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HomeMy WebLinkAboutRBPR-07-2012-15968.TIFContractor THIS IS NOT A PERMIT Case # RBPR-07-2012-15968 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Deck/Porch SAME AS OWNER, , IMPROVEMENT Owner THOMAS CATLETT, 1897 JAYA DR, SHERRILLS FORD NC H:8284289857C:9492750989 NAME TO APPEAR ON PERMIT Thomas Catlett SITE ADDRESS: 1897 JAYA DR, SHERRILLS FORD NCW3 ��P\IN # 460904748277 NAME of SUBDIVISION: ..�hite Dove Estate �Lot` 1 39 ) Section/Block PROPERTY SIZE: Square Feet Acres 0.83% DIRECTIONS: Hwy 150 / Sherrills ford rd / right Molly's Backbone / Left Lynmore / Right Jaya / House on Left side PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: WATER SUPPLY: Public Water Public water is **NOT** available for this property. DESCRIBE WORK: 12 x 20 Covered Screened Porch with electrical will be attached to existing deck APPLICATION FOR: STRUCTURE TYPE: FACILITY TYPE: Single Family Residence DESCRIPTION OF House EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 67 x 60 NUMBER OF EXISTING BEDROOMS: 3 PROPERTY EASEMENTS: none NEW STRUCTURE DIM:: 12 x 20 BASEMENT? No Existing Structure PRIMARY RESIDENCE OTHER DESCRIPTION: # OF OCCUPANTS: 2 PROPOSED CONSTRUCTION BASEMENT FIXTURES? No PLUMBING REQUIRED? No 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 asst ce please call 828-466-7291 �*rn. MINIMUM SETBACKS FRONT: 30 SIDE: 15 REAR: 30 MAX HEIGHT: FEENAME Improvement Permit Fee TOTAL FEES DATE FEE AMOUNT 07/12/2012 $150.00 $150.00 CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) FJ - ehapplicatim 07/13/2012 12:22 Page 1 of 3 IS42 SM THIS IS NOT A PERMIT Case # RBPR-07-2012-15968 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Deck/Porch IMPROVEMENT Contractor SAME AS OWNER, , Owner THOMAS CATLETT, 1897 JAYA DR, SHERRILLS FORD NC H:8284289857C:9492750989 NAME TO APPEAR ON PERMIT Thomas Catlett SITE ADDRESS: 3867 54TH AV NE, HICKORY NC 28601 PIN # 373510457719 NAME of SUBDIVISION: Lot # Section/Block PROPERTY SIZE: Square Feet Acres DIRECTIONS: Hwy 150 / Sherrills ford rd / right Molly's Backbone / Left Lynmore / Right Jaya / House on Left side PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: WATER SUPPLY: Public Water Public water is **NOT** available for this property. DESCRIBE WORK: 12 x 20 Covered Screened Porch with electrical will be attached to existing deck APPLICATION FOR: STRUCTURE TYPE: FACILITY TYPE: Single Family Residence DESCRIPTION OF House EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 67 x 60 NUMBER OF EXISTING BEDROOMS: 3 PROPERTY EASEMENTS: none NEW STRUCTURE DIM:: 12 x 20 BASEMENT? No Existing Structure PRIMARY RESIDENCE OTHER DESCRIPTION: # OF OCCUPANTS: 2 PROPOSED CONSTRUCTION BASEMENT FIXTURES? No PLUMBING REQUIRED? No 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. l` Date: %' L I ) }'Z Signature of Applicant or Agent t 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: 15 REAR: 30 MAX HEIGHT: FEENAME Improvement Permit Fee TOTAL FEES DATE FEE AMOUNT 07/12/2012 $150.00 $150.00 CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 1 9 - rhapplicaiion 07/12/2012 11:12 Page 1 of THIS IS NOT A PERMIT d C % CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 1842 sM 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 �i�� l EJ'w,�c�. `Q�jZ �l�-� Subdivision Lot # Acres Section/Block/Phase Driving Directions to Property t- .M v l; 1 r-,�� �,c� �r t L i J- L NAME TO APPEAR ON PERMIT? [Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name ` Address Phone Owner Contact Information Name Address 1 ct1 Phone -3 Z Y .4 Contractor Contact Information Name Address Phone Cell Phone Cell Phone Cell Phone r\. L z'� L2 3 WHO WILL BE THE PRIMARY CONTACT? [B Owner ❑ Applicant El Contractor Description of Existing Structures on Site u pw�e # of Bedrooms * j 3 Structure Dimensions ly !Cl w # of Occupants Basement ❑ Yes N)b No Basement Fixtures ❑ Yes ,E' No Planned Future Additions or Improvements (Building Permit NOT requested at this time) Describe Proposed Future Structure Dimensions # of Bedrooms *'j if applicable Are there easements or right-of-ways recorded on this property ❑ Yes 9 No Describe 2 - Is a public water supply available on or adjacent to the above property ** Yes ❑ No Check type available ❑ Community Well ❑ Semi -Public Well ❑ County/City/Township Water Line Existing water supply in use ❑ 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) 0 LLJW a V W m THIS IS NOT A PERMIT Q C CATAWBA COUNTY HEALTH DEPARTMENT �° sc Application for Environmental Services Page 2 i 184 2 u� Proposed Facility Type Primary Residence ❑ New Residence V Addition to Residence # of New Bedrooms *t (5 Project Description i 5C re 0_w.