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HomeMy WebLinkAboutRBPR-07-2017-27037.TIF`hy,A 1842 SM Contractor Owner THIS IS NOT A PERMIT Case # RBPR-07-2017-27037 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICA'T'ION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Building New IMPROVEMENT - AUTH CONST -NEW WELL *DETWEILER, DENNIS D (DENNIS D DETWEILER), 1482 JV PARKER DR, HICKORY NC 286( 14:828244967013:8283269649 C:828-244-9671 HOME:8282449670F:828-326-9649 SAME AS PHOP DETWEILERCONST n AOL.COM ERNEST DELLINGER, 1729 YODER FARM, NAME TO APPEAR ON PERMIT ERNEST DELLINGER SITE ADDRESS: 1765 YODER FARM RD, HICKORY NC 28602 PIN # 360901154116 NAME of SUBDIVISION: Lot # Section/Block PROPERTY SIZE: Square Feet Acres 1223 DIRECTIONS: Hwy 10 W, turn right on Whitener Rd, turn right on Yoder Farm Rd, propert 1/2 mi on left PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP/AC/Well, 360 GPD, New, one-story, single family dwelling, 3 bedroom home, with attached garage no bons room 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 1s 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: STRUCTURE TYPE: FACILITY TYPE: Single Family Residence DESCRIPTION OF EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: New Structure PRIMARY RESIDENCE OTHER DESCRIPTION: NUMBER OF EXISTING BEDROOMS: # OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 48x64 Single Family Dwelling # OF NEW BEDROOMS:: 3 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. APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO E9 - chapphcation 07/25/2017 16 15 Page I of 4 ew CATAWBACOUNTS case# RBPR-07-2017-27037 Public Health Department Environmental Health Division Subdivision ve PO Box 389, 100-A Southwest Blvd, Newton. NC 28658 PINY 360901154116 Ig.t w NAME ON PERMIT: ( ERNEST DELLINGER), 1729 YODER FARM, ( ERNEST DELLINGER) Site Address: 1765 YODER FARM RD, HICKORY NC 28602 Property Size: Square Feet Acres 12'23 Directions: Hwy 10 W, turn right on Whitener Rd, turn right on Yoder Farm Rd, propert 1/2 mi on 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 correct. Authorizedffffff��,,,,,,ounty a d state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws an 'ries. I und�a� e oolely r-Baonsible for the proper identification and labeling of all property lines and corners and making the site access i s tha a coni a uati can be performed. Date: %— ZS' 2 0 I % Signature of Applicant or Agent �.tn..� 1 An Environmental health Specialist will contact you within - working days of application date. If you need further information or assistance please call 828-466-7291 AREA2 FEENAME DATE ' ' FEE AMOUNT Authorization to Construct Fee (New/Expansion) 07/25/2017 $150.00 Fee Improvement Permit Fee Well Permit & Inspection Fee 07/25/2017 $150.00 07/25/2017 $300.00 " TOTAL FE ES $600.00 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) 1'9 - chapphcauun 07/25/2017 16 16 Page 2 of 4 CA'IAWBA THIS IS NOTA PERN11 I' COUNTTY[l..a-V V, 14J�,., CATAWBA COUNTY HEALTH DEPARTMENT n„ ,o Application for Environmental Services Page 1 Improvement PermitN Authorization to Construct Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well PermitReplacement Well ElWell Abandonment ❑ Well Repair F1Existing Sysle t tspection (Pre -Approval Required) ❑ Application is fm• New(Construction X Existing Facility ❑ 'Properh,Address /765// r �L'/_'M�. Subdivision siKd/'p. Lot# Acres%, 372, O Section/Block/Plyase . Driving Directions to Property NAME TO APPEAR ON PERMIT? ❑ Owner Applicant Contact Information Name Address Me S/J Phone Owner Contact Information Nalue Zawt„S J) ��tLr Pi d-r).r %? M, /P i3i., - (Applicant Contractoi i Cell Phone f52 8 — .24?0 — ?/0 7/ Address /7 `19 VcJ,,- r a, k1.4 Phone 70LI L/./7- IM9 Contractor Contact Inl'ornlat'on NamesS�% e �!� J Pio( (Address Phone - F1'I'IO WILL BE TIIF I'R71'IARY CONTACT? ❑ Owner %Fitt .CSD//A. Ceii P11011e Cell Phone 5I2 g- ;Z 4yyr 7/ ❑ Applicant VI Contractor Description of Existing Structures on Site # of Bedrooms TT Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures Q Yes 0 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 A No Does the site contain any jurisdictional wetlands? ® Yes ANo Does the site contain ally existing wastewater systems? 0 Yes XNo Is any wastewater going to be generated on the site other than domestic sewage? ,14 Yes Q 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 ❑ Community Well ❑ Semi -Public Well ❑ County/City/Township Nater Line Is a public water supply available? " ❑ Yes ❑ No 11'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 0 innovative 0 Other �7 Any C'�t TI IS IS NOTA PERJ\1II'l' COUNTY C�iT' WBA COUNTY" HEALTH DEPARTIIMENT COUNTY �-.