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Home My WebLink AboutRBPR-07-2012-15935.TIFSBA THIS IS NOT A PERMIT Case # RBPR-07-2012-15935 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 SM Residential Building Plan Review - Accessory Structure gev,,6ed 0atzk� IMPROVEMENT Owner NANCY LEONARD, 5069 W NC 10 HWY, HICKORY NC 28602-7135 H:704-462-2044 NAME TO APPEAR ON PERMIT Nancy Leonard SITE ADDRESS: 5069 W NC 10 HWY, HICKORY NC 28602 PIN # 269802995135 NAME of SUBDIVISION: i— Lot # 1 Section/Block PROPERTY SIZE: Square Feet Acre 2.44 DIRECTIONS: Hwy 10 Past Blackburn Elementary School go 1.2 miles to Drive next to Blackburn Baptist Church yard PRIMARY CONTACT: Oow err GALLONS PER DAY: l DESCRIBE WORK: 30 x 21 Carport APPLICATION FOR: ST�CTURE 7.PE: F CILITY TYPE.: Single Family Residence DESCRIPTION OF house EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 28 x 54 NUMBER OF EXISTING BEDROOMS: 3 PROPERTY EASEMENTS: none NEW STRUCTURE DIM:: 30 x 20 BASEMENT? No SEWER TYPE: Septic Tank WATER SUPPLY: Private Well Public water is **NOT** available for this property. New Structure ACCESSORY STRUCTURE OTHER DESCRIPTION: # OF OCCUPANTS: 2 PROPOSED CONSTRUCTION BASEMENT FIXTURES? No PLUMBING REQUIRED? I understand that this is a formal application for a well permit, Improvement permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is transferable and may be eligible for a non -expiring date, but may be revoked if this information, site plans or intended use changes for the proposed facility. A Well Permit and Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or structure location should conform to applicable setbacks. Date: Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 working days of application date. If you need further information or assistance please call 828-466-7291 MINIMUM SETBACKS FRONT: 30 SIDE: 10 REAR: 5 MAX HEIGHT: FEENAME Improvement Permit Fee TOTAL FEES DATE FEE AMOUNT 07/03/2012 $150.00 $150.00 CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 1;9 - ehapplication 07/06/2012 09:10 Page 1 of 3 A O� THIS IS NOT A PERMIT Case # RBPR-07-2012-15935 Y CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 142 sM Residential Building Plan Review - Accessory Structure IMPROVEMENT Owner NANCY LEONARD, 5069 W NC 10 HWY, HICKORY NC 28602-7135 H:704-462-2044 NAME TO APPEAR ON PERMIT Nancy Leonard SITE ADDRESS: 5069 W NC 10 HWY, HICKORY NC 28602 PIN # 269802995135 NAME of SUBDIVISION: Lot # Section/Block PROPERTY SIZE: Square Feet Acres DIRECTIONS: Hwy 10 Past Blackburn Elementary School go 1.2 miles to Drive next to Blackburn Baptist Church yard PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: WATER SUPPLY: Private Well Public water is **NOT** available for this property. DESCRIBE WORK: 30 x 21 Carport APPLICATION FOR: STRUCTURE TYPE: FACILITY TYPE: Accessory Structure DESCRIPTION OF house EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 28 x 54 NUMBER OF EXISTING BEDROOMS: 3 PROPERTY EASEMENTS: none NEW STRUCTURE DIM:: 30 x 20 BASEMENT? No New Structure ACCESSORY STRUCTURE OTHER DESCRIPTION: # OF OCCUPANTS: 2 PROPOSED CONSTRUCTION BASEMENT FIXTURES? No PLUMBING REQUIRED? I understand that this is a formal application for a well permit, Improvement permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is transferable and may be eligible for a non -expiring date, but may be revoked if this information, site plans or intended use changes for the proposed facility. A Well Permit and Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or structure location should conform to applicable setbacks. Date: 7 _ 3 Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 working days of application date. If you need further information or assistance please call 828-466-7291 MINIMUM SETBACKS FRONT: 30 SIDE: 10 REAR: 5 MAX HEIGHT: FEENAM E Improvement Permit Fee TOTAL FEES DATE FEE AMOUNT . 07/03/2012 $150.00 $150.00 CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 1:9 - chappli aiicm 07/03/2012 11:30 Page 1 of 11 �v v G THIS IS NOT A PERMIT I Z Q aCATAWBA COUNTY (HEALTH DEPARTMENT zU Application for Environmental Services G�S Page I 1842 l / Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre -Approval Required) ❑ Application is for New Construction ❑ ',Existing Facility ❑ -� Property Address So �Oa !