 31 0° 00 40 O�. 2 V §* o sue - m• (9 Sy t / 25.00 �.4 1 7 I) ��"M i IH �-4 4.94 80.35 ��as • • .. Parcel: 367804505363, 3281 BIRD DOG LN 1in=50ft MAIDEN, 28650 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 06/08/2016 • CATAWBA COUNTY HEALTH DEPARTMENT ,rot Evaluation Improvement Permit z....------- Repair Permit Completion Permit 1 Owner/Agent BC1 T_T0N GA W5 (In , Phone Address )/-1 NrN2?7i M4)N.RUer Subdivision QuAJL- C FTA( NEk,7-a, 4/,c- .2eG,sh-- Section/Block Lot # pp Lot Size Direct ions: mi /45 LFRT 14/70 4 kii/c. C.et R( s.,V.j) DF igA T M )) l'i -i 7— I-r- C-EFi .2 611) LlrT oN c_'c?" L�i .S/O Facility: House_-Pt bile Hare Business : Other: Zoning Approval /Wino # )Q:303 Multi-family Other ; 100% Repair Areano Bedrooms 3 Baths„ — Seats Employees . GPD Flow Application Rate , Garbage Disposal ._3pecial Fixtures . REPAIR NOTICE: REPAIRS MUST BE WITHIN 30 Basement yes Basement Plumbing yes, ro> . DAYS OR DAYS FRa4 DATE OF PERMIT. Water Supply: Private public Type of System: Trench[_—Bed System Other (Specify) Tank Size: Septic Tank /d0 G Pump Tank Nitrification Field: Total Square Feet 790 Depth of Stone )„,,z " Bed Size Trench Width �3 I Total Length of All Trenches _29G Number of Trenches Individual Trench Length -6 /86 /cD/ / Feet on Center Maximum Trench Depth Distance to Nearest Well 3-0 '-4- Lot Evaluation: Approved (---Disapproved ************ ************************** ********** Sketch of Lot Evaluation Site - System Design Fin _ - - _ - - - _ - .- J (-- v ....,_ , , \ li li ik \ , , c. , , ti '.) 4 " i i_ \ \ i , k ,k / r 4„ , \ \'.,, 7% 1i 1 11 ' f kd 'X3 ',--- *************************-r****** *********************************************** **** Permit Date 31 - 8) (Lot Evaluation and Improvement Permit void after 36 • ths) Owner/Agent?c J 4/, ---.L.2) Sanitarian L ,A/-0:-,y,,,,,,,,,,� Installed By C.4,t,�c < Date Sanitarian (Note any char s/information in red or by sketch on back) Topo S PS U Drainage S PS U Depth S PS U Restrictive Hoz. S PS U Space S PS U Soil S PS U III Loars: Sandy Clay, Silt, Clay, Silty Clay .6-.4 IVa Clays: Sandy, Silty, Clay .4-.2 WHITE-OFFICE COPY , • YELLOW-OWNER/AGENT COPY ■ KLicf'rniA p CATAWBA COUNTY � f A G, 100A SOUTHWEST BLVD 1 z NEWTON,NORTH CAROLINA 28658 INVOICE/RECEIPT W W 4r .,;4 �e� PHONE: 828.465.8399 Wednesday, June 8, 2016 \ ' 1$42 se www.catawbacountync.gov Invoice Number: 06-16-329191 Invoice Date: 06/08/2016 EHPR-06-2016-24053 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 3281 BIRD DOG LN, MAIDEN NC 28650 Applicant *STEVE A DELLINGER, 3599 KELSIE LN, MAIDEN NC 28650 B:704-483-5568C:704-400-7396F:704-489-6612 ACCOUNT: 6378 Owner VICKIE BLANTON, 2074 CORDIA CIR,NEWTON NC 28658 H:704-201-2033 PAYOR: *STEVE A DELLINGER FEES EHPR-06-2016-24053 FEE AMT DUE AMT Improvement Permit Fee 06/08/2016 $150.00 $150.00 FEES: $150.00 $150.00 TOTAL FEES: $150.00 $150.00 invoicereceipt 06/08/2016 12.05 Page 1 of 1