•�---_-._... Applicai ion fior Envircui nen±al Services Proposed Facility Type [j Primary Residence Ikj New Resideence ❑t Additii/on to Residence p of'New Bedrooms *'j Project Dcsci iption ��r40 e( i.l P IA lLn Structure Dimensions _I$°{�. # of (3ccupants Basement ❑ Yes P No Basement Fixtures 0 Yes M No ❑ AccessoryStructure(s) Describe # of Nets Bedrooms *'j if applicable Structure Dimensions # of Occupar"s Accessory Dwelling ❑ Yes L No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Nlulii-Funnily Residence # Units _ _ #11edrooms per Unit*'' Total # Bedrooms ' j Structure Dimensions ❑ Food Service Specify Type Page 2 3 # Seats Floor Space -Entire Food Service Facility (Sq Fi) # Employees per Shift _ _ # of Shifts . Dining Area (Sq. Ft.) ❑ Business Specific Type of Business Retail Flour Space # of Employees per Shift i. # of stills ❑ Other Facility Type Specify If Church # of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abatulonttnent/Repair Proposed Well Type Individual Well ❑ Semi -Public Well ❑ Community Well Abandonr Type Drilled ❑ Bond ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ No Describe. Calcu!a£ed Design Flow, Commercial T. Additional information ma} be required to determine design flotr from certain facilities. 'Phis value will be determined during consultation with on-site staff. 'Any i ocnt that nidi he in: ended for sleep» ag, : the title of coils, nuc- ion or for fut.:i c consideration slio..=.'d 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 Pu i:dill g permi-, issuance. Tit is :nay la ovcut the need for septic system size increase in the future lf'structure is plumbed but no bedrooms, calerilated design flow is required. *` If No, a well permit must be issued with the Authorization to Construct. SYSTEAM REDESIGN AND/OR RETRIP PdILL INCUR AN ADDI'T'IONAL CHARGE (SGT FEE SCIIFDULE) tmpi oveutent 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 (S) five years from the date issued and is not transferable; Improvement Perin its and Well Permits are transferrable Permits may be revoked if the information on this application, sire plans or intended use changes far the proposed facility. I have read this application and certify that lire information provided herein is true, complete and con ect. Authorized county and state officials tire granted right of entry to conduct necessary inspections to determine compliance with applicable lawn and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines aid corners and umking the site accessible so that a complete site evnluLteformedSignature ofOwner or A ent, ✓„ Date �— 2` % Printed Name of Owner or Agent wl� /ey made wroder my aveyed a -.-q cleaffy twed is I this- trat:on nunlbei and seat 12829 Ix?. 373 A, cres Casey L. Barnett O,q , Z I Tg P9 1218 O j1prothx L DR 27V P& eo PC E I All't cu IJO l. Edgi D5 2.787 3 11y m Casey L. Barnett O,q , Z I Tg P9 1218 Catawba County Environmental Health Parcel: 360901154116, HICKORY, 28602 1 in=200ft 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 07/25/2017 Parcel Report Page I of 1 Parcel Report - Catawba County NC Parcel Information: Parcel ID: 360901154116 Parcel Address: City: HICKORY, 28602 LRK(REID): 311 Deed Book/Page: 3335/0077 Subdivision: Lots/Block: / Last Sale: $45,000 on 2012-09-10 Plat Book/Page: 77/33 Legal: Calculated Acreage: 12.230 Tax Map: 001 J 05007 Township: JACOBS FORK State Road #: 1288 TaxlValue Information: Tax Rates(pdf) City Tax District: All in County County Fire District: PROPST Building(s) Value: $0 Land Value: $50,900 Assessed Total Value: $50,900 Year Built/Remodeled: / Current Tax Bill Miscellaneous: Building Permits for this parcel. Building Details Watershed: WS -III Protected Area Voter Precinct: P3 Parcel Report Data Descriptions List all Owners Deed History Report Owner Information: Owner: DELLINGER ERNEST JAMES Owner2: Address: 1729 YODER FARM RD Address2: City: HICKORY State/Zip: NC 28602-8133 School Information: School District: COUNTY Elementary School: BLACKBURN Middle School: JACOBS FORK High School: FRED T FOARD Zoning Information: Zoning District: COUNTY Zoningl: R-40 Zoning2: Zoning3: Zoning Overlay: DWMH-O,WP-O,FPM-O Small Area: MOUNTAIN VIEW Split Zoning Districts: / Zoning Agency Phone Numbers Firm Panel Date: 2007-09-05 Firm Panel #: 3710360900J 2010 Census Block: 3000 2010 Census Tract: 011802 Agricultural District: Proximity Assessment Report This map/report product was prepared from the Catawba County, NC Geosparal 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 maptreport product or the use thereof by any person or entity. © 2017, Catawba County Government, North Carolina. All rights reserved. L+1 E R (vC� 3QO G http://gis.catawbacowltync.gov/nomap/parcel_report.plip?key=3609011 54116Ktyp=P 7/25/2017