-1._,� 10 v3 Subdivision A 1, <ku c �� Ai C 1, kb G Lot # Acres Driving Directions to Property }a W 1 5 C k(1I � 1 I C rv�Q_U�l PSection/Block/Phase a S d —t 6 1 Q C, k t1 Lk If ,1\ f_ l rn e vx _� C.; r NAME TO APPEAR ON PERMIT? wner ❑ Applicant ❑ Contractor Applicant Contact Information Name �w Address Phone Owner Contact Information Name D S '}) . L co a-, Address rS o cI C w 4 I Phone ' 7 o Lj - L ( (.g a® y Contractor Contact Information Name Address IPhone Cell Phone c- Y_ � , N«V(-"o k Cell Aone �-a%. (p 1 a'Sa q i Cell Phone WHO WILL BE THE PRIMARY CONTACT? XOwner ❑ Applicant ❑ Contractor Description of Existing Structures on Site __jk,xA. # of Bedrooms *'j Structure Dimensions a $ X 5 cl # of Occupants Basement ❑ Yes MNo Basement Fixtures ❑ Yes 9 No Planned Future Additions or Improvements (Building Permit NOT requested at this time) Describe Proposed Future Structure Dimensions # of Bedrooms *t if applicable Are there easements or right-of-ways recorded on this property ❑ Yes M No Describe Is a public water supply available on or adjacent to the above property ** ❑ Yes 93 No Check type available ❑ Community Well ❑ Semi -Public Well ❑ County/City/Township Water Line Existing water supply in use M Individual Well ❑ Community Well ❑ Semi -Public Well ❑ County/City/Township Water Line ❑ I WOULD LIKE TO SCHEDULE A COMBINED FLAGGING AND SOIL EVALUATION (SEE COMBINED EVALUATION PROCEDUES) TUIS IS NOT A PERMIT CAT'AWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 1842 Su Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *`t* Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement 1� iXtures ❑ Yes ❑ No '. Accessory Structure(s) Describe f-- G\ t' o C, -I-- # of New Bedrooms `1 if applicable 6 Structure Dimensions 30 X d # of Occupants 0 Accessory Dwelling ❑ Yes Z 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 ❑ Other Facility Type Specify # of Shifts 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 ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ No Describe Calculated Design Flow, Commercial f 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. ** IfNo, a well permit must be issued with the Authorization to Construct. Note: You must obtain Zoning approval prior to locating a home or structure on this property. Any representation by you of house or structure location should conform to applicable setbacks. Q CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL. INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) W 44 1 understand that this is a formal application for Environmental Services and authorize Catawba County Environmental Flealth employees to go on this property for evaluation purposes. I certify the above information to be correct and understand o that an Improvement Permit issued as a result of this information is valid for 5 years or may be non -expiring under certain �i specified conditions. Improvement Permits and Well Permits are transferrable, but may be revoked if this information, site �plans or intended use changes for the proposed facility. An Authorization to Construct issued by this department is valid for ca (5) five years from the date issued and is not transferable in Signature of Owner or Agent 0`�~� "` Printed Name of Owner or Agentr�- Date r] - 3 1 Ilk vv 'AY ** Op. Permit and/or Cert. Op. Required (Must be completed bbl l CArk TA.WBAPL C01UkJr °i' 144 FA M.wrM E3EPAnrrk-1ENT (704) 46 8270 Lot Eval. Improve. Permit Repair Permit Cert. of Comp. Permit Oper. Permit P. Leo+jr-,c� Owner/Agent �a � rs Phone 3 ZZ - S4 Cj Zc+ Address (L \ RO)( qb) - L Subdivision ft (.kvrZy Q C-Section/Block/Phase Lot# Lot Size I Directions: it) W OM_T Qc4 bQ P,-/ e 81v�riz1ou, .j ,SUIn Ci #Z -k/ 16 Facility: House Mobile Home Business Other: Tax Map # 5'0'-2--5-A Multi -family Other Zoning Approval # 1?1-94101,V ZO Bedrooms 3 Seats Employees Application Rate GPD Flow Hot Tub or Spa yes/no Special Fixtures 100% Repair Area yes/no REPAIR NOTICE: Basement yes/no Basement Plumbing yes/no REPAIRS MUST BE WITHIN 30 DAYS OR Water Supply:_ Private Public DAYS FROM DATE OF PERMIT. Type of System: Trench K Bed Pump Pump/Panel Panel LPP Other Tank Size: Septic Tank L"X,�5rrNG Pump Tank Nitrification Field:- Total Square Feet &06 Depth of Stone / Z Bed Size Trench Width -36 Total Length of All Trenches 206 Number of Trenches. --� Individual Trench Length V%/lo'/ W'I /_/_ Feet on Center ci Maximum Trench Depth Distance of Nearest Well Lot Evaluation: Approved �ei s/no (Void After 24 months) Topo % Slope Sketch of lot Evaluation Site - System Design - Final Texture Structurei �� New Clay Min. 