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HomeMy WebLinkAboutEHPR-08-2016-24445.TIF BA COQ THIS IS NOT A PERMIT Case # EHPR-08-2016-24445 F' CATAWBA COUNTY HEALTH DEPARTMENT D �;��'o:f.S . ' ,{ ®°' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES *� 1842 5M Environmental Health Plan Review - OSWP o ro .CI.� • IMPROVEMENT .1:1 o nx Applicant LONNIE FERREN, 763 HICKORY AIRPORT RD, HICKORY NC 28601 H:8283281415 C:8283124414 HOME:8283281415 NAME TO APPEAR ON PERMIT Lonnie Ferren SITE ADDRESS: 6639 MOUNTAIN GROVE RD, HICKORY NC 28602 PIN # 278001495715 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 26,179.56 Acres .601 DIRECTIONS: Hwy 127 South, Right onto Mtn Grove Rd, Go about 1/2 mile on Right , Lot is across from 6586. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water 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? Yes Property Easements Description: 30 foot easement for shared driveway 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: 6 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 32x60 #OF NEW BEDROOMS:: 3 BASEMENT? Yes BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: 1:,9-ehapplication 08/04/2016 13:26 Page 1 of 4 /A \ CATAWBA COUNTY Case# EHPR-08-2016-24445 H AM" Public Health Department Subdivision �� Qi��, Environmental Health Division PIN# v'" 4 'C 278001495715 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 /842 :M NAME ON PERMIT: (LONNIE FERREN), 763 HICKORY AIRPORT RD, HICKORY NC 28601 ( Lonnie Ferren) Site Address: 6639 MOUNTAIN GROVE RD, HICKORY NC 28602 Property Size: Square Feet 26,179.56 Acres .601 Directions: Hwy 127 South, Right onto Mtn Grove Rd, Go about 1/2 mile on Right , Lot is across from 6586. 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 accessi so thhaa comp) site evaluation can be performed. Date:08-0 y-av�b Signature of Applicant orAgen C , ��-- An Environmental Health Specialist will contact you within 5 working ays of application date. If you need further information or assistance please call 828-466-7291 AREA2 DATE FEE AMOU.� NT Improvement Permit Fee 08/04/2016 $150.00 ` TOTAL FEES: ' � ' ; � � � $'150 011 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) 1:9-ehapplication 08/04/2016 13:26 Page 2 of 4 CATAwBA THIS IS NOT A PERMIT COUNTY F; CATAWBA COUNTY HEALTH DEPARTMENT '' °-'; ..,,,,c. ,o„� Application for Environmental Services Page 1 Improvement Permit Authorization to Construct n Septic Repair Septic Malfunction❑ Septic Expansion ❑ New Well Permit Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) rr ��ff,�,, A pliiccattiio-n is for New Construction Existing Facility n Property Address!O/ �”/r� �j("ail� 4� Subdivision /1///Q MCLI9Ay NC 2J 4 2- Lot# / Acres / 9g Section/Block/Phase Driving Directions to Property /c27 doe&-744 /Zr9GrZ D)7 Mr ‘,---2,6k, P,-._ �((J]J�me %Z /7?(le_ do /2<y/7tz- JrK'ne4 ohc� NAME TO APPEAR ON PERMIT? [Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name L-.0i7r)/l G t r-7 ,,1 �e Address 7/, / /L/C/ o ,--p - /2,,,,e.. Phone yes- 3/a ".7/ -57 Cell Phone Owner Contact Information Name� . c Address-761!� rg ckoe/ ijrr-� 2& Phone �te- gJ e /c/ s---- Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site _4 At 1p #of Bedrooms *t Structure Dimensions #of Occupants Basement ❑ Yes ❑ No Basement Fixtures a Yes rlig 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. El YesIo Does the site contain any jurisdictional wetlands? ri Yes grRo Does the site contain any existing wastewater systems? 0 Yes EllSIo Is any wastewater going to be generated on the site other than domestic sewage? K2 Yes ,122No Is the site subject to approval by any other public agency? EYes lelo Are there any easements or right of ways on this property? Describq-Od/ed dc%!