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HomeMy WebLinkAboutRBPR-07-2012-16007.tifBA O� THIS IS NOT A PERMIT Case # RBPR-07-2012-16007 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Accessory Structure IMPROVEMENT Contractor HARWELL CONSTRUCTION, TIM E, 1455 MUSKET DR, CATAWBA NC 28609 B:828 -241-3223C:828-234-1301 USE AS PRIMARY PHONEF :NA NA Owner DARRIN WIDENER, 1621 SAMARIA LN, CONOVER NC 28613-9232 H:828-381-7813 NAME TO APPEAR ON PERMIT Darrin Widener SITE ADDRESS: 1621 SAMARIA LN, CONOVER NC 28613 IJP # 375008796274 NAME of SUBDIVISION: DARRIN W & JUDA C WIDENER Lo 10 & 11 SectionBlock PROPERTY SIZE: Square Feet Acres 1.15 DIRECTIONS: Hwy 10 East / Left Emmanuel Church Rd / Right Rachael vinyard / Left Samaria Ln / 2nd House on Left PRIMARY CONTACT: Contractor GALLONS PER DAY: 4D DESCRIBE WORK: 24 x 30 Detached Garage - single story APPLICATION FOR: STRUCTURE TYPE: FACILITY TYPE: Accessory Structure DESCRIPTION OF House EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 50 x 60 NUMBER OF EXISTING BEDROOMS: 3 SEWER TYPE: Septic Tank WATER SUPPLY : Public Water Public water IS available for this property. New Structure ACCESSORY STRUCTURE # OF OCCUPANTS: 2 PROPOSED FUTURE ADDITIONS 120 x 40 Covered Deck / patio in real of house OR IMPROVEMENTS: PROPERTY EASEMENTS: none PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 24 x 30 GARAGE BASEMENT? No 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 ance please call 828-466-7291 AREA 2 MINIMUM SETBACKS FRONT: 30 SIDE: 10 REAR: 5 MAX HEIGHT: FEENAME Improvement Permit Fee TOTAL FEES DATE FEE AMOUNT 07/18/2012 $150.00 $150.00 E9 - ehapplication 07/18/2012 16:48 Page I of 3 THIS IS NOT A PERMIT Case # RBPR-07-2012-16007 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Accessory Structure IMPROVEMENT Contractor HARWELL CONSTRUCTION, TIM E, 1455 MUSKET DR, CATAWBA NC 28609 B:828 -241-3223C:828-234-1301 USE AS PRIMARY PHONEF:NA NA Owner DARRIN WIDENER, 1621 SAMARIA LN, CONOVER NC 28613-9232 H:828-381-7813 NAME TO APPEAR ON PERMIT Darrin Widener SITE ADDRESS: 1621 SAMARIA LN, CONOVER NC 28613 PIN # 375008796274 NAME of SUBDIVISION: Lot # Section/Block PROPERTY SIZE: Square Feet Acres DIRECTIONS: Hwy 10 East / Left Emmanuel Church Rd / Right Rachael vinyard / Left Samaria Ln / 2nd House on Left PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: WATER SUPPLY: Public Water Public water is **NOT** available for this property. DESCRIBE WORK: 24 x 30 Detached Garage - single story APPLICATION FOR: New Structure STRUCTURE TYPE: ACCESSORY STRUCTURE FACILITY TYPE: Accessory Structure OTHER DESCRIPTION: DESCRIPTION OF House EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 50 x 60 NUMBER OF EXISTING BEDROOMS: 3 # OF OCCUPANTS: 2 PROPOSED FUTURE ADDITIONS 120 x 40 Covered Deck / patio in real of house OR IMPROVEMENTS: PROPERTY EASEMENTS: none PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 24 x 30 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? No 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. Dat psi -ice Signature of Applicant or Agent An Environmental Health Specialist will contact you thin 2 working days of application date. If you need further information or assistance please call 828-466-7291 -Arc-a- 2)N MINIMUM SETBACKS FRONT: 30 SIDE: 10 REAR: 5 MAX HEIGHT: FEENAME Improvement Permit Fee TOTAL FEES DATE FEE AMOUNT 07/18/2012 $150.00 $150.00 [ Q - chapphcalion 07/18/2012 13:46 Page 1 of 3 O W 0 V W C0 V tn 41 F=► Z 0 iz cc0 W. Z ftft THIS IS NOT A PERMIT Q a CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 1842 spa 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 EJ Existing Facility ❑ Property Address %�j/ �mr9��4 C�b%r4� Subdivision Oenev,a ,�(! �fl Co �, .3 Lot # Acres Section/Block/Phase Driving Directions to Property aJu 4 t, g!fChJ4,,a1 1110 s�,�P, field 41-� l NAME TO APPEAR ON PERMIT? /E Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information_ Name Address Phone I Cell Phone Contractor Contact Information Name��� /i9,�. Address /�_t �i'tr� sir? -t" �2, �/ � sA w ��4 1` C 211(,0 9 Phone ��� _ ��cyC� j `7�D/ Cell Phone 5Ht,,_e_ WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant RrContractor Description of Existing Structures on Site Alp t�h — # of Bedrooms *'j 3 Structure Dimensions p # of Occupants ;2— Basement � Yes ❑ No Basement Fixtures ❑ Yes ONO Planned Future Additions or Improvements (Building Permit NOT requested at this time) Describe yoX 2d L'o ),,cca( \Ar { - / Pa Lvv Proposed Future Structure Dimensions # of Bedrooms *'j 