'i otic Soil Wetness - LC Soil Depth ( ut Restric. Hoz. at _" �� ` PX/ ;TD�S Available space yes/no( I 1 1 x r� Overall Class S PS U ( 1 Comments: ! ► \\ �• 1 1 1 i i Septic Tank Contractors MUST contact the Sanitarian BEFORE changing permit. **NO GUARANTEE OR WARRAN'T'Y IS IMPLIED OR GIVEN THROUGH THE ISSUANCE OF THIS PERMIT** *********ARA********A********************************************************************* Permit Date�'�� (Improvement Permit d after 60 months) Owner/Agent yew\ °'� S,itarian,1� cG✓i�}S . Installed By D' GflicO�r/ht2� Date -7/ z�/��/ Sanitari-n f /GS (N a any changes/informati6n n red or by sketch on 7iack) *******IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE******** IS AN ADDITIONAL $25 CHARGE. , . . T.IL.:.... A-rc n1.... n1.1- T--- /'--.- 17-11 /1..-..... /A---. /�... .. ...�. D1.7 .. T--- T 11 CATAWBA COUNTY HEALTH DEPARTMENT NEWTON, NORTH CAROLINA ` COMPLETION PERMIT FOR SEPTIC TANKS 106 �i jr� PERMIT # c — 1789. E� DATE. csJ 1 / � Sf � 79 OWNER ir�i ,o Jt ADDRESS BUILDING CONTRACTOR „S DIVISION / LOCATION _� ' ra.. ��'' -ve LOT SIZE c� „l,,,o BLOCK OR SECTION HOUSE ( ) MOBILE HOME (v)1--�BUSINESS ( ) OTHER ( ) FHA -VA LOAN ( ) SEPTIC TANK: (SIZE 16®e) GALS) WATER SUPPLY: NO. BEDROOMS _NO FIXTURES INDIVIDUAL PUBLIC GARBAGE DISPOSAL UNIT:YES ( NO (�-IF WELL, TYPE: BORED DRILLEDI1G AUTO WASHING MACHINE: YES ( ) NO (�-) D. -DISTANCE FROM SEPTIC TANK OR NEAREST NITRIFICATION FIELD: SQ.FT. POLLUTION: / -9 __ FT. 1) NUMBER OF LINES �, SEPTIC TANK INSLLED BY: 2) LENGTH AND WIDTH OF LINES,, 9� '/O j PERMIfi FEE / LE79 a) BED' SYSTEM (.,.) CERTIFICATE OF04COMPT-ION.BY: b) TRENCH SYSTEM ( ) 3) DEPTH OF STONE IN LINES / a REMARKS: ADEQUATE FALL (GRADE) ON: 1) BUILDING (HOUSE) SEWER LINE: YES (%,)-' NO ( ) 2) NITRIFICATION LINES: DATE INSTALLED: YES ( vK NO ( ) SEPW TANK LAYOUT A HEALTH DEPARTMENT COPY Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geospatial Information System, Catawba County has made substantial efforts to ensure the accuracy of location and labeling information N contained on this map Catawba County promotes and recommends the independent verification of any data contained on this map 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 product or the use thereof by any person or entity. Selected Parcel Number: 2698-02-99-5135 1 inch = 150 feet Prepared for: (f 610.50"" 26.93 20 '�---.- 42900 � -- --` 318.00 2.44A N w 51,35 o0 0 233.50 L95.60 BLACKBURN 1 BAPTIST j —_1^ ,CHU.RCHt 7.26A/ ~ 0826 Aol /16 THIS IS NOT A LEGAL DOCUMENT Date:',7/3/2012 jime:•11:33:19'AM R-20 K •k] CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 2698-02-99-5135 Name: LEONARD DENNIS PAUL Name2: LEONARD NANCY F Address: 5069 W NC 10 HWY Address2: City: HICKORY State: NC Zip: 28602-7135 Account: 41027500 Calc Acreage: 2.44 Tax Map: 005 J 02005A LRK: 4715 Deed Book: 1307 Deed Page: 0633 Subdivision Name: Subdivision Block: Lots: 1 Plat Book: 18 Plat Page: 234 Building Number: 5069 Street Name: W NC 10 HWY Site Zip: 28602 Township: JACOBS FORK Fire Code: PROPST City Code: COUNTY State Road: Total Bldgs Value: $118,000 Land Value: $16,800 Total Value: $134,800 Year Built: 1983 Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 89 Watershed: Watershed Split: Voter Precinct: P3 E911 District: COUNTY Zoning: R-20 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: BLACKBURN Middle School: JACOBS FORK High School: FRED T FOARD School Split: NO P&Z Case Number: Census Tract 2010: 011802 Census Block 2010: 3002 Small Area Plan: PLATEAU Agricultural District: Proximity Printed: Tuesday, July 03, 2012 11:33 AM