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HomeMy WebLinkAboutRBPR-04-2018-28931.TIF �ro3A TRIS IS NOTA PERMIT Case# RBPR-04-2018-28931 7,.. kin TSV ._ -. .---c..46:4 CATAWBA COUNTY HEALTH DEPARTMENT Or'id �o 0 r PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 327„' ti' * X842 s" Residential Building Plan Review- Modular G r7 I v& . i4k r( IMPROVEMENT- AUTH_CONST- NEW WELL • ya - Applicant *CLAYTON HOMES# 162 (LONNIE STROUD). 1044 N ANDY GRIFFITH I'KWY.NIT AIRY NC 27030 C:3367898826 Contractor *CLAYTON HOMES# 162 (LONNIE STROUD), 1044 N ANDY GRIFFITH PKWY,MT AIRY NC 27030 C:3367898826 Owner DOUGLAS SMITI I. 1385 SI'ARTOWN RD. LINCOLNTON NC 28092 NAME TO APPEAR ON PERMIT • *Clayton Homes # 162 (Lonnie Stroud) SITE ADDRESS: 5093 WICKFORD LN, DENVER NC 28037 PIN# 460603328980 NAME of SUBDIVISION: WICKFORD ACRES Lot ti 5 Section/Block PROPERTY SIZE: Square Feet Acres 2.35 DIRECTIONS: N Catawba burns Right bankhead Left sally brook right wicklord lane lot on right. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: New Modular home 26x26 3 bedrooms 2 baths rear deck 12x20 front deck 6x33 total dimensions 32x66 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 Vacant EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: 0 it OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 32x66 #OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: YES INNOVATIVE: ANY: Other described: 25%REDUCTION APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO chapplicmion 04/19/2018 12:29 Page I of `,:4.'A THIS IS NOTA PERMIT Case# RBPR-04-2018-2893 I / G �/, � 2 " Poe CATAW3A COUNTY HEALTI 1 DEPARTMENT ,.yrq d 10 ' c �� °� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICESI t 1842 sM Residential Building Plan Review- Modular �0 - •ro o �t • IMPROVEMENT- AUTH_CONST- NEW WELL o, ,.0 Applicant 'CLAYTON HOMES# 162 (LONNIE SIROU)). 1044 N ANDY GRI ITITH PKWY,MT AIRY NC 27030 C:3367898826 Contractor *CLAYTON HOMES# 162 (LONNIE STROUD), 1044 N ANDYGRIFFITFI PKWY,MT AIRY NC 27030 C:3367898826 Owner DOUGLAS SMITHI, 1385 STARTOWN RD,LINCOLNTON NC 28092 NAME TO APPEAR ON PERMIT *Clayton Homes # 162 (Lonnie Stroud) SITE ADDRESS: 5093 WICKFORD LN.DENVER NC 28037 PIN # 460603328980 NAME of St II3DIVISION: WICKFORD ACRES Lot# 5 Section/Block PROPERTY SIZE: Square Feet Acres 2.35 DIRECTIONS: N Catawba burris Right bankhead Left sally brook right wickford lane lot on right. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: New Modular home 26x26 3 bedrooms 2 baths rear deck 12x20 front deck 6x33 total dimensions 32x66 SITE INFORMATION Do any of the following apply to the properly 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 properly? Yes APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF Vacant EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: 0 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 32x66 #OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: YES INNOVATIVE: ANY: Other described: 25% APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO eliupplion[ion 04/18/2018 13:16 Page 1 of 4 l,t' -.l , CAT.A\�BA COUNTY cases RBPR-04-2018-28931 .T .t.�� \ Public Health Department �� ;figs"; Subdivision WICKFO�.'D ACRES < ®,�Y Environmental Health Division PIN# 460603328980 \ - / PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 N4%W NAME ON PERMIT: *CLAI'TON FIOMES# 162 ( LONNIE STROUD), 1044 N ANDY GRIFFITH PKWY,NIT AIRY NC 27030 *Clayton Homes# 162 ( Lonnie Site Address: 5093 WICKFORD LN,DENVER NC 28037 Property Size: Square Feet Acres 2.35 Directions: N Catawba bums Right bankhead Left sally brook right wickford lane lot on right. Completed applications are valid for a period of 2 years.Improvement Permits are valid:with complete site plan=60 months(5 years);with complete plat =without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid.An