� "o ' = s �� -z��(L Structure Dimensions Fox I Z _ _� # of Occupants 2 - Basement Basement ❑ Yes 1,P No Basement Fixtures ❑ Yes 'E'No ❑ Accessory Structure(s) Describe # of New Bedrooms *t 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 *-I' 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 ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ No Describe Calculated Design Flow, Commercial j 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. 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. CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) I understand that this is a formal application for Environmental Services and authorize Catawba County Environmental Health 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 valid for 5 years or may be non -expiring under certain 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 (5) five years from the date issued and is not transferable Signature of Owner or Agent - Printed Name of Owner or Agent T0, 1-L k Date -11 [ 1 1 1 1— 11 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: 4609-04-74-8277 1 inch = 60 feet Prepared for: 9475 38 323. 932E C? c 39 4.16 8277"' 4 3g1 0 . �3 8157 9 2.oL41co:)349 .1 8046 c.r N THIS IS NOT A LEGAL DOCUMENT2 00 rc- 0 0 T,.. 1 Date:T7/12/2012} Time 11117:51 AM 306. 92 CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel I D: 4609-04-74-8277 Name: CATLETT THOMAS H , Name2 CATLETT CATHY J Address: 1897 JAYA DR Address2: City: SHERRILLS FRD State: NC Zip: 28673-7290 Account: 159747100 Calc Acreage: 0.82 Tax Map: LRK: 801408 Deed Book: 2937 Deed Page: 1985 Subdivision Name: WHITE DOVE ESTATES PH 2 Subdivision Block: Lots: 39 Plat Book: 49 Plat Page: 30 Building Number: 1897 Street Name: JAYA DR Site Zip: 28673 Township: MOUNTAIN CREEK Fire Code: SHERRILLS FORD City Code: COUNTY State Road: Total Bldgs Value: $181,800 Land Value: $30,400 Total Value: $212,200 Year Built: 2004 Year Remodeled: Last Sale Date: 6/9/2004 Last Sale Amount: $185,000 Neighborhood: 128 Watershed: WS -IV Protected Area Watershed Split: NO Voter Precinct: P31 E911 District: COUNTY Zoning: R-20 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: WP -0 Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: SHERRILLS FORD Middle School: MILL CREEK High School: BANDYS School Split: NO P&Z Case Number: Census Tract 2010: 011502 Census Block 2010: 1032 Small Area Plan: SHERRILLS FORD Agricultural District: Printed: Thursday, July 12, 2012 11:17 AM �O Cr 04 C'9— C� CA,TAWBA COUNTY HEALTH DEPARTMENT PUSfed Telephone: (828) 465-8270 TDD: (828) 465-8200 WLS #.-�V03 -6/001/ IP ',_AC__X Rpr. Prmt. Opr. Prmt. Sys. Type _Z_ Well Prmt. Replacement Well Well Rpr. Prmt. Owner/Agent -L/n Phone__20 S<- ,3o F" 210 Address /91F� j r9 �} PrP% (/F Subdivisions /'-�� '0V r a 7S@o6e&13imW Lase 7� Lot# — Lot Size Q , Directions: 50 to Fes', '/�(rS c7141� �J ' - l2 ��' �'aP T,���5' �� y�v r�©.�� D rel tJ✓� �� ��y A ,�� � �T�t � `� o tel/ L Facility: HouseX Mobile Home Business Multi -family Other: Pin Number n 9 fl 2r11 Other . Zoning Approval #a # Bedrooms # Seats # Employees . Application Rate , GPD Flow l/ Hot Tub or Spa ye no pecial Fixtures Basement ye /no 100 % Repair Are es no Basement Plumbing y%no? Water Supply: Private Well Public Semi -Public *********************#***********************************************************************��,�*i**ik*ire***u�** Type of System: Trench' - Bed-- Pump — Pump/Panel-- Panel LPP— Other le?r-734C4:i A,1 Septic Tank Size h /Pump Tank Size '---r Nitrification Field: Total Square Feet % aoa Depth of Stone ZA Bed Size Trench Width '31, Total Length of All Trenches d100 Number of Trenches S Trench Length — Feet on Center r Maximum Trench Depth Distance Distance of Nearest Well /ll/j6 *DO NOT INSTALL SEPTIC WHEN WET *WELI, RECORD REQUIRED AT COMPLETION* Topo % Slope Texture Structure I Clay Min. Soil Wetness Soil Depth Restric. Hoz, at Available space yes/no Overall Class S PS U Comments: I -=-7 I i I 5, I Filter Required I Riser required when I O tank is more than 6 I 1 inches deep. **NO GUARANTEE OR WARRANTY IS IM LIED OR GIVER AS TO TI- E RFORM,+.NCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** / 00 (******************************************** *Improvement Permit has no expiration date and is transferable, 6ut may be revoked if sire plans or intended terse 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 t I by the Health Department staff is to provide protection from known possible sources of contamination. No volume of water is guar tt tai site b the ealth Department. �^ , Permit Date EHS Owner/A C11. Septic Tank Installed By I'M eA AX Date -3 ' ;Zq -oy EH S Well Installed By 111-I//L Well Grout Approval Date_ Well Head proval Date} Date Sample Collected Date of Results Results ' • n I EHS__ White - Office Yellow - Owner/Agent Pink - Building Inspection Authorization to Construct