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HomeMy WebLinkAboutRBPR-07-2012-15984.TIFBA THIS IS NOT A PERMIT Case # RBPR-07-2012-15984 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 ski Residential Building Plan Review - Manufactured Home 2 IMPROVEMENT, -7 Applicant RICHARD ELLENBURG, 5468 PITTSTOWN, HICKORY NC 28602-9715 H:828 -294-3282C:8282440824 Owner RICHARD ELLENBURG, 5468 PITTSTOWN, HICKORY NC 28602-9715 H:828 -294-3282C:8282440824 NAME TO APPEAR ON PERMIT Richard Ellenburg SITE ADDRESS: 1478 BROOKSOUTH DR, HICKORY NC 28602 PIN # 278001273344 NAME of SUBDIVISION: SPRING BROOK DEVELOPMENT Lot # 15 Section/Block PROPERTY SIZE: Square Feet Acres 0.52 DIRECTIONS: 127 South to mr Grove Rd / 1.3 mile to Machine Shop Rd / to Brooksouth / 6th Lot on right PRIMARY CONTACT: ContractorSEWER TYPE: Septic Tank GALLONS PER DAY: CATER SUPPLY: Community Well ill�after is **NOT** available for this property. DESCRIBE WORK: Class A Double Wide Mobile Home / must screen or remove towing tongue / must have min 36 sf deck on front / masonry underpinning / previous mobile home already removed - new mobile home will be placed parallel to road APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Mobile Home OTHE IPTION: DESCRIPTION OF 14X80 MH HAS BEEN REMOVED EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: 3 J # OF OCCUPANTS: 4 PROPERTY EASEMENTS: none PROPOSED CONSTRUCTION NEW STRUCTURE DIM::) 36 x 57 (INCLUDES 6X8 FRONT PORCH AND REAR DECK) # OF NEW BEDROOMS:: 3 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 AREA2 MINIMUM SETBACKS FRONT: 30 SIDE: 15 REAR: 30 MAX HEIGHT: FEENAME Improvement Permit Fee TOTAL FEES DATE FEE AMOUNT 07/16/2012 $150.00 $150.00 E9-chapplication 07/16/2012 17:01 Pa -e I of �$A CG THIS IS NOT A PERMIT Case # RBPR-07-2012-15984 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 $M Residential Building Plan Review - Manufactured Home IMPROVEMENT Applicant RICHARD ELLENBURG, 5468 PITTSTOWN, HICKORY NC 28602-9715 H:828 -294-3282C:8282440824 Owner RICHARD ELLENBURG, 5468 PITTSTOWN, HICKORY NC 28602-9715 H:828 -294-3282C:8282440824 NAME TO APPEAR ON PERMIT Richard Ellenburg SITE ADDRESS: 1478 BROOKSOUTH DR, HICKORY NC 28602 PIN # 278001273344 NAME of SUBDIVISION: SPRING BROOK DEVELOPMENT Lot # 15 Section/Block PROPERTY SIZE: Square Feet Acres 0.52 DIRECTIONS: 127 South to mr Grove Rd / 1.3 mile to Machine Shop Rd / to Brooksouth / 6th Lot on right PRIMARY CONTACT: Contractor SEWER TYPE: N/A GALLONS PER DAY: WATER SUPPLY: N/A Public water is **NOT** available for this property. DESCRIBE WORK: Class A Double Wide Mobile Home / must screen or remove towing tongue / must have min 36 sf deck on front / masonry underpinning / previous mobile home already removed - new mobile home will be placed parallel to road APPLICATION FOR: STRUCTURE TYPE: FACILITY TYPE: Mobile Home DESCRIPTION OF EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: PROPERTY EASEMENTS: none NEW STRUCTURE DIM:: 48 x 57 # OF NEW BEDROOMS:: 3 New Structure PRIMARY RESIDENCE OTHER DESCRIPTION: # OF OCCUPANTS: 4 PROPOSED CONSTRUCTION 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,: .i �rit0 /�� Signature of Applicant or Agent d -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 AREA2 ********************************************************************************************************************** MINIMUM SETBACKS FRONT: 30 SIDE: 15 REAR: 30 MAX HEIGHT: FEENAME Improvement Permit Fee TOTAL FEES DATE FEE AMOUNT 07/16/2012 $150.00 $150.00 1:9 - ehapplication 07/16/2012 11:41 Page I of 3 THIS IS NOT A PERMIT Q' a CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 184 � 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 Construe ion ❑ Existing Facility ❑ Property Address /-1{7� c �A C*tt/�✓� Subdivision j 6 &/ice Z/,4V ,C67, - Lot # /-6- z Acres sS- SectionBlock/Phase Driving Directions to Property X07 ra it �4A� - / o , /tieve /,s tel% ;�o NAME TO APPEAR ON PERMIT? D-dwner ❑ Applicant ❑ Contractor Applicant Contact Information Name G1/ -q /I Address Phone Owner Contact Information' Name Cell Phone Address h/f .4? - Phone Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? 0Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site A49W 6 - n -y1 hk MrY7' Y-vn viccn Y1 rel # of Bedrooms *'j 3 Structure Dimensions Iy K YO # of Occupants Basement ❑ Yes ©'moo Basement Fixtures ❑ Yes ❑ 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 RrNo Describe Is a public water supply ava' ble on or adjacent to the above property ** E] Yes ❑ No Check type available M Community Well ❑ Semi-P� blic 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) Q Fes► W Ca C V W m THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence [bg New Residence ❑ Addition to Residence # of New Bedrooms * j Project Description 6G�e Iid�C XY10kdlCr, l o X V-fior)+ �Yrh Structure Dimensiony X'j-1 # of Occupants Basement ❑ Yes � No Basement Futures ❑ Yes P No ❑ Accessory Structure(s) Describe # of New Bedrooms *'i if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi -Family Residence # Units Total # Bedrooms *'I ❑ Food Service Specify Type #Bedrooms per Unit* j Structure Dimensions 01 w X g re ate 01 CL # 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 AuthorizationtoConstruct issued by this department is valid for (5) five years from the date issued andtferab Signature of Owner or Agent ,� > P' dN f A rtnte ame oveinlet or gent Date �.�c,/�-- r'd N I 1 inch = 40 feet ik, 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 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: 2780-01-27-3344 Prepared for: Is 12. 189.19 117. 1_A -I R-20 3344 5 N coI 2�s8 � o 6 1� 72 16 RA -I MeTodh �MMWIMOR 122.7 mo o\ 3 RC' sus- S�•86 43.44 14 THIS IS NOTA LEGAL DOCUMENT1. 07A Date:,7/16/2012 ,Time:A .55: O'vAM; '--- - I— - - CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 2780-01-27-3344 Name: ELLENBURG RICHARD OLLIE Name2: ELLENBURG SADIE WHITENER Address: 5468 PITTSTOWN RD Address2: City: HICKORY State: NC Zip: 28602-9715 Account: 19701480 Calc Acreage: 0.52 Tax Map: 135H 04015 LRK: 90098 Deed Book: 1333 Deed Page: 0871 Subdivision Name: SPRING BROOK DEVELOPMENT Subdivision Block: Lots: 15 Plat Book: 28 Plat Page: 41 Building Number: 1478 Street Name: BROOKSOUTH DR Site Zip: 28602 Township: HICKORY Fire Code: MOUNTAIN VIEW City Code: COUNTY State Road: Total Bldgs Value: Land Value: $8,900 Total Value: $8,900 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 78 Watershed: Watershed Split: Voter Precinct: P24 E911 District: COUNTY Zoning: R-20 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: DWMH-O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: MOUNTAIN VIEW Middle School: JACOBS FORK High School: FRED T FOARD School Split: NO P&Z Case Number: Census Tract 2010: 011801 Census Block 2010: 1010 Small Area Plan: MOUNTAIN VIEW Agricultural District: Printed: Monday, July 16, 2012 11:21 AM NO 02724 C A T AW S A C C3U H T Y HEALTH D E P A R T M E N T (704) 465-8270 Lot Eval.-,X.Imprbve. Permit X Repair Permit Cert. of Comp. Permitl_Oper. Permit Owner/Agent 4� I C NA2�x EL L EAJ UJRPhone R Z 4 .(' Address 4 1, Sol, Z ea iC too -Y Aj r Subdivision s p2iar�BR.QeL >` S T. Section/Block Lot* -La/ Lot Size - y 9 Ac. Directions: I Z1 5* M 7XIG2o� ('tfc�Qcrt I -oA tv (i 07., �1 E S�lrs F' �I. — A-3 , t� c->4 �2�o1= SOc1-ny R -n L A5 T L � 0 7')FF S 4 G. Facility: House Mobile Home Business Other: Zoning App=al ye no 4 / Z Multi -family Other 100% Repair Area Nes/)ho Bedrooms_ Seat Employees GPD Flow _AppAcation Rate �1 Hot Tub or Sp yes no Special Fixtures_�0,-[& REPAIR ,�� ��..a: REPAIRS MST BE WITHIN Basement ye no Basement Plumbing yesen 30 DAYS OR DAYS FROM DATE OF Mater Supply: Private Public PE1KET. +es.+et.s.:.s.sw•s�:*..w•*was•:.::w*w•.s+►..w....w.ss:...w�::..s.�eww*www*.w�e•.•w::.....s��**w Type of System: Trench_kBed Pump Pump/Panel Panel LPP Other Tank Size: Septic Tank__-LAr1C) GAL.. Pump Tank Nitrification Field: Total Square Feet 100 / Depth of Stone IZ // Bed Size Trench Width .,:�(o Total Length of All Trenches 3 do Number of Trenches L% Individual Trench Length 15/ 7s /Z$/ 7,5/_ Feet on Center g Maximum Trench Depth? 7 Distance of Nearest Well )000' Lot Evaluation. Approved /no (Void After 24 months) wwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwww wwwwwwwwwwwwwwwwwwwwwwwwwww ;opo /S %Slope I Sket of lot Evaluation Site - System Design Final Texture C— � U- 11) I I Structure S E3►c- I Clay Nin. 1-1 Soil Wetness AIIA- i 'S'v� psi v Soil Depth 140 1'4- 1 Restric. Hoz. at �" I P / /,,/V'( Available space yes/nol 3 X yD Overall Class S PS U I Comments: 1 7 * l�,s-rrT�L o,.► I � \ COti1Tbv� i \�\ � I I O I **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN THROUGH THE ISSUANCE OF THIS PERMIT** wwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwt►wwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwww Permit Date / Z (Improvement Permit void after 60months) Owner/Agent �4 Sanitarian (?` /K r Installed By Date i /S {l / Sanitarian ( to any changes/infgrmation in red or by sketch'on &ck)