Authorization to Construct issued for septic repair is valid for 60 months(5 years).Permits may be revoked if the information on this application/site plan changes or if the intended use for the proposed facility changes. Permits may be revoked if site conditions are altered such that they effect permit conditions or installation requirements 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. The undersigned is the owner of the property or legal agent of the owner. Date: 1/7)67 ( e Signature of Applicant or Agent / '^///� S If you need further information or assista please call 828-466-7291 AREAI ************t**********************t******************k*******#*t***CYC*******+**I,**********t*************** SETBACKS: Avoid duke easment TEENANIE DATE FEE AMOUNT Authorization to Construct Fee(New/Expansion) 04/18/2018 $150.00 Fee Improvement Permit Fee 04/18/2018 $150.00 Well Permit& Inspection Fee 04/18/2018 S300.00 TOTAL FEES $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) • chappliva:i.,,, 04/18/2018 1396 Page 2 of 4 C ATA ]B® THIS IS NOT A PERMIT COUNTY i ,,i ri CATAWBA COUNTY HEALTH DEPARTMENT -- \ 4 60 to 0;s 90 � � Application for Environmental Services ✓1�,� - � � 0 Application is for: /' New Construction 1 Existing Facility Improvement Permit X Authorization to Construct X. Septic n Septic Repair/Malfunction n Septic Relocation Septic Expansion Existing System Inspection or Reconnection NNew Well IT Replacement Well n Well Abandonment Well Repair Property AddressSn93 Li, ctcroiej L ANE Subdivision 1AAc cE n.a Ac-a-t= 5 0l:r%)vt1Z a__ —18037 Lot # S Acres o7-SS5 Driving Directions to Property hl «*r,ri,.n3A h,c..11-12.i C (17) 174.44 tr&fro (CJ Ips L'e 8 Roo K 2Kfo Win'ZIT gy;V p9—a ` °.9/ZE5r so 43 Applicant Contact Information Name CkAv Tejo 14on.E5 Sr-AcE.Sv,ccc /AOA,- c..i55 t —is (ceRor iN-,N(cR) Address &o to vwC�iHS ,ot . R S� E•' ,VL& r . & 25 ' Phone 20`1 673 Y7 CellPhone "33(0 (o ye 7 /3D / Owner Contact Information Name DoV&- s 5r.,-{-1 /we,ect 5-ON tr 4 Address )?65 S1`At�iowa( K0 ltevioce,r,o4 NC- GP?601-2 Phone Cell Phone Contractor Contact Information Name 5,g",t /{S HPPLtC- License I# INI! / ,S'°j/e/,3 Address JJJ Phone 7 01-/ 6 73 . 5 LC? Cell Phone 334 bye 7130 Name to Appear on Permit? ❑ Owner XApplicant ❑ Contractor Who will be the Primary Contact? ❑ Owner .Applicant I i Corn actor •• Existing Structures on Site? ❑ Yes XNo If yes, describe # of Bedrooms * #of Occupants Structure Dimensions Basement ❑ Yes , No Basement Plumbing ❑ Yes [_,No Existing Water Supply? ❑ Individual Well ❑ Community Well ❑ County/City/Township Water Line Is a public water supply available? ** n Yes gi,No Well Construction/Abandonment/Repair Proposed Well Type Yinclividual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug _ Unknown Well Repair Requested ❑ Yes ❑ No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well I-lead to Pressure Tank?,'es 0 No ATA\AT A THIS IS NOT A PERMIT Lou��l� r L & v 1L➢Cl� CATAWBA COUNTY HEALTH DEPARTMENT • Application for Environmental Services Proposed New Construction - Residential Primary Residence zi New Residence ❑ Addition to Residence #of New Bedrooms *'j Project Description p ;aJ n,vo- MZ HprEL. Wer 4 26'X2&' IZEoR l.?