/P ezi y Existing water supply in use [ Individual Well ❑ Community Well H Semi-Public Well ,County/City/Township Water Line Is a public water supply available? ** ,P--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 JA Any cATAwBA THIS IS NOT A PERMIT COUNTY ,, CATAWBA COUNTY HEALTH DEPARTMENT North Cornlina Application for Environmental Services Page 2 Proposed Facility Type Primary Residence .2 New Residence ❑ Addition to Residence #of New Bedrooms *t 8j Project Description j.Q.,t-C 9 O' 'a 1 / ,t 'gyl�)C Structure Dimensions_/j„&e, # of Occupants Basement,. Y s ❑ No Basement Fixtures 0 Yes ,0 No E. Accessory Structure(s) Describe # of New Bedrooms *1. if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence#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 ❑ Yes ❑ No If Daycare Specify Occupancy • Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well n Community Well Abandonment Type ❑ Drilled Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ No Describe Calculated Design Flow, Commercial 1. 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 Agen Date T>d — %Printed Name of Owner or Agent Le:,/) - �e� ki 1 1 Catawba County Environmental Health / • r i 6 11/44,4„:e'' ' s a 41P:" r µ© 50 X 4140 flcRp p s.,„,,,,,....,............::„......,,,,NN.... ,„ , .c.' , , (518) -,, ‘9.9" ' 't,,,,,, ,ro) ,„ , , ,_ .. \'■■■ '3/41444*4,444,4 ...• (218' „...,,,,,,,,,,,,N....1/4,,,N) a. R Parcel: 278001495715, 6586 MOUNTAIN 1 in=60ft GROVE RD 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 08/04/2016 Catawba County Environmental Health ti { ,:, /, ," aQ 1 ,...il ; vfil 1 " iG'wk',o ,11 / Y ) h I .1 : I kk. •rl ) '.. lt jr/ 4 I 1041) t to, , I N (516 i _ it: ul _-395. o... Parcel: 278001495715, 6586 MOUNTAIN 1 in=150ft GROVE RD 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. I Copyright 2014 Catawba County NC 08/04/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 278001495715 Owner: SMITH ROY W Parcel Address: 6586 MOUNTAIN GROVE RD Owner2: FERREN LONNIE C JR City: HICKORY, 28602 Address: 763 HICKORY AIRPORT RD LRK(REID): 59552 Address2: Deed Book/Page: 3319/1645 City: HICKORY Subdivision: State/Zip: NC 28601-7282 Lots/Block: / Last Sale: School Information: Plat Book/Page: School District: COUNTY Legal: Elementary School: MOUNTAIN VIEW Calculated Acreage: 8.120 Middle School: JACOBS FORK Tax Map: 177H 01004 High School: FRED T FOARD Township: HICKORY School Map State Road #: 1128 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: MOUNTAIN VIEW Zoning1: R-20 Building(s) Value: $52,800 Zoning2: Land Value: $52,600 Zoning3: Assessed Total Value: $105,400 Zoning Overlay: Year Built/Remodeled: 1956/ Small Area: MOUNTAIN VIEW Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: Building Details 2010 Census Block: 2057 WaterShed: 2010 Census Tract: 011101 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 from this map/report product or the use thereof by any person or entity. ©2016, Catawba County Government, North Carolina. All rights reserved. hro-e_gd, POIt'd http://gis.catawbacountync.gov/nomap/parcel_report.php?key=278001495715&typ=P 8/4/2016 „14g'P Cc) CATAWBA COUNTY ��' w � 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT PHONE: 828.465.8399 V °' 1� arp1 Thursday, August 4, 2016 u /842 sM www.catawbacountync.gov PAYOR: Ferren,Lonnie PAYMENTS TRANSACTION NUMBER: TRC-766096-04-08-2016 PAYMENT DATE : 08/04/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-331266 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EHPR-08-2016-24445 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 6639 MOUNTAIN GROVE RD, HICKORY NC 28602 Applicant LONNIE FERREN, 763 HICKORY AIRPORT RD, HICKORY NC 28601 H:8283281415C:8283124414 **NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 08/04/2016 13:26 Page 1 of 1