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 ** Q 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 j County/City/Township Water Line ❑ I WOULD LIKE TO SCHEDULE A COMBINED FLAGGING AND SOIL EVALUATION (SEE COMBINED EVALUATION PROCEDUES) THIS IS NOT A PERMIT Q C , '� CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 184 Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms * j Project Description Structure Dimensions Basement ❑ Yes ❑ No # of Occupants Basement Fixtures ❑ Yes ❑ No ❑ AccessoryStructure(s) Describe ;�`-(—X Q 'D-C_-14(w4C--k"aLV Lam` , .e i # of New Bedrooms "I if applicable Structure Dimensions RL�- 30 # of Occupants Accessory Dwelling ❑ Yes XQ1No Plumbing ❑ Yes ONO Describe Plumbing Needed ❑ Multi -Family Residence # Units #Bedrooms per Unit*'j Total # Bedrooms *-J' 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. i 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 tr nsferable Signature of Owner or Agent Printed Name of Owner or Agent Date 7— / u— / Z 1 inch = 60 feet 4 .5437 62.06 2S Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geospatial Infonnation 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: 3750-08-79-6274 Prepared for: 00 6 PLAT 46-148 LO CD t , 7448 h d. 6 rr ai 0 4 11 , R�Zo 5321 -J t I TR A ti O O 00 PLAT 68-25 0 06 1.15A rn --�} _...27.32 r -- - -- - -. 6274 _. cry f � $•27 O N 10 c o THIS IS NOT A LEGAL DOCUM 1©s 219.3s r� i� i 93.6-1 •i I' 09 z 0) 0 Datea7/18/2012'. U') M V- I f Rid Time: 1:27:15 PM!. 150. ,Q! 13 9403- 167.5 9217 f 167.5, 911 PLAT 130 4 118? 04 CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3750-08-79-6274 Name: WIDENER DARRIN WADE Name2: WIDENER JUDA CAROL Address: 1621 SAMARIA LN Address2: City: CONOVER State: NC Zip: 28613-9232 Account: 159770134 Calc Acreage: 1.15 Tax Map: LRK: 901820 Deed Book: 3065 Deed Page: 0041 Subdivision Name: DARRIN W & JUDA C WIDENER Subdivision Block: Lots: 10&11 Plat Book: 68 Plat Page: 25 Building Number: 1621 Street Name: SAMARIA LN Site Zip: 28613 Township: NEWTON Fire Code: CLAREMONT RURAL City Code: COUNTY State Road: Total Bldgs Value: $157,000 Land Value: $40,700 Total Value: $197,700 Year Built: 2002 Year Remodeled: Last Sale Date: 3/18/2004 Last Sale Amount: $159,000 Neighborhood: 120 Watershed: WS-IV Protected Area Watershed Split: NO Voter Precinct: P22 E911 District: COUNTY Zoning: R-20 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: WP-O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: CLAREMONT Middle School: RIVER BEND High School: BUNKER HILL School Split: NO P&Z Case Number: Census Tract 2010: 011401 Census Block 2010: 1048 Small Area Plan: CATAWBA Agricultural District: Printed: Wednesday, July 18, 2012 01:27 PM �,� plc t itJ�S zoo( — ©O(sff -- l�("`� CATAWBA COUNTY HEALTH DEPARTMEr// OW Telephone`. (828)465-822n7�0 TDD: (828) 465-8200 IP�_AC�_Rpr. mt. O r, t. Sys. pe Z /T Well t.—Replacement Well Well Rpr. Prmt. Owner/Agent p �/�,, Phone Address Subdivision t- f �Afn x Ut /4�IOt Sec Lou Lot / Size F� Directions: /U i � p f lid- _ Property Addres /b Z/ Facility: HouseX, Mobile Home Business Multi-family . Other: Pin NumberLY 750 Z 7 Other . Zoning Approval #�jih/ 7. Y Qf / 9 # Bedrooms,3 # Seats # Employees . Application Rate r .3.5 GPD Flow 3 6 ZU Hot Tub or Spa yeCod Special Fixtures Basement yes4�5 100% Repair Ar a no Basement Plumbing yes/no Water Supply: Private Well Public Semi-Public Type of System: Trench K Bed Pump Pump/Panel Panel LPP Other ` / Septic Tank Size 1 Pump Tank Size .-- Nitrification Field: Total Square Feet 1DZ9 Depth of Stone 1 7-- Bed Size Trench Width `t'r Total Length of All Trenches 34 Zi Number of Trenches of Trench Length I / �D dX/ O/JAZ/_/_ Feet on Center ! Maximum Trench Depth 36 4,Distanceof Nearest Well A11A *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* Topo % Slope Texture Structure Clay Min. -Soil Wetness Soil Depth +r I 1 I Restric. Hoz. at I - I� -,15 K Available space es/no Overall Class SM U— Comments: �GQr I I Filter Required Riser required when tank is more than 6 inches deep. **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) rive 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 pons le u ces of contamination. No volume of water is guaranteed at any site by the Health Dept} nt. Permit Date 2 la �/ �Well EHS Lcr Owner/Agent ptic Tank Installed y_--7 C 7'%1� rrruu Date EHS By WellGrout Approval Date Well Head A roval a (2)ie Sample Collected Date of Results Results _ EHS White - Office Blue - Building Inspection Operation Permit Yellow - Owner/Agent Green - Building Inspection Authorization to Construct