/ZC of iC G,,, &cK Structure Dimensions .3.? X (PCS # of Occupants Z tec3yPo9-CN /7"R si-53-- 13asement ❑ Yes a No Basement Plumbing ❑ Yes R: No Accessory Structure(s) Describe Structure Dimensions Plumbing n Yes ❑ No Describe Plumbing Needed Accessory Dwelling ❑ Yes n No # of New Bedrooms *j' # of Occupants Proposed New Construction - Commercial Food Service Specify Type # Seats Floor Space -Entire Food Service Facility(Sq. Ft.) # Employees per Shift # of Shifts Dining Area (Sq. Ft.) Business/Other Specify Type Structure Dimensions Retail Floor Space #of Employees per Shift # of Shifts If Church #of Seats Commercial Kitchen fl Yes ❑ No If Daycare-# of Children If Multi-Family Residence;# of Apartments #Bedrooms per Apartment*t Total# l3edrooms *j Other Information Calculated Design Flow, Commercial j (This value will be determined by EH staff) 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 mist attach supporting documentation. ❑ Yes Ol.No Does the site contain any jurisdictional wetlands? O Yes c6No Does the site contain any existing wastewater systems? ❑ Yes ic No Is any wastewater going to be generated on the site other than domestic sewage? AYes I No Is the site subject to approval by any other public agency? Yes P-No Are there any easements or right of ways on this property? Describe 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 0 Alternative :Conventional 0 Innovative A Other 0 Any *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 floor plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system expansion in the fiance. t If structure is plumbed but has no bedrooms,calculated design flow will be determined by EH Staff ** If No,a well permit must be issued with the Authorization to Construct. RETRIP'r0 THE PROPERTY AND/OR SYSTEM REDESIGN WILL INCUR AN ADDITIONAL CHARGE(SEE FEE SCHEDULE) Completed applications are valid for a period of 2 years. Improvement Permits are valid:with complete site plan=60 months(5 years); with complete plat=without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid. An Authorization to Construct, issued for septic repair is valid for 60 months(5 years). Permits may be revoked if the information on this application/site plan changes or if the intended use for the proposed facility changes. Permits may be revoked if site conditions are altered such that they effect permit conditions or installation requirements. 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. The undersigned is the owner of the prope•y or I- s • it- t of the owner. Signature of Owner or Legal Agent _ /QAllrall Cit Boa 40"-ES Date via/IB Printed Name of Owner or Legal ._enL-Jq,GQ5s EL -3 _57-4-Tess,t c LE CATAWBA- Geospatial Real Estate Search — • Information Services �0 Si\ <y©i 2: 0 60 e-3< <'t ' "a 5 i co •'. .- f+' ,nit . fr +�., 4 127,j1 •err' I 1/ a : /di. 20.71 Q 122. 7 • re 9z3 �+'Cr �. .1 -9:.. i. 2 ��a { • (38) 31035 /y, • + + ' 61,7' 3 , 4.\...Y �, Q .1 1 2.49 29 162-' �� Eu , \ + A' .71->_,, ' EA �, i5 O P F.+ 149.2 E 29,26 -`'� e.c / .n- -per > O , 152.4 /. �. . .95 t45.37 12x.0. F RO `O c3�,5 .5 t- '7C�<S 1.97.31 �' Run"' 5 T-Qv c j Ut:(C' 43.94 69 4.. 119.r, ea v it Ptit2P LING$ 53.76 .a I 725 n 21,39 "�' F 1 Cy, '"9 $ 19 r .2 =' 14 4 - i vi ''oma 0231 - - l DO V N.wYs 222.1' $1.4 103.6' IZ .17- 02S S 1c Atzc=/q L Al ' 11a,,S E 512E ---?.?i �.' X (G (o r / N AZ"' (�ORui 6' x33 SAoaLL E REPA I Alin=200ft s ✓JZtR G( A1�GC 4 47 1 X2co Parcel: 460603328980, 5093 WICKFORD LN DENVER, 28037 RtER o cc K 1 a' X Z o ( Owners: SMITH DOUGLAS'E, SMITH LUCILLE Owner Address: 1385 STARTOWN RD �°C) Lt a ES Ma Cakt L D Values - Building(s): $0, Land: $24,800, Total: $24,8000 CoJC1 -5 f'-ARKEQ 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 03/07/2018 • Catawba County Environmental Health V /. /7) ..N. ...N.\\\ / iii.00. 0 / rs, a4i‘llIllIll. 0 40 / rob \ Li/ Nisc lit . oA. ,F Q1-1., 0 C,L . .42 `��` 13S' S fsp 9• 1 ---1:::\:\ 145.37 57 51 Parcel: 460603328980, 5093 WICKFORD LN lin=80ft DENVER, 28037 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 04/18/2018 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 460603328980 Owner: SMITH DOUGLAS E Parcel Address: 5093 WICKFORD LN Owner2: SMITH LUCILLE City: DENVER, 28037 Address: 1385 STARTOWN RD LRK(REID): 802614 Address2: Deed Book/Page: 3082/0987 City: LINCOLNTON Subdivision: WICKFORD ACRES State/Zip: NC 28092-8038 Lots/Block: 5/ School Information: Last Sale: $33,335 on 2011-07-01 School District: COUNTY Plat Book/Page: 60/64 Legal: LOT 5 WICKFORD ACRES PL 60-64 Elementary School: SHERRILLS FORD Middle School: MILL CREEK Calculated Acreage: 2.350 High School: BANDYS Tax Map: Township: MOUNTAIN CREEK School Map State Road #: 2682 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoningl: R-30 Building(s) Value: $0 Zoning2: Land Value: $24,800 Zoning3: Assessed Total Value: $24,800 Zoning Overlay: CRC-O,WP-O Year Built/Remodeled: / Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710460600J Building Details 2010 Census Block: 4018 WaterShed: WS-IV Critical Area 2010 Census Tract: 011504 Voter Precinct: P41 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 el forts to ensure the accuracy at 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 ariso from this map/report product or the use thereof by any person or entity. ©2017, Catawba County Government, North Carolina. All rights reserved. (Mr Nick,3 Nom() 0,41 4300 http://gis.catawbacountync.gov/nomap/parcel_report.php?key=460603328980&typ=P 4/18/2018 /°G CATAWBA COUNTY HEALTH DEPARTMENT . Telephone: (828) 465-8270 TDD: (828)465-8200 WLS N a6UQ-d oP la Improvement Permit /� AC Retwir Permit. Operation Permit.System TYPe Well Permit. Replacement Well_ Owner/Agent l.reSeki " Ke.S0c4,cces 'LEC_ Phone r �r Address PO 'BO jc a [eh, Subdivision (A. VLe c �Ctc5 . erty ti C. _- _ Section/Bloc- Phase ��22Lotf II Lo ize I. 5�i�jDirections: Irat* Q 5 t 'AW 1U - !t ; . f2� 0 co ,,bc,_ VUYrri pW tdnc II 1 e vuelc. v rd 1, y lo+- ,,,, _ ' arc wi- t-- r ` t--- Property Address tjteL(ei c� ed. •Facility: House Mobile Home BusinessMulti-familyOther: Pin Number Of%/-U�G'Q/o -�.j'-,77 i'-%56'-T Other ' . Zoning Approval # #Bedrooms /{ #Seats # Employees . Application Rate ,3O GPD Flow `/re) Hot Tub or Spa yes/no Special Fixtures Basemen-Ey-Th/110 . 100% Repair Area 6s/no Basement Plumbing/no Water Supply: Private Well Ix Public Semi-Public__ Type of System: Trench Bed ' Pump_`` !-y� Pump/Panel Panel LPP 4:4r ;y 5 0 ,5r /rR ._L/Rc6, Septic Tank Size I.DOU6jf 'I Pump Tank Size I.0ikie �-( Nitrification Field: Total Square Feet /ZOO Depth of Stone A..)//1-- Bed Size Trench Width .3(€2Toal Length of All Trenches Ala Number of Trenches _ Trench Length / / /_/ ng _/ Feet on Ce net 1 Maximum Trench De,tha9-.3O Distance of Nearest Well So "/' *DO NOT INSTALL SEPTIC WHEN WET* *WE . RECORD REQUIRED AT COMPLETION* ************************************************** **********ffk*#v************ -****************************************** Tope 0- % Slope I Ilt U . Texture)//r!/{(/ — Structure Slot Clay Min. / >I Soil Wetness P5 " I (140 Soil Depth It 4' " Restric. Hoz. at 4/6" I Available space, /no Overall Class S !�U Comments: 1nlk t Lt-Lt-/-t-(A. t'11t.t . 1. (015 • lY 1 J (q'(t,PP )5 4 .scpkt. DfktN.Ciel r; - - -1 ` Filter Required ~ ----.="I' t Riser required when tank is more than 6 at, c inches deep. j **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** ************************************************************************************************************************ *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility. An Authorization to Construct is valid for (5) five years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. The siting of the well by the Health Department staff is to provide protection from know ssible sources of contamination. No volume of water is guaranteeda/t/any site by the health Department. _ Permit Date tLa -7—z'/ EIiS / Owner em `- --A Septic Tank Instal •• By Date EHS Well Installed By Well Grout Approval Date Well Head Approval Date Date Sample Collected Date of Results Results EliS White-Office Yellow-Owner/Agent Pink-Building Inspection